World Journal of Nuclear Medicine

: 2011  |  Volume : 10  |  Issue : 2  |  Page : 246--248

Abstracts of Poster Presentations (Miscellaneous)


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Plasma Therapy: A New Era of Therapeutic Techniques

Ahmed Biman T., Hossain N., Islam N., Anwar-Ul-Azim

Nuclear Medicine, Institute of Nuclear Medicine and Ultrasound, Dhaka, Bangladesh

Physics as ("Plasmon") can be accelerated up to heated electrons velocities. Keep in account that the mass ratio of electrons and ions (for proton 1840); one can assume that the "Plasmon's" get enough high energies from the heating system; while the heated electrons were found 250 kev (the peak of the spectrum of X-ray quanta) at stationary process of plasma heating by beam plasma discharge. A series of experiments of electron heating by beam plasma discharge into the mirror magnetic trap were executed in "Kurchatov Institute" on the installation "Oratoria-10" as stationary mode and adiabatic compression of plasma. The experiments showed that electrons reached the energy level 270 - 300 kev at stationary mode with the heating parameters (MF; 600 Gs, Vacuum 10-6 Torr, Beam energy about 3 - 4 kev) and average energy of heated electrons were found upto 2 Mev in adiabatic compression of plasma (where the change of magnetic ratio was up to 1.5). If we like to keep these results in account one can assume that to separate "Plasmons" from the heated electrons need some electron capturing filters (like carbon). Thus we can get the high-energized "plasmons"; which may introduce as a new technique of external beam therapy. Comparison of the new proposed technique to the existing technique is low costing and having the opportunity to neutralize the generated radicals in same way as proton beam therapy (with regulation of energy) and also can reach the electro-neutrality of affected organs.


Early Outcome of Chemotherapy for Lymphoma Patients Using TC-99M-Tetrofosmin Scintigraphy

M. A. Rafique, S. Haque, S. Fatima, F. Muhammad F, J. Irfanuillah

Department of Nuclear Medicine, Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan

Introduction: Tc-99m-Tetrofosmin (TF) scintigraphy can be a useful, non-invasive tool, similar to Tc-99m-sestamibi (MIBI), in predicting response to chemotherapeutic agents in lymphoma patients early during the course of therapy.

Objectives: To determine the frequency of early outcome of chemotherapy in lymphoma patients using Tc-99m-Tetrofosmin scintigraphy. Main outcome measures: Lesion to Background Ratio (LBR), percentage of early outcome frequency.

Study Design: Descriptive Case Series Setting: Nuclear Medicine department of NORI Islamabad.

Subjects: 73 consecutive lymphoma patients with supra-diaphragmatic disease, prior to start of chemotherapy, were recruited in this study after the informed consent from every patient.

Materials and Methods: Ten minutes after the intravenous administration of 370-925 MBq (10-25 mCi) of TF, planar images of supra-diaphragmatic regions were acquired using dual-head gamma camera (GE, Infinia USA) and LEHR collimator. Quantitative analysis was performed by calculating mean Lesion to Background Ratio (LBR) on pre-therapy and post-therapy scans, by drawing regions of interest (ROI) over the abnormal TF uptake regions (tumor sites) and contralateral normal regions (for background activity). A cut-off of 30% response was used to classify the patients as responder and non-responder.

Results: Out of 73 patients, 50 had Non-Hodgkin lymphoma (NHL) while 23 had Hodgkin disease (HD). Mean age of the patients was 38 years and male to female ratio was 2.47:1. Visual analysis (VAS) of images showed abnormal TF accumulation at the disease sites in pre-therapy scans. The intensity of TF uptake declined in post-therapy scans obtained after 2 to 3 cycles of chemotherapy (CHOP or ABVD). Quantitative analysis also showed decrease in LBR in post-therapy scans as compared to pre-therapy scans. Mean response rate obtained was 45%. 44 patients were classified as responders while 29 non-responders (percentage responders 60.29).

