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ORIGINAL ARTICLES
A comparative study of
68
Gallium-prostate specific membrane antigen positron emission tomography-computed tomography and magnetic resonance imaging for lymph node staging in high risk prostate cancer patients: An initial experience
Manoj Gupta, Partha S Choudhury, Dibyamohan Hazarika, Sudhir Rawal
July-September 2017, 16(3):186-191
DOI
:10.4103/1450-1147.207272
PMID
:28670175
Lymph node staging plays an important role in planning initial management in nonmetastatic prostate cancer. This article compares the role of
68
Gallium (
68
Ga)-prostate specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET-CT) with magnetic resonance imaging (MRI), which is considered the standard staging modality. Out of 39 high-risk prostate cancer patients who underwent
68
Ga-PSMA PET-CT for staging (December 2014–December 2015), 12 patients underwent radical prostatectomy along with ePLND and were included in the analysis. Findings of the PSMA PET and MRI were compared with final histopathology. Sensitivity, specificity, positive predicative value (PPV), negative predicative value (NPV), and accuracy of
68
Ga-PSMA PET-CT and MRI were calculated for numbers of patients and pelvic lymph node metastasis. Chi-square test, McNemar's test, and receiver operating characteristic (ROC) analysis were also done.
68
Ga-PSMA PET-CT and MRI sensitivity, specificity, PPV, NPV, and accuracy for number of patients detection were 100%, 80%, 87.5%, 100%, 91.67%, and 57.14%, 80%, 80%, 57.4%, 66.67%, respectively. For detection of metastatic lymph node, it was 66.67%, 98.61%, 85.71%, 95.95%, 95.06% and 25.93%, 98.61%, 70%, 91.42%, 90.53%, respectively. Difference of lymph nodal detectability was statistically significant on Chi-square test. On McNemar's test,
P
value was statistically insignificant for number of patient detection (
P
= 0.250) but statistically significant for lymph nodal detection (
P
= 0.001) for
68
Ga-PSMA PET-CT. In ROC analysis, area under the curve was also significantly high for lymph node detectability by
68
Ga-PSMA PET-CT. Our initial experience shows that
68
GaPSMA PET-CT is a very promising tracer for N staging in the initial workup of prostate cancer. It has the potential to impact patient's initial management and can up- and down-stage effectively.
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44
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686
REVIEW ARTICLES
Radiosynovectomy in the Therapeutic Management of Arthritis
Liepe Knut
January 2015, 14(1):10-15
DOI
:10.4103/1450-1147.150509
PMID
:25709538
Radiosynovectomy is a well-established therapy in arthritis and involves an intra-articular injection of small radioactive particles to treat a synovitis. In Europe, frequent indications are rheumatoid and poly-arthritis. Especially in Germany radiosynovectomy is the second common therapy in Nuclear Medicine with about 40,000-60,000 treated joints per year. In Spain, USA, Turkey, Argentines and Philippines the therapy is more use in hemophilic arthritis with excellent results. Especially in developing countries with low availability of clotting factors, the radiosynovectomy represent a cost effective therapeutic option for repeated bleedings in hemophilic arthropathy. The special focus in these countries is maintaining of mobility and work ability. Often only the knee and medium joints (ankle, elbow and shoulder) are treated using yttrium-90, rhenium-186 or phosphorus-32. However, in rheumatoid arthritis most common affected joints are the fingers. For the treatment in these small joints, erbium-169 is necessary. Unfortunately, erbium-169 is only available in Europe. Further indications for radiosynovectomy are osteoarthritis and the articular effusion after joint replacement. The reported response rates in rheumatoid and poly-arthritis range from 60% to 80% depends from the stage of previous arthrosis. The best effectiveness of therapy was observed in hemophilic arthritis with response rate of 90% and significant reducing of bleeding frequency. The therapy is well-tolerated with low rate of side effects. In respect of the specific uptake of particles in the synovia and short range of beta radiation, the radiation exposure outside the joint is very low. The radiosynovectomy has efforts in comparison to surgical synovectomy: it's a minor intervention with low costs; and simultaneous treatments of multiple joints or treatment in short intervals are possible. The presented paper summarized the published papers and reports our own experiences in >15,000 treated joints.
