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PET Clinics Jul 2018Recent advances in nuclear medicine instrumentation have led to the emergence of improved molecular imaging techniques to image breast cancer: dedicated gamma cameras... (Review)
Review
Recent advances in nuclear medicine instrumentation have led to the emergence of improved molecular imaging techniques to image breast cancer: dedicated gamma cameras using γ-emitting Tc-sestamibi and breast-specific PET cameras using F-fluorodeoxyglucose. This article focuses on the current role of such approaches in the clinical setting including diagnosis, assessing local extent of disease, monitoring response to therapy, and, for gamma camera imaging, possible supplemental screening in women with dense breasts. Barriers to clinical adoption and technologies and radiotracers under development are also discussed.
Topics: Breast; Breast Neoplasms; Female; Gamma Cameras; Humans; Positron-Emission Tomography; Radionuclide Imaging; Reproducibility of Results
PubMed: 30100076
DOI: 10.1016/j.cpet.2018.02.008 -
Langenbeck's Archives of Surgery Dec 2022A successful focused surgical approach in primary hyperparathyroidism (pHPT) relies on accurate preoperative localization of the parathyroid adenoma (PA). Most often,...
PURPOSE
A successful focused surgical approach in primary hyperparathyroidism (pHPT) relies on accurate preoperative localization of the parathyroid adenoma (PA). Most often, ultrasound is followed by [Tc]-sestamibi scintigraphy, but the value of this approach is disputed. Here, we evaluated the diagnostic approach in patients with surgically treated pHPT in our center with the aim to further refine preoperative diagnostic procedures.
METHODS
A single-center retrospective analysis of patients with pHPT from 01/2005 to 08/2021 was carried out followed by evaluation of the preoperative imaging modalities to localize PA. The localization of the PA had to be confirmed intraoperatively by the fresh frozen section and significant dropping of the intraoperative parathyroid hormone (PTH) levels.
RESULTS
From 658 patients diagnosed with pHPT, 30 patients were excluded from the analysis because of surgery for recurrent or persistent disease. Median age of patients was 58.0 (13-93) years and 71% were female. Neck ultrasound was carried out in 91.7% and localized a PA in 76.6%. In 23.4% (135/576) of the patients, preoperative neck ultrasound did not detect a PA. In this group, [Tc]-sestamibi correctly identified PA in only 25.4% of patients. In contrast, in the same cohort, the use of [C]-methionine or [C]-choline PET resulted in the correct identification of PA in 79.4% of patients (OR 13.23; 95% CI 5.24-33.56).
CONCLUSION
[C]-Methionine or [C]-choline PET/CT are superior second-line imaging methods to select patients for a focused surgical approach when previous ultrasound failed to identify PA.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Adenoma; Choline; Hyperparathyroidism, Primary; Methionine; Parathyroid Hormone; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Adolescent; Young Adult; Adult
PubMed: 35945299
DOI: 10.1007/s00423-022-02648-9 -
Langenbeck's Archives of Surgery Feb 2018Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for...
BACKGROUND
Primary hyperparathyroidism (pHPT) is caused by single- or multiglandular disease (MGD). Patients with MGD have an increased risk of complications at surgery and for persistence and recurrence after surgery. The study evaluated whether preoperative clinical and biochemical characteristics could predict MGD in patients with pHPT.
METHODS
We retrospectively evaluated patients operated 1989-2013 for first-time, non-hereditary pHPT. MGD was defined in patients with more than one pathological gland excised at surgery or with persistent hypercalcemia after the excision of a single pathological parathyroid gland, confirmed by histopathology. Clinical and biochemical variables were compared in patients with single- and multiglandular disease. Logistic regression was used to identify variables predicting MGD, yielding odds ratios (OR) with 95% confidence intervals (CI).
RESULTS
There were 707 patients, of which 79 (11%) had MGD. Patients with MGD were more likely to have negative sestamibi scintigraphy than patients with single-gland disease, 15 of 49 (31%) vs. 70 of 402 (17%; p = 0.03), to suffer from diabetes (12 of 74, 16%) vs. 45 out of 626 patients (7.2%; p < 0.01) and had lower preoperative levels of urinary calcium (3.80 vs. 4.44 mmol/L; p = 0.04). Multivariable analysis identified negative scintigraphy (OR 2.42; 95% CI 1.18 to 4.79), diabetes (OR 2.75; 95% CI 1.31 to 4.97) and elevated levels of osteocalcin (OR 3.79, 95% CI: 1.75 to 8.21) as predictors of MGD.