Conclusion: TF scintigraphy is a useful, non-invasive, cost-effective tool to predict early response to chemotherapy in lymphoma patients.


Preparation of In-111 Oxine for Labeling of Stem Cell

A. Sattari A., A. Gholamrezanezhad 1 , M. Mirzaei, M. R. Adoudzadeh

Nuclear Medicine Research Group, Agriculture and Medicine Research School, Karadj-Iran, 1 Department of Nuclear Medicine, Tehran University, Tehera, Iran

Introduction: Stem cell therapy seems to be a new treatment option for some diseases. So, tracking the distribution of stem cells is crucial to their therapeutic use.

Materials and Methods: Indium-111 with physical half-life of 3 days is produced through the cyclotron by proton irradiation of cadmium-112. In this study, oxine labeled with [111In] Indium chloride. After culturing mesenchymal stem cells (MSCs), for radio-labeling, the sample (which contained 1×106MSCs) were mixed, and suspended with 50 μCi 111In-oxine.

Results: The [111In] oxine complex was obtained at pH = 5.5 in acetate buffer medium at 25°C in 2 hours. Radio-TLC showed a radiochemical purity of more than 95 ± 2%.

Conclusion: [111In](III) oxinate used in this study is a widely available agent for use in stem cell labeling studies.


Sentinel Node Biopsy in Malignant Melanoma-Role of Lymphoscintigraphy in the Detection of Unpredictable Lymphatic Drainage

A. Zamfirescu, R. Anghel

Bucharest Oncology Institute, Bucharest, Romania

Aim: Our study intended to estimate the role of lymphoscintigraphy in the detection of sentinel nodes and to establish correlations between the localization of the primary melanoma and the lymphatic drainage. We intended to highlight the importance of the lymphatic mapping of the melanomas with unpredictable and/or multiple potential drainage typical to their anatomical localization, also.

Materials and Methods: 80 patients were included in the study between March 2007 - November 2010. All the patients had the primary melanoma removed at their first presentation at the Oncology Institute. None of the patients showed clinical or radiological signs of tumor dissemination. The tumoral stages have been from T1a to T4b, with tumoral indices Breslow between 0.25 mm and 11 mm, and Clark between II and V. The localization of the primary melanoma has been as following: head and neck: 6; upper limbs: 12; lower limbs: 31; trunk: 31.The first two tasks to be completed for the patients included in the study, were the regional evaluation of the disease and the correct localization of the primary Tumor. In order to reach these objectives, we have used sentinel lymph node biopsy. The protocol for lymphoscintigraphy was as follows: 74-100MBq/1ml Tc99mNannocoll injected intradermal along the melanoma scar; dynamic study in the first 15-20 minutes, 1 frame/20 sec followed by static images of the lymphatic basin/s. The surgical procedure was done in the same/next day.

Data/Observations: Depending on the localization of the primary melanoma, we have identified lymphatic drainage in one, two or three different directions, as following: head and neck: 3/6 one direction, 3/6 two directions; upper limbs: 11/12 one direction, 1/12 two directions; lower limbs: 30/31 one direction, 1/31 two directions; trunk: 25/31 one direction, 5/31 two directions, 1/31 three directions. Lymphatic drainage of the melanoma of the head and neck has been unilateral or bilateral. Lymphatic drainage of the melanoma of the limbs has been unilateral only. Lymphatic drainage of the melanoma of the trunk area has been uni, bi, or contralateral. We have identified one totally unexpected sentinel node - the first drainage of one abdominal melanoma, for a woman, was in one lymph node situated in the right breast. We have explored 91 lymphatic basins. The sentinel nodes were identified and surgically removed in all patients included in the study.

Conclusions: Lymphoscintigraphy is an essential component of any procedure of sentinel node biopsy by indentifying unexpected drainage routes and offering the possibility of easily detecting alternative drainage paths.