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LETTERS TO EDITOR
Journal Impact Factor: Its Use, Significance and Limitations
Mohit Sharma, Anurag Sarin, Priyanka Gupta, Shobhit Sachdeva, Ankur V Desai
May-August 2014, 13(2):146-146
DOI
:10.4103/1450-1147.139151
PMID
:25191134
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3,821
DOSIMETRY
Dosimetric Considerations in Radioimmunotherapy and Systemic Radionuclide Therapies: A Review
Kelvin S.H Loke, Ajit K Padhy, David C.E Ng, Anthony S.W Goh, Chaitanya Divgi
July-December 2011, 10(2):122-138
DOI
:10.4103/1450-1147.89780
PMID
:22144871
Radiopharmaceutical therapy, once touted as the "magic bullet" in radiation oncology, is increasingly being used in the treatment of a variety of malignancies; albeit in later disease stages. With ever-increasing public and medical awareness of radiation effects, radiation dosimetry is becoming more important. Dosimetry allows administration of the maximum tolerated radiation dose to the tumor/organ to be treated but limiting radiation to critical organs. Traditional tumor dosimetry involved acquiring pretherapy planar scans and plasma estimates with a diagnostic dose of intended radiopharmaceuticals. New advancements in single photon emission computed tomography and positron emission tomography systems allow semi-quantitative measurements of radiation dosimetry thus allowing treatments tailored to each individual patient.
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6,915
1,077
REVIEW ARTICLES
Cadmium telluride semiconductor detector for improved spatial and energy resolution radioisotopic imaging
Samira Abbaspour, Babak Mahmoudian, Jalil Pirayesh Islamian
April-June 2017, 16(2):101-107
DOI
:10.4103/1450-1147.203079
PMID
:28553175
The detector in single-photon emission computed tomography has played a key role in the quality of the images. Over the past few decades, developments in semiconductor detector technology provided an appropriate substitution for scintillation detectors in terms of high sensitivity, better energy resolution, and also high spatial resolution. One of the considered detectors is cadmium telluride (CdTe). The purpose of this paper is to review the CdTe semiconductor detector used in preclinical studies, small organ and small animal imaging, also research in nuclear medicine and other medical imaging modalities by a complete inspect on the material characteristics, irradiation principles, applications, and epitaxial growth method.
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ORIGINAL ARTICLES
Clinical Effectiveness of
18
F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Management of Renal Cell Carcinoma: A Single Institution Experience
Aung Zaw Win, Carina Mari Aparici
January 2015, 14(1):36-40
DOI
:10.4103/1450-1147.150535
PMID
:25709543
Positron emission tomography (PET) is currently the most advanced technique of metabolic imaging available for tumor diagnosis and follow-up. The aim of this study was to examine the versatility and accuracy of fluorodeoxyglucose (FDG) PET/computed tomography (CT) in the metastasis detection of renal cell carcinoma (RCC). We also compared our findings to other similar studies from the literature. This is the biggest study so far to examine the sensitivity and specificity of FDG PET/CT in the management of RCC. A retrospective review was carried out on all the FDG PET/CT studies done from January 1999 to January 2014 at our institution. Biopsy results were considered the gold standard. For our patients (
n
= 315) with biopsy results, FDG PET/CT studies exhibited 100% sensitivity, 100% specificity. Our results were better than results achieved by other studies. The use of FDG PET/CT in restaging and metastasis detection of RCC has many advantages, in addition to high accuracy. This imaging technique has great potential in influencing treatment decisions. We recommend the incorporation of FDG PET/CT in routine standard protocols for RCC.
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411
18
F sodium fluoride PET/CT in patients with prostate cancer: Quantification of normal tissues, benign degenerative lesions, and malignant lesions
Jorge D Oldan, A Stewart Hawkins, Bennett B Chin
May-August 2016, 15(2):102-108
DOI
:10.4103/1450-1147.172301
PMID
:27134560
Understanding the range and variability of normal, benign degenerative, and malignant
18
F sodium fluoride (
18
F NaF) positron emission tomography/computed tomography (PET/CT) uptake is important in influencing clinical interpretation. Further, it is essential for the development of realistic semiautomated quantification techniques and simulation models. The purpose of this study is to determine the range of these values in a clinically relevant patient population with prostate cancer.
