European journal of nuclear medicine and molecular imaging
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Eur. J. Nucl. Med. Mol. Imaging · Apr 2004
Comparative Study Clinical Trial Controlled Clinical TrialFinding an optimal method for imaging lymphatic vessels of the upper limb.
Lymphoscintigraphy involves interstitial injection of radiolabelled particulate materials or radioproteins. Although several variations in the technique have been described, their place in clinical practice remains controversial. Traditional diagnostic criteria are based primarily on lymph node appearances but in situations such as breast cancer, where lymph nodes may have been excised, these criteria are of limited use. ⋯ Image quality correlated inversely with time after injection at which the best image was obtained, consistent with the notion that good vessel definition was dependent on a "narrow" bolus width. k was approximately three times higher after id injection than after sc injection but it was not significantly different between radiopharmaceuticals for either injection route. Intradermal (99m)Tc-HIG gave a cardiac blood pool signal that, over the first 60 min, increased about five times faster than that with sc (99m)Tc-HIG, but no clear difference was observed in the rate of increase in hepatic activity between id (99m)Tc-nanocolloid and sc (99m)Tc-nanocolloid. We conclude that id injection provides rapid access of radiotracers to lymphatic vessels, which is ideal for imaging lymphatic vessel morphology. (99m)Tc-HIG is marginally superior to nanocolloid for this purpose and, in drainage basins from which lymph nodes have been excised, is not handicapped by a potentially inferior ability, compared with radiocolloid, to image lymph nodes.
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Eur. J. Nucl. Med. Mol. Imaging · Apr 2004
Comparative Study Clinical Trial Controlled Clinical TrialFDG-PET delayed imaging for the detection of head and neck cancer recurrence after radio-chemotherapy: comparison with MRI/CT.
In advanced head and neck cancer, an organ-sparing approach comprising radiation therapy combined with intra-arterial chemotherapy has become an important technique. However, the high incidence of residual masses after therapy remains a problem. In this study, we prospectively evaluated the use of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) delayed imaging for the detection of recurrence of head and neck cancer after radio-chemotherapy, and compared the FDG-PET results with those of magnetic resonance imaging (MRI) or computed tomography (CT). ⋯ Receiver operating characteristic (ROC) analysis showed that retrospective evaluation with the standardised uptake ratio yielded the best results (sensitivity 87.5%, specificity 81.5%), followed by visual interpretation and then the tumour/neck muscle ratio. An FDG-PET delayed imaging protocol yielded significantly better results for the detection of recurrence of head and neck cancer after radio-chemotherapy than MRI/CT. Because of the high negative predictive value of FDG-PET (91.3%), if PET is negative, further invasive procedures may be unnecessary.
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Eur. J. Nucl. Med. Mol. Imaging · Apr 2004
Comparative Study Clinical Trial Controlled Clinical TrialComparison of whole-body 18F-FDG PET, 99mTc-MIBI SPET, and post-therapeutic 131I-Na scintigraphy in the detection of metastatic thyroid cancer.
