European journal of nuclear medicine and molecular imaging
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Eur. J. Nucl. Med. Mol. Imaging · Sep 2002
Comparative Study[(18)F]FDG in childhood lymphoma: clinical utility and impact on management.
Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) is a very useful technique for the imaging of lymphomas in the adult population. It provides unique information about the behaviour of malignant cells and contributes to more accurate staging of the illness and better assessment of response to therapy. The purpose of this study was to evaluate the usefulness of FDG PET in childhood lymphoma compared with conventional imaging methods (CIMs) and clinical data. ⋯ False-positive results were observed in two NHL patients with thymic uptake and one false-negative result was obtained in a patient whose NHL relapsed 1 month after a negative FDG PET. The questionnaire emphasised the impact of FDG PET on clinical management, which was modified on the basis of the FDG PET results in 23% of patients. As previously demonstrated in the adult population, FDG PET appeared to be a very sensitive imaging technique for staging and restaging of lymphoma in children and was very useful for monitoring the response to therapy.
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Eur. J. Nucl. Med. Mol. Imaging · Aug 2002
Clinical Trial Controlled Clinical TrialLow whole-body insulin sensitivity in patients with ischaemic heart disease is associated with impaired myocardial glucose uptake predictive of poor outcome after revascularisation.
We tested the hypothesis that low whole-body insulin sensitivity in patients with ischaemic heart disease and impaired left ventricular (LV) function is associated with abnormalities of insulin-mediated myocardial glucose uptake affecting outcome after coronary bypass surgery (CABG). We studied 29 patients with ischaemic heart disease and impaired LV ejection fraction (EF) and age-matched healthy volunteers ( n = 30). As assessed by euglycaemic glucose-insulin clamp, 15 patients had a low and 14 a normal whole-body insulin sensitivity. ⋯ Hyperaemic blood flow was impaired in both patient groups. A major cardiac event after CABG could partly be predicted by the LV extent of normoperfused segments with PET-reverse mismatch. We conclude that low whole-body insulin sensitivity in patients with ischaemic heart disease and impaired LV function is associated with impaired insulin-mediated myocardial glucose uptake, which is partially predictive of a worse outcome after CABG.
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Eur. J. Nucl. Med. Mol. Imaging · Aug 2002
Comparative StudyHypoxia-induced alteration of tracer accumulation in cultured cancer cells and xenografts in mice: implications for pre-therapeutic prediction of treatment outcomes with (99m)Tc-sestamibi, (201)Tl chloride and (99m)Tc-HL91.
Weak visualization of tumours in pre-therapeutic scintigrams with technetium-99m sestamibi (MIBI) is likely a predictive sign of unfavourable tumour response to radiotherapy and chemotherapy. However, factors relating to this scintigraphic finding are not well understood. The presence of hypoxic tumour cells is one of the major reasons for therapeutic failure; consequently, we attempted to determine whether oxygenation status affects (99m)Tc-MIBI accumulation in tumour cells. ⋯ In conclusion, hypoxia reduced accumulation of (99m)Tc-MIBI and (201)Tl in tumour cells. Accordingly, hypoxia may be an important factor in terms of the interpretation of scintigraphic findings obtained with these tracers for pre-therapeutic prediction of tumour response to treatment. Furthermore, the enhanced (99m)Tc-HL91 accumulation in hypoxic tumour cells indicates the usefulness of this tracer in this regard.
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The aim of post-surgical follow-up for differentiated thyroid carcinoma is the early identification of the small proportion of patients who have residual disease or develop a recurrence. When total thyroidectomy and radioiodine ablation have been the initial treatment, three powerful tools are available for the follow-up: basal and TSH-stimulated serum thyroglobulin (Tg) measurement, iodine-131 whole body scan (WBS) and neck ultrasound. ⋯ In the last case, WBS under TSH stimulation (either after withdrawal of L-thyroxine therapy or after recombinant human TSH stimulation) and neck ultrasound are the most informative tests for the detection of distant or local metastases, respectively, that require more appropriate treatment (surgery and/or radioiodine therapy). Using this strategy, most patients will achieve definitive cure and will have a normal quality of life.
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Eur. J. Nucl. Med. Mol. Imaging · Aug 2002
Comparative StudyDetection of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities.
In 1%-2% of head and neck oncology patients, the only symptom of a malignancy is a positive cervical node. The aim of this study was to compare the value of positron emission tomography using fluorine-18 fluoro-2-deoxy- D-glucose (FDG-PET) and conventional diagnostic modalities (CT and/or MRI, panendoscopy) in detecting unknown primary tumours and distant metastases in patients suffering from such a cervical metastasis. Fifty patients (37 men and 13 women) with cervical metastases of an unknown primary tumour were included. ⋯ For the conventional diagnostic modalities these values were 92% and 76%. FDG-PET had an exclusive effect on the applied therapy in 20% of the patients referred for diagnosis of an unknown primary tumour. The data obtained in this study strongly support the diagnostic strategy of performing FDG-PET in patients suffering from cervical metastases of an unknown primary tumour before any other diagnostic technique.