Lymphoscintigraphy can identify the exact number of sentinel nodes and distinguish the sentinel nodes from the satellite nodes. In malignant melanoma of the upper and lower limbs, the lymphatic drainage is generally predictable, following the expected unilateral lymphatic drainage paths and basins. In melanoma situated in the head, neck and trunk areas, the lymphatic drainage can be unpredictable and multiple.


Dual-phase Tc99m-MIBI Scinitigraphy in Lymphoma as a Predictor of Response to Chemotherapy

Z. Chiragh, A. Fatima, S. Fatima, S. Fatmi, I. Alam

Department of Nuclear Medicine, Bahawalpur Institute of Nuclear Medicine and Oncology (BINO), Balawalpur, Lahore, Islamabad, Pakistan

Lymphomas carry a high cure rate but failure of chemotherapy is a major problem faced by treating physicians.

Objective: To asses role of dual-phase 99mTc-MIBI scintigraphy in response prediction in patients receiving chemotherapy for malignant lymphomas and to correlate uptake ratios and Retention Index % (RI%) with various prognostic markers.

Materials and Methods: Lymphoma patients with histologically proven diagnosis (all age groups and both sexes) were included in the study. Dual-phase 99mTc-MIBI scintigraphy (pre-chemotherapy) was performed at 10 minutes and 3 hours.

Results: Retention Index % (RI%) was calculated from the 25 lesions visualized by 99mTc-MIBI scintigraphy. CT scan picked up 32 lesions (size 50 ± 14 mm). 99mTc-MIBI scintigraphy picked up 81% (25/32) of the lesions in total. The diagnostic accuracy in supra-diaphragmatic regions was 86% (26/29). RI% of responders was 86.6 ± 11.8% and of non-responders 60.0 ± 12.9%. The response was correlated with various prognostic markers including stage and biochemical markers.

Conclusion: Dual-phase 99mTc-MIBI scintigraphy can be a helpful, non-invasive tool to predict the response to chemotherapy in patients of malignant lymphomas.


Review of Utilization of Surveillance Scans in Lymphoma Patients: A Pilot Study

J. Nguyen, W. Xiong, M. Goris

Department of Nuclear Medicine, Stanford University Medical Center, Stanford, USA

Purpose: The American Cancer Society reported 8,490 new cases of Hodgkin disease (HD) and 65,540 new cases of non-Hodgkin lymphoma (NHL) in the United States in 2010. The estimated number of deaths for the same year was 1,320 from HD and 20,210 from NHL. PET/CT is the standard of care in lymphoma and allows for the evaluation of tumor burden, metabolic response to therapy and disease recurrence. This retrospective review assesses the utility of surveillance scans in HD and NHL patients in order to determine the average time to recurrence, if it occurred.

Materials and Methods: 1,703 PET/CTs performed between September 2003 and May 2011 were collected for this study. Patients with either NHL or HD were included. Those with a second, concurrent malignancy were excluded. For each patient, a series of PET/CTs was identified. Each series began with the first negative PET/CT after definitive treatment was completed (eg. surgery, chemotherapy, radiation, etc.). The last study in the series was defined as the first subsequent study that became positive for recurrence. If recurrent disease did not occur, the series was followed out to the last recorded PET/CT. As such, 167 series were ultimately identified. These 166 series were comprised of a total of 750 PET/CTs.

Results: Of the 166 series, 72 demonstrated true positive recurrence and 94 stayed in remission. The shortest amount of time for follow-up was 42 days. The maximum follow-up time frame was 1,910 days. The median time to recurrence occurred by day 388. Of the patients who stayed in remission, the median follow-up time frame was 956 days.

Conclusion: These initial results indicated that surveillance scans in lymphoma patients exhibited the most utility after 100 days, or approximately 3 months. The majority of studies that demonstrated disease recurrence had all occurred by 500 days, or 16 months, after the first negative surveillance study. If disease recurrence was not documented by day 1400, these patients were likely to remain in remission. Lastly, only 9.6% of the 750 PET/CT studies performed actually went on to demonstrate recurrence. These findings raise concern about the cost-effectiveness of surveillance scans in lymphoma patients.