CONCLUSION
Negative sestamibi scintigraphy, diabetes and elevated osteocalcin levels were predictors of MGD.
Topics: Aged; Blood Glucose; Female; Humans; Hyperparathyroidism, Primary; Logistic Models; Male; Middle Aged; Osteocalcin; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies
PubMed: 29294178
DOI: 10.1007/s00423-017-1647-9 -
Nuclear Medicine Review. Central &... 2021Cancer and cardiovascular disease are the most significant causes of morbidity and mortality worldwide. Although the cancer survival rate has increased due to improved...
Cancer and cardiovascular disease are the most significant causes of morbidity and mortality worldwide. Although the cancer survival rate has increased due to improved treatment approaches, especially targeted therapy, some side effects such as cardiotoxicity decrease the efficiency of the clinical outcome. Radiation therapy and chemotherapy have a long-established history of potential cardiotoxic effects. A new multi-disciplinary and translational field known as cardio-oncology has been developed for the identification, prevention, and treatment of cardiovascular dysfunctions associated with cancer treatment approaches. One of the important tools for detecting and monitoring cardiotoxic effects is non-invasive nuclear cardiac imaging techniques. Cardiac nuclear imaging modalities especially recent findings positron emission tomography (PET) tracers have a quintessential role in the early detection of cardiovascular disorders. Moreover, comprehensive studies are required to investigate novel nuclear medicine treatment approaches such as peptide receptor radionuclide therapy (PRRT), fibroblast activation protein (FAP), and chemokine receptor (CXCR) targeting probes for possible cardiac side effects that play important roles in the treatment of malignancies.
Topics: Antineoplastic Agents; Cardiotoxicity; Heart; Humans; Neoplasms; Nuclear Medicine; Positron-Emission Tomography
PubMed: 34382672
DOI: 10.5603/NMR.2021.0019 -
The Israel Medical Association Journal... Apr 2017Four-dimensional parathyroid computed tomography (4DCT) is a relatively new parathyroid imaging technique that provides functional and highly detailed anatomic...
BACKGROUND
Four-dimensional parathyroid computed tomography (4DCT) is a relatively new parathyroid imaging technique that provides functional and highly detailed anatomic information about parathyroid tumors.
OBJECTIVES
To assess the accuracy of 4DCT for the preoperative localization of parathyroid adenomas (PTAs) in patients with biochemically confirmed primary hyperparathyroidism (PHPT) and a history of failed surgery or unsuccessful localization using 99mTc-sestamibi scanning and ultrasonography.
METHODS
Between January 2013 and January 2015, 55 patients with PHPT underwent 4DCT at Hillel Yaffe Medical Center, Hadera, Israel. An initial unenhanced scan was followed by an IV contrast injection of nonionic contrast material (120 ml of at 4 ml/s). Scanning was repeated 25, 60, and 90 seconds after the initiation of IV contrast administration. An experienced radiologist blinded to the earlier imaging results reviewed the 4DCT for the presence and location (quadrant) of the suspected PTAs. At the time of the study, 28 patients had undergone surgical exploration following 4DCT and we compared their scans with the surgical findings.
RESULTS
4DCT accurately localized 96% (27/28) of abnormal glands, all of which were hypervascular and showed characteristic rapid enhancement on 4DCT that could be distinguished from Level II lymph nodes. Surgery found hypovascular cystic PTA in one patient who produced a negative 4DCT scan. All patients had solitary PTAs. The scan at 90 seconds provided no additional information and was abandoned during the study.
CONCLUSIONS
4DCT accurately localized hypervascular parathyroid lesions and distinguished them from other tissues. A three-phase scanning protocol may suffice.
Topics: Adenoma; Dimensional Measurement Accuracy; Female; Four-Dimensional Computed Tomography; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Neoplasm, Residual; Outcome and Process Assessment, Health Care; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Postoperative Complications; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reoperation; Technetium Tc 99m Sestamibi
PubMed: 28480673
DOI: No ID Found -
The Journal of Surgical Research Oct 2015Proper localization is crucial in performing minimally invasive parathyroidectomy for primary hyperparathyroidism. Ultrasonography (US) and Tc-99m sestamibi (MIBI)...