18
F NaF PET/CT scans were analyzed in patients with prostate cancer (
n
= 47) referred for evaluation of bone metastases. Mean and maximum standardized uptake values [SUVs (SUV
mean
and SUV
max
)] were made in normal background regions (
n
= 470) including soft tissues (liver, aorta, bladder, adipose, brain, and paraspinal muscle) and osseous structures (T12 vertebral body, femoral diaphyseal cortex, femoral head medullary space, and ribs). Degenerative joint disease (DJD;
n
= 281) and bone metastases (
n
= 159) were identified and quantified by an experienced reader using all scan information including coregistered CT. For normal bone regions, the highest
18
F NaF PET SUV
mean
occurred in T12 (6.8 ± 1.4) and it also showed the lowest coefficient of variation (cv = 21%). For normal soft tissues, paraspinal muscles showed very low SUV
mean
(0.70 ± 0.11) and also showed the lowest variability (cv = 16%). Average SUV
mean
in metastatic lesions is higher than uptake in benign degenerative lesions but values showed a wide variance and overlapping values (16.3 ± 13 vs 11.1 ± 3.8;
P
< 0.00001). The normal
18
F NaF PET uptake values for prostate cancer patients in normal background, benign degenerative disease, and osseous metastases are comparable to those reported for a general population with a wide variety of diagnoses. These normal ranges, specifically for prostate cancer patients, will aid in clinical interpretation and also help to establish the basis of normal limits in a semiautomated data analysis algorithm.
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419
REVIEW ARTICLE
Systematic review on the accuracy of positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging in the management of ovarian cancer: Is functional information really needed?
Subapriya Suppiah, Wing Liong Chang, Hasyma Abu Hassan, Chalermrat Kaewput, Andi Anggeriana Andi Asri, Fathinul Fikri Ahmad Saad, Abdul Jalil Nordin, Sobhan Vinjamuri
July-September 2017, 16(3):176-185
DOI
:10.4103/wjnm.WJNM_31_17
PMID
:28670174
Ovarian cancer (OC) often presents at an advanced stage with frequent relapses despite optimal treatment; thus, accurate staging and restaging are required for improving treatment outcomes and prognostication. Conventionally, staging of OC is performed using contrast-enhanced computed tomography (CT). Nevertheless, recent advances in the field of hybrid imaging have made positron emission tomography/CT (PET/CT) and PET/magnetic resonance imaging (PET/MRI) as emerging potential noninvasive imaging tools for improved management of OC. Several studies have championed the role of PET/CT for the detection of recurrence and prognostication of OC. We provide a systematic review and meta-analysis of the latest publications regarding the role of molecular imaging in the management of OC. We retrieved 57 original research articles with one article having overlap in both diagnosis and staging; 10 articles (734 patients) regarding the role of PET/CT in diagnosis of OC; 12 articles (604 patients) regarding staging of OC; 22 studies (1429 patients) for detection of recurrence; and 13 articles for prognostication and assessment of treatment response. We calculated pooled sensitivity and specificity of PET/CT performance in various aspects of imaging of OC. We also discussed the emerging role of PET/MRI in the management of OC. We aim to give the readers and objective overview on the role of molecular imaging in the management of OC.
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Assessment Lumboperitoneal or Ventriculoperitoneal Shunt Patency by Radionuclide Technique: A Review Experience Cases
Sunanta Chiewvit, Sarun Nuntaaree, Potjanee Kanchaanapiboon, Pipat Chiewvit
May-August 2014, 13(2):75-84
DOI
:10.4103/1450-1147.139135
PMID
:25191120
Hydrocephalus-related symptoms that worsen after shunt placement may indicate a malfunctioning or obstructed shunt. The assessment of shunt patency and site of obstruction is important for planning of treatment. The radionuclide cerebrospinal fluid (CSF) shunt study provides a simple, effective, and low-radiation-dose method of assessing CSF shunt patency. The radionuclide CSF shuntography is a useful tool in the management of patients presenting with shunt-related problems not elucidated by conventional radiological examination. This article described the imaging technique of ventriculoperitoneal (VP) shunt and lumbar puncture (LP) shunt. The normal finding, abnormal finding of completed obstruction and partial obstruction is present by our cases experience. The radiopharmaceutical (Tc-99m diethylenetriaminepentaacetic acid) was injected via the reservoir for VP shunt and via lumbar puncture needle in subarachnoid space for LP shunt, then serial image in the head and abdominal area. The normal function of VP and LP shunt usually rapid spillage of the radioactivity in the abdominal cavity diffusely. The patent proximal tube VP shunt demonstrates ventricular reflux. The early image of patent LP shunt reveals no activity in the ventricular system contrast to distal LP shunt reveals early reflux of activity in the ventricular system. The completed distal VP and LP shunt obstruction show absence of tracer in the peritoneal area or markedly delayed appearance of abdominal activity. The partial distal VP and LP shunt obstruction recognized by slow transit or accumulation of tracer at the distal end or focal tracer in the peritoneal cavity near the tip of distal shunt. The images of the normal and abnormal CSF shunt as describe before are present in the full paper. Radionuclide CSF shuntography is a reliable and simple procedure for assessment shunt patency.