The usefulness of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in differentiated thyroid cancer (DTC) has been demonstrated by many investigators, but in only a small number of studies have FDG-PET images been compared with those obtained using other non-iodine tumour-seeking radiopharmaceuticals. In most of the studies, planar imaging was performed for comparison using thallium-201 chloride or technetium-99m 2-methoxyisobutylisonitrile ((99m)Tc-MIBI). Furthermore, FDG-PET studies were not always performed in the hypothyroid state with increased levels of thyroid stimulating hormone (TSH), which are known to increase FDG uptake by DTC. The aim of this study was to compare the ability of FDG-PET to detect metastatic DTC with that of (99m)Tc-MIBI whole-body single-photon emission tomography (SPET) and post-therapeutic iodine-131 scintigraphy, evaluated under TSH stimulation. Nineteen patients (8 men, 11 women; age range, 38-72 years, mean 60 years; 17 thyroidectomised and 2 inoperable patients following (131)I ablation of the remaining thyroid tissue; 16 papillary and 3 follicular carcinomas) with metastatic DTC underwent FDG-PET whole-body scan (WBS) and (99m)Tc-MIBI SPET WBS at an interval of less than 1 week, followed by (131)I therapy. The SPET images were reconstructed using the maximum likelihood expectation maximisation (ML-EM) method. All patients were hypothyroid at the time of each scan. (131)I WBS was performed 3-5 days after oral administration of the therapeutic dose. A total of 32 lesions [10 lymph node (LN), 15 lung, 6 bone, 1 muscle] were diagnosed as metastases, as confirmed by histopathology and/or other imaging modalities (X-ray, US, CT, MRI, bone, (201)Tl and (131)I scans). FDG-PET, (99m)Tc-MIBI SPET and post-therapeutic (131)I scintigraphy respectively revealed a total of 26 (81.3%), 20 (62.5%) and 22 (68.8%) lesions. These techniques respectively demonstrated nine (90.0%), eight (80.0%) and six (60.0%) LN metastases, and eleven (73.3%), seven (46.7%) and ten (66.7%) lung metastases. They each demonstrated five of the six bone metastases (83.3%). FDG-PET and (99m)Tc-MIBI SPET were positive in 17 (78.3%) and 14 (63.6%) of the 22 (131)I-positive lesions, respectively, and also in nine (90.0%) and six (60.0%) of the ten (131)I-negative lesions, respectively. Three of the five (131)I-positive and FDG-PET-negative lesions were miliary type lung metastases with a maximal nodular diameter of less than 10 mm. Comparison of FDG-PET with (99m)Tc-MIBI SPET revealed concordant results in 24 lesions, and discordant results in eight lesions (seven with positive FDG-PET alone and one with positive (99m)Tc-MIBI SPET alone). ⋯ (a) even using whole-body SPET, FDG PET is superior to (99m)Tc-MIBI in terms of ability to detect metastases of DTC; (b) the higher sensitivity of FDG-PET compared with the previous studies could partly be due to increased serum TSH.
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Eur. J. Nucl. Med. Mol. Imaging · Mar 2004
Comparative Study Clinical Trial Controlled Clinical TrialApplication of statistical parametric mapping to SPET in the assessment of intractable childhood epilepsy.
Statistical parametric mapping (SPM) quantification and analysis has been successfully applied to functional imaging studies of partial epilepsy syndromes in adults. The present study evaluated whether localisation of the epileptogenic zone (determined by SPM) improves upon visually examined single-photon emission tomography (SPET) imaging in presurgical assessment of children with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE). The patient sample consisted of 24 children (15 males) aged 2.1-17.8 years (9.8+/-4.3 years; mean+/-SD) with intractable TLE or FLE. ⋯ Concordance of SPM and SPET with syndrome was lower in patients younger than 6 years than in those aged 6 years and above. SPM is effective in localising the potential epileptogenic zone but does not provide additional benefit beyond SPET in presurgical assessment of children with intractable epilepsy. The impact of different pathologies on the efficacy of SPM warrants further study.
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Eur. J. Nucl. Med. Mol. Imaging · Mar 2004
Comparative Study Clinical Trial Controlled Clinical TrialOptimised nuclear medicine method for tumour marking and sentinel node detection in occult primary breast lesions.
The aim of this study was to evaluate the feasibility of sentinel node (SN) biopsy in occult breast lesions with different radiopharmaceuticals and to establish the optimal lymphoscintigraphic method to detect both occult lesions and SNs (SNOLL: sentinel node and occult lesion localisation). Two hundred and twenty-seven consecutive patients suspected to have clinically occult breast carcinoma were enrolled in the study. In addition to the radioguided occult lesion localisation (ROLL) procedure, using macroaggregates of technetium-99m labelled human serum albumin (MAA) injected directly into the lesion, lymphoscintigraphy was performed with nanocolloids (NC) injected in a peritumoral (group I) or a subdermal site (group II). ⋯ Pathological findings revealed breast carcinoma in 148/227 patients (65.2%) and benign lesions in 79 (34.8%). A total of 131 axillary SNs were removed in 118 patients with breast carcinoma; intraoperative examination of the SNs revealed metastatic involvement in 16 out of 96 cases of invasive carcinoma (16.7%). It is concluded that the combination of the ROLL procedure with direct injection of MAA into the lesion and lymphoscintigraphy performed with subdermal injection of radiocolloids represents the method of choice for accurate localisation of both non-palpable lesions and SNs.