BACKGROUND
Proper localization is crucial in performing minimally invasive parathyroidectomy for primary hyperparathyroidism. Ultrasonography (US) and Tc-99m sestamibi (MIBI) scintigraphy are common methods used for localization. As the appearance and activity of the thyroid gland may impact parathyroid localization, the purpose of this study was to determine how exogenous use of the thyroid hormone, levothyroxine (LT), affects parathyroid localization.
METHODS
Adult patients with non-familial primary hyperparathyroidism who underwent initial parathyroidectomy from 2000-2014 were retrospectively identified. LT (+LT) and non-LT (-LT) patients were matched 1:3 based on age, gender, goiter status, and preoperative parathyroid hormone levels. Subgroup analysis was performed on patients previously treated with radioactive iodine and patients undergoing single adenoma resection.
RESULTS
Of the 1737 patients that met inclusion criteria, 286 were on LT at the time of their parathyroid localization scan. Use of LT did not impact the percentage of correct MIBI localization scans when compared with -LT patients (P = 0.83). Interestingly, use of LT significantly hindered localization by US in comparison with the -LT group (48.4 versus 62.2%, P < 0.01). When examining only patients where a single upper gland was removed, the +LT group was less likely to have a correct US compared with the -LT group (50 versus 72.8%, P < 0.01). However, there was no difference in US accuracy for patients who only had a single lower gland removed (P = 0.51).
CONCLUSIONS
Exogenous LT is associated with impaired parathyroid localization with US but not MIBI. Surgeons should be aware of localization efficiency for this subset of patients in the era of personalized medicine and cost effectiveness.
Topics: Adenoma; Aged; Female; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sestamibi; Thyroxine
PubMed: 25917998
DOI: 10.1016/j.jss.2015.03.079 -
Hellenic Journal of Nuclear Medicine 2017This study aimed to evaluate the diagnostic role of breast-specific gamma camera imaging (BSGI) with technetium-99m-methoxy isobutyl isonitrile (Tc-MIBI) and magnetic... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
This study aimed to evaluate the diagnostic role of breast-specific gamma camera imaging (BSGI) with technetium-99m-methoxy isobutyl isonitrile (Tc-MIBI) and magnetic resonance imaging (MRI) in patients with breast cancer through a meta-analysis.
METHODS
Three reviewers searched articles published in medical journals before June 2016 in MEDLINE, EMBASE and Springer Databases; the references listed in original articles were also retrieved. We used the quality assessment of diagnostic accuracy studies (QUADAS) tool to assess the quality of the included studies. Heterogeneity, pooled sensitivity and specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC) curves were calculated by Meta-DiSc software to estimate the diagnostic performance of BSGI and MRI. Ten studies with 517 patients were included after meeting the inclusion criteria. We did a subgroup analysis of the same data type.
RESULTS
The pooled sensitivities of BSGI and MRI were: 0.84 (95% CI, 0.79-0.88) and 0.89 (95% CI, 0.84-0.92) respectively, and the pooled specificities of BSGI and MRI were: 0.82 (95% CI, 0.74-0.88) and 0.39 (95% CI, 0.30-0.49) respectively. The areas under the SROC curve of BSGI and MRI were 0.93 and 0.72 respectively.
CONCLUSION
The results of our meta-analysis indicated that compared with MRI, BSGI has similar sensitivity, higher specificity, better diagnostic performance, and can be widely used in clinical practice.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Image Enhancement; Magnetic Resonance Imaging; Middle Aged; Observer Variation; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Sestamibi
PubMed: 28315905
DOI: 10.1967/s002449910503 -
International Journal of Surgery... May 2017The diagnosis of thyroid nodular diseases requires an integrated approach that has been widely established over the past years. This strategy includes: ultrasonography...
BACKGROUND
The diagnosis of thyroid nodular diseases requires an integrated approach that has been widely established over the past years. This strategy includes: ultrasonography (US) with; implemented Color-Power-Doppler, conventional scintigraphy also with positive indicators, specific pathological studies targeted by immunohistochemically-assays, and the fine needle; aspiration biopsy (FNAB), which, usually, in case of "Follicular Lesions" (10-20%) findings is; unable to distinguish carcinoma from follicular adenoma, then indicating the necessity of surgery to; obtain a correct diagnosis. The aim of this study was to evaluate the role of the scintigraphy with; positive indicators, both preoperatively in diagnostic approach of the thyroid nodules and; intraoperatively as a guide to the extension of the surgical excision.
METHODS
On 4482 Thyroidectomy performed, we selected 360 cases of follicular neoplasms (192; females and 168 males). In the preoperative phase, these patients underwent 99 m Tc-sestaMIBI; scintigraphy with both early (10 min) and late (2 h) image acquisition, which were later; compared to the ones obtained by image subtraction of means 99 m Tc-pertechnetate. Following the; sestamibi administration before intervention, we selected the most up-taking nodularity with the; assistance of a specific surgical probe (Neoprobe), quantifying uptake with relation to the surgical pathology, for an amount of 324 total thyroidectomies and 36 hemi thyroidectomies.
RESULTS
In all cases of multinodular goiter the benign nodules showed an intraoperative low sestamibi uptake whereas follicular carcinomas showed both a high preoperative uptake and, as a; percentage, the highest values of intraoperative uptake; on the other hand, follicular adenomas had; both pre-and intraoperative mean values of uptake. On the contrary, papillary carcinomas only; showed a mild uptake.
CONCLUSIONS
Preoperative sestamibi scintigraphy confirmed its importance in improving the information obtained through different diagnostic investigations. Also intraoperatively, it pointed; out high-risk nodules more accurately. Therefore, radio (Sestamibi) guided surgery could have an; interesting rule in the thyroid follicular lesion treatment.
Topics: Adenocarcinoma, Follicular; Adult; Aged; Biopsy, Fine-Needle; Carcinoma, Papillary; Female; Goiter, Nodular; Humans; Image-Guided Biopsy; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Ultrasonography, Doppler, Color
PubMed: 28506419
DOI: 10.1016/j.ijsu.2017.03.081 -
Asian Journal of Surgery Apr 2005
Review
Topics: Humans; Hyperparathyroidism; Minimally Invasive Surgical Procedures; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Treatment Outcome
PubMed: 15851357
DOI: 10.1016/S1015-9584(09)60266-9 -
Journal of Nuclear Medicine : Official... Nov 1993Since 201Tl, 99mTc-sestamibi and 99mTc-teboroxime concentrate in cardiac cells through different mechanisms, we compared their uptake in cultured normal cells and... (Comparative Study)
Comparative Study
Since 201Tl, 99mTc-sestamibi and 99mTc-teboroxime concentrate in cardiac cells through different mechanisms, we compared their uptake in cultured normal cells and carcinoma cell lines in order to define their possible use for tumor evaluation in vivo. Four lines of normal cells from animals, including myocytes from newborn rats, and four lines of human carcinoma cell lines were incubated for 1 hr with 37 kBq of either tracer. Results, expressed in percent of the total activity taken up by 1 million cells, showed a 9% difference between the uptake of teboroxime by normal and carcinoma lines (24.6% +/- 2.8% versus 22.5% +/- 2.1%, respectively, p < 0.05). Mean uptake was 80% higher in tumor than in normal cells for 201Tl (5.39% +/- 1.33% versus 3.00% +/- 1.08%, respectively, p < 0.001) and nearly 4 times higher for sestamibi (5.37% +/- 2.34% versus 1.44% +/- 1.88%, p < 0.001). For both agents, uptake by the myocytes and carcinoma cells was comparable (5.14% +/- 0.11% for 201Tl and 5.28% +/- 1.03% for sestamibi). When the myocytes are excluded from the group of normal cells, the uptake is 112% higher in tumor than in normal cells for 201Tl (5.39% +/- 1.33% versus 2.54% +/- 0.44%, p < 0.001) but it becomes nearly nine times higher for sestamibi (5.37% +/- 2.34% versus 0.60% +/- 0.23%, p < 0.001). It is concluded that these experiments show that the uptake of sestamibi was the most discriminant to separate between normal and malignant cells, while teboroxime was the less discriminant. Potential clinical applications for tumor visualization based on differences in sestamibi and teboroxime uptake could be envisioned.
Topics: Animals; Fibroblasts; Humans; In Vitro Techniques; Muscles; Organotechnetium Compounds; Oximes; Rabbits; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tumor Cells, Cultured
PubMed: 8229240
DOI: No ID Found