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ORIGINAL ARTICLES
Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of
177
Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience
Ajit S Shinto, KK Kamaleshwaran, Sudipta Chakraborty, K Vyshakh, SG Thirumalaisamy, S Karthik, VN Nagaprabhu, KV Vimalnath, Tapas Das, Sharmila Banerjee
May-August 2015, 14(2):81-88
DOI
:10.4103/1450-1147.153908
PMID
:26097417
The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using
177
Lu-labeled hydroxyapatite (
177
Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of
177
Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of
177
Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (
P
= 0.01) and duration of the disease (
P
= 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those with more advanced changes (Steinbrocker's Grades III and IV) in terms of VAS improvement (75% vs. 45.8%) (
P
< 0.001). The overall success rate (VAS ≥ 50) was 80%. Remission of pain during the night was achieved in 100%, and knee flexibility was improved in 80%. The changes in the blood pool phase before RSV were 3.2 ± 0.7 and after the therapy 1.4 ± 0.7 (
P
< 0.001). The J/B ratio was: Before RSV 2.4 ± 0.3; after treatment 1.0 ± 0.2 (
P
< 0.05). CRP concentration 4 and 24 weeks after the therapy was significantly lower than before treatment. The fibrinogen level was not different before and after RSV. RSV side-effects assessed for the whole follow-up period were minor and not significant. RSV with
177
Lu-HA was safe and effective in patients with knee joint chronic painful synovitis of rheumatoid origin. It exhibited significant therapeutic effect after 6 months follow-up period with no significant side-effects. The preliminary investigations reveal that
177
Lu-labeled HA particles hold considerable promise as a cost-effective agent for RSV. More elaborate and controlled clinical trials are necessary to evaluate the therapeutic efficacy and safety of the agent compared with the treatment with other radionuclides and glucocorticosteroids.
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REVIEW ARTICLES
Lacrimal Outflow Mechanisms and the Role of Scintigraphy: Current Trends
Efstathios T Detorakis, Athanassios Zissimopoulos, Konstantinos Ioannakis, Vassilios P Kozobolis
January-April 2014, 13(1):16-21
DOI
:10.4103/1450-1147.138569
PMID
:25191107
Lacrimal outflow can be compromised by anatomical obstructions or stenoses (nonfunctional epiphora) or by defective lacrimal "pump" function (functional epiphora). Although classic imaging modalities, such as X-ray dacryocystography, computed tomography, or magnetic resonance imaging can effectively evaluate the former, their success is much less in the evaluation of the latter. This is largely due to the fact that forced diagnostic injection of fluid into the canalicular system can overcome partial obstruction sites. On the other hand, lacrimal scintigraphy mimicks "physiological" lacrimal outflow, being performed under pressure gradients present in everyday life. This is why it is considered more suitable for the study of functional epiphora. Furthermore, quantitative lacrimal scintigraphy (with time-activity curves) enables the accurate measurement of lacrimal clearance from the conjunctival fornices and may be used to study the physiology of the lacrimal "pump." Data obtained from the scintigraphic study of lacrimal outflow may be used to design more effective procedures in the management of functional and nonfunctional epiphora. This is a review article, based on a literature search with emphasis on recent publications and on those supporting interdisciplinary cooperation between ophthalmology and nuclear medicine.
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5,918
720
ORIGINAL ARTICLES
Metastatic Bone Pain Palliation using
177
Lu-Ethylenediaminetetramethylene Phosphonic Acid
Mehrosadat Alavi, Shapour Omidvari, Alireza Mehdizadeh, Amir R Jalilian, Ali Bahrami-Samani
May-August 2015, 14(2):109-115
DOI
:10.4103/1450-1147.157124
PMID
:26097421
177
Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using
177
Lu-EDTMP for MBP palliation.
177
Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward.
177
Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed.
177
Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for patients with bone metastasis.
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3,449
359
Focal Colonic FDG Activity with PET/CT: Guidelines for Recommendation of Colonoscopy
Tianye Liu, Spencer Behr, Sana Khan, Robert Osterhoff, Carina Mari Aparici
January 2015, 14(1):25-30
DOI
:10.4103/1450-1147.150524
PMID
:25709541
Focal
18
F-fluorodeoxyglucose (FDG) colonic activity can be incidentally seen in positron emission tomography/computed tomography (PET/CT) scans. Its clinical significance is still unclear. The purpose of this study was to assess the significance of focal FDG activity in PET/CT scans by correlating the imaging findings to colonoscopy results, and come up with some guidelines for recommendation of follow-up colonoscopy. A total of 133 patients who underwent both
18
F-FDG PET/CT for different oncological indications and colonoscopy within 3 months were retrospectively studied. Imaging, colonoscopy and pathology results were analyzed. Of the 133 FDG-PET/CT scans, 109/133 (82%) did not show focal colonic FDG activity, and 24/133 (18%) did. Of the 109/133 PET/CTs without focal colonic FDG activity, 109/109 (100%) did not have evidence of colon cancer after colonoscopy and histology. Of the 24/133 PET/CTs with focal colonic FDG activity, 10/24 (42%) had pathologic confirmation of colon cancer and 14/24 (58%) did not have evidence of colon cancer after colonoscopy and histological analysis. Sensitivity was 10/10 (100%), specificity 109/123 (89%), positive predictive value (PPV) 10/24 (42%) and negative predictive value (NPV) 109/109 (100%). Incidental focal
18
FDG activity in PET/CT imaging shows a high sensitivity, specificity and NPV for malignancy, with a not so high PPV of 42%. Although some people would argue that a 42% chance of malignancy justifies colonoscopy, this maybe is not possible in all cases. However, the high sensitivity of the test does not allow these studies to be overlooked. We provide our recommendations as per when to send patients with focal FDG colonic activity to have further characterization with colonoscopy.
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REVIEW ARTICLE
68
Ga-prostate-specific membrane antigen positron emission tomography/computed tomography for prostate cancer imaging: A narrative literature review
Jose M Oliveira, Catarina Gomes, Diogo B Faria, Tiago S Vieira, Fernando A Silva, Joana Vale, Francisco L Pimentel
January-March 2017, 16(1):3-7
DOI
:10.4103/1450-1147.198237
PMID
:28217012
The
68
Ga-prostate-specific membrane antigen (
68
Ga-PSMA) has been recently developed to be used, as a ligand, in positron emission tomography/computed tomography (PET/CT) prostate cancer imaging, to detect prostate disease. The main objective of this review was to collect data and findings from other studies and articles to assess, theoretically, if
68
GA-PSMA PET/CT is a more appropriate prostate cancer diagnostic technique in comparison with others available such as CT,
18
F-fluoro-2-deoxyglucose PET/CT, or
18
F-fluoromethylcholine (
18
F-choline) PET/CT. For that purpose, PubMed, the online scientific articles' database, was consulted where the keywords "PSMA" and "PET" were used to find relevant articles. The clinicaltrials.gov, clinical trials' database, was also consulted where the keywords "
68
Ga-PSMA" and "prostate" were used to search clinical trials. Based on the reviewed scientific literature, several studies were conducted to assess and compare the
68
Ga-PSMA PET/CT detection rate in prostate cancer with other available techniques. One of those studies, conducted by Giesel
et al
., concluded, within study sample, that 75% of patients with lymph nodes detected by
68
Ga-PSMA PET/CT would have not been identified using other conventional morphological criteria based techniques. In Eiber
et al
.'s study,
68
Ga-PSMA PET detected prostatic disease findings in 67% of patients with prostate-specific antigen levels <1 ng/mL, when compared with choline-based PET that presented detection rates between 19% and 36%. In Bluemel
et al
.'s study,
68
Ga-PSMA identified positive prostatic disease in 43.8% of the patients with negative findings in F-choline PET/CT. Findings from this review demonstrate that
68
Ga-PSMA PET/C is more effective in detecting metastases, lymph nodes, and recurrent prostate cancer when compared to
18
F-choline-based PET/CT and CT.
68
Ga-PSMA PET/CT presents also more imaging contrast and can be more cost-effective.
68
Ga-PSMA has already been subjected to first-in-human trials, and it is now being tested in Phase II and III trials.
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755
REVIEW ARTICLES
Technetium-99m methylene diphosphonatesingle-photon emission computed tomography/computed tomography of the foot and ankle
Bhavin Upadhyay, Jonathan Mo, Clare Beadsmoore, Tom Marshall, Andoni Toms, John Buscombe
April-June 2017, 16(2):88-100
DOI
:10.4103/1450-1147.203077
PMID
:28553174
The complex anatomy and function of the foot and ankle can make it difficult to determine the cause of symptoms in patients with foot and ankle pathology. Following initial clinical and radiographic assessment, additional imaging with magnetic resonance imaging may be required, which is often seen as the modality of choice. Although sensitive to pathological changes in bone metabolism and vascularity, technetium-99m (Tc-99m) bone scintigraphy often lacks the specificity and resolution required to evaluate the structures of the foot and ankle. Tc-99m methylene diphosphonate single-photon emission computed tomography/computed tomography (SPECT/CT) combines this sensitivity with the superior anatomical detail of CT, enabling better localization of pathological uptake and evaluation of associated structural changes. As a result, SPECT/CT has been growing in popularity for the assessment of patients with foot and ankle pathology where it can provide additional information that may change the initial diagnosis and subsequent management plan. Studies have reported modification of the surgical approach and site of intra-articular local anesthetic injections following SPECT/CT with good results. Interpretation of SPECT/CT studies requires an understanding of the pathological changes that result in increased tracer accumulation in addition to the CT changes that may be seen. This review aims to highlight the advantages of SPECT/CT, potential applications and explain the imaging appearances of common pathologies that may be observed.
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ORIGINAL ARTICLES
Efficacy and safety of
177
Lutetium-prostate-specific membrane antigen therapy in metastatic castration-resistant prostate cancer patients: First experience in West Asia – A prospective study
Ramin Akbarian Aghdam, Mahasti Amoui, Mohammadali Ghodsirad, Sepide Khoshbakht, Bahram Mofid, Fateme Kaghazchi, Mehrdad Tavakoli, Elahe Pirayesh, Hojjat Ahmadzadehfar
July-September 2019, 18(3):258-265
DOI
:10.4103/wjnm.WJNM_66_18
PMID
:31516369
Prostate-specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on the surface of prostate cancer (PC) cells, making it an excellent radiotracer for both therapeutic and diagnostic purposes. In this prospective study, we investigated the efficacy and toxicity of
177
Lutetium (Lu)-PSMA in metastatic castration-resistant PC (mCRPC) patients for the establishment and approval of this therapy in Iran. Fourteen mCRPC patients (mean age 70.57 ± 7.3 years) were treated with a single dose of
177
Lu-PSMA. Complete blood count, liver function tests (aspartate aminotransferase and alanine aminotransferase), alkaline phosphatase levels, renal function tests (urea and creatinine), and prostate-specific antigen (PSA) levels were obtained for the patients at baseline and every 2 weeks. A majority of the patients (11 patients, 64.2%) experienced a decline in their PSA levels; in 5 (45.4%) of these patients, the PSA levels declined > 50%.The severity of pain decreased in 8 (57.1%) patients, and performance status was improved in 5 (45.4%) patients. The treatment was well tolerated, and no severe hematological or nonhematological side effects were observed. Our findings show that
177
Lu-PSMA had a high efficacy and a low toxicity in an Iranian population and is a promising treatment option for PC patients.
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12
3,793
415
Radioiodine Thyroid Ablation in Graves' Hyperthyroidism: Merits and Pitfalls
JF Nwatsock, D Taieb, L Tessonnier, J Mancini, F Dong-A-Zok, O Mundler
January-June 2012, 11(1):7-11
DOI
:10.4103/1450-1147.98731
Ablative approaches using radioiodine are increasingly proposed for the treatment of Graves' disease (GD) but their ophthalmologic and biological autoimmune responses remain controversial and data concerning clinical and biochemical outcomes are limited. The aim of this study was to evaluate thyroid function, TSH-receptor antibodies (TRAb) and Graves' ophthalmopathy (GO) occurrence after radioiodine thyroid ablation in GD. We reviewed 162 patients treated for GD by iodine-131 (
131
I) with doses ranging from 370 to 740 MBq, adjusted to thyroid uptake and sex, over a 6-year period in a tertiary referral center. Collected data were compared for outcomes, including effectiveness of radioiodine therapy (RIT) as primary endpoint, evolution of TRAb, and occurrence of GO as secondary endpoints. The success rate was 88.3% within the first 6 months after the treatment. The RIT failure was increased in the presence of goiter (adjusted odds ratio = 4.1, 95% confidence interval 1.4-12.0,
P
= 0.010). The TRAb values regressed with time (
r
= −0.147;
P
= 0.042) and patients with a favorable outcome had a lower TRAb value (6.5 ± 16.4 U/L) than those with treatment failure (23.7 ± 24.2 U/L,
P
< 0.001). At the final status, 48.1% of patients achieved normalization of serum TRAb. GO occurred for the first time in 5 patients (3.7%) who were successfully cured for hyperthyroidism but developed early and prolonged period of hypothyroidism in the context of antithyroid drugs (ATD) intolerance (
P
= 0.003) and high TRAb level (
P
= 0.012). On the basis the results of this study we conclude that ablative RIT is effective in eradicating Graves' hyperthyroidism but may be accompanied by GO occurrence, particularly in patients with early hypothyroidism and high pretreatment TRAb and/or ATD intolerance. In these patients, we recommend an early introduction of LT4 to reduce the duration and the degree of the radioiodine-induced hypothyroidism.
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11
5,579
1,118
Kinetic Modeling Application to
18
F-fluoroethylcholine Positron Emission Tomography in Patients with Primary and Recurrent Prostate Cancer Using Two-tissue Compartmental Model
Mustafa Takesh
September-December 2013, 12(3):101-110
DOI
:10.4103/1450-1147.136734
PMID
:25214813
Although
18
F-fludeoxyglucose-positron emission tomography (PET) is the most applied diagnostic method in tumor staging, its role in prostate cancer (PCA) is limited because glucose metabolism tends to be low unless PCA has high Gleason score. Alternatively, choline PET was introduced as a valuable imaging method. Kinetic analysis of PET acquisition has increasingly gained momentum as an investigative tool because it provides a non-invasive approach to obtain kinetic and metabolic data from tissues of interest including transport and metabolism of the administered material. In this regard, we sought to apply it in
18
F-fluoroethylcholine (FECH)-PET/computed tomography (CT) in patients with PCA. 64 patients, the mean age 69 (range: 47-87 years) with primary/recurrent PCA were encompassed. They underwent
18
F-FECH-PET started with a dynamic acquisition using a 20-frame each 30 s over the prostate region and followed at 1 h post-injection by a static whole body imaging. The kinetic evaluation of the data was performed using the software package PMOD (PMOD Technologies Ltd., Zürich, Switzerland). Significant increase in mean values for K1, K3, FD, standardized uptake value (SUV) and global influx in tumor tissue versus normal tissue (
P
< 0.05). Moderate but significant correlation (
r
: 0.28,
P
= 0.023) between SUV and K1. By contrast, no correlation between SUV and K3 (
r
: −0.08,
P
= 0.79). In patients with recurrent tumors, there is no significant difference in all kinetic parameters and SUV (
P
> 0.1) between the different types of recurrences. The kinetic analysis of dynamic FECH-PET provides a novel method in primary PCA diagnosis and could be of potential value in the delineation of tumor focus.
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11
4,010
375
Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnostic Evaluation of Carcinoma Urinary Bladder: Comparison with Computed Tomography
Dhritiman Chakraborty, Bhagwant Rai Mittal, Raghava Kashyap, Utham Kumar Mete, Vikram Narang, Ashim Das, Anish Bhattacharya, Niranjan Khandelwal, Arup K Mandal
January-April 2014, 13(1):34-39
DOI
:10.4103/1450-1147.138572
PMID
:25191110
Bladder carcinoma is the most frequent tumor of the urinary tract and accounts 7% of all malignancies in men and 2% of all malignancies in women. This retrospective study was carried out to assess the diagnostic utility of F18-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the imaging evaluation of bladder carcinoma. Seventy-seven consecutive patients diagnosed to have carcinoma urinary bladder referred for F18-FDG PET/CT were included in this study. Thirty-four patients were for initial staging after transurethral biopsy and remaining 43 patients were for restaging. All patients also underwent CT scan of the abdomen and pelvis. PET/CT findings were correlated with diagnostic CT scan and histopathological findings. In 30 of the 34 patients for initial staging, both PET/CT and CT confirmed the primary lesion in the bladder. Histopathology report was available in 23 patients. Lymph nodes FDG uptake reported to be metