Clinical nuclear medicine
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Clinical nuclear medicine · Jul 2014
ReviewSentinel lymph node mapping in melanoma: the issue of false-negative findings.
Management of cutaneous melanoma has changed after introduction in the clinical routine of sentinel lymph node biopsy (SLNB) for nodal staging. By defining the nodal basin status, SLNB provides a powerful prognostic information. Nevertheless, some debate still surrounds the accuracy of this procedure in terms of false-negative rate. ⋯ The clinical impact of a false-negative SLNB on the prognosis of melanoma patients remains controversial, because the majority of studies have failed to demonstrate overall statistically significant disadvantage in melanoma-specific survival for false-negative SLNB patients compared with true-positive SLNB patients. When new more effective drugs will be available in the adjuvant setting for stage III melanoma patients, the implication of an accurate staging procedure for the sentinel lymph nodes will be crucial for both patients and clinicians. Standardization and accuracy of SLN identification, removal, and analysis are required.
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Clinical nuclear medicine · Jul 2014
Comparative StudyFDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses.
This study aims to assess and compare the value of FDG PET with combined In-labeled leukocyte/Tc-sulfur colloid bone marrow (WBC/BM) imaging for diagnosing infection in hip and knee prostheses. ⋯ Based on this study, the diagnostic performance of FDG PET scan in detecting infection in painful hip and knee prostheses is optimal for routine clinical application. Considering the complexity and costs of WBC/BM imaging and related safety issues associated with this preparation, FDG PET seems to be an appropriate alternative for assessing these patients.
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Clinical nuclear medicine · Jul 2014
Diastolic function with 16-phase gated myocardial perfusion SPECT.
Diastolic dysfunction is commonly associated with heart failure with preserved systolic function. Diastolic abnormality includes progressively impaired left ventricle (LV) relaxation, followed by pseudonormal mitral inflow pattern with Valsalva enhancement, and finally restrictive LV filling. ⋯ Gated myocardial perfusion SPECT evaluates systolic function with LV volumes and ejection fraction, but its ability to identify diastolic dysfunction is not typically considered. We correlate 16-phase gated SPECT time-volume curves with echo Doppler early/late diastolic flow ratios for diastolic dysfunction.
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Clinical nuclear medicine · Jun 2014
Prediction of survival and cancer recurrence using metabolic volumetric parameters measured by 18F-FDG PET/CT in patients with surgically resected rectal cancer.
The goal of the present study was to determine whether the volumetric parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by F-FDG PET/CT could be used as prognostic factors for the recurrence-free survival (RFS) and overall survival (OS) in patients with surgically resected rectal cancer. ⋯ In conclusion, the results of this study suggest that volumetric parameters of F-FDG PET/CT could be significant prognostic factors in surgically resected rectal cancer.
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Clinical nuclear medicine · Jun 2014
Somatostatin receptor imaging in non-(131)I-avid metastatic differentiated thyroid carcinoma for determining the feasibility of peptide receptor radionuclide therapy with (177)Lu-DOTATATE: low fraction of patients suitable for peptide receptor radionuclide therapy and evidence of chromogranin A level-positive neuroendocrine differentiation.
The aim of the study was to evaluate somatostatin receptor expression in non-I-concentrating metastatic differentiated thyroid carcinoma by Ga-DOTATATE PET-CT/Tc-HYNIC-TOC scintigraphy and to determine the feasibility of Lu-DOTATATE (therapeutic analog) therapy in cases with positive Ga-DOTATATE PET-CT/Tc-HYNIC-TOC scintigraphy. ⋯ Avid expression of the SSTR on Ga-DOTATATE PET-CT/Tc-HYNIC-TOC scintigraphy in non-I-concentrating metastatic differentiated thyroid cancer is observed in a relatively low fraction of patients that could favor the feasibility of Lu-DOTATATE therapy. Although seen in a small fraction, taking into account that no treatment exists in this group, somatostatin receptor-targeted imaging can be an alternative diagnostic modality in the therapeutic decision making with peptide receptor radionuclide therapy and monitoring. The documentation of elevated serum chromogranin A level in 3 patients with intense tracer uptake could suggest a possible neuroendocrine differentiation in the affected tissues leading to the expression of chromogranin A along with SSTR-avid expression. This observation needs to be explored in future studies. No definite conclusions can be drawn on the therapeutic efficacy of the Lu-DOTATATE therapy in this group at present, and more prospective research is required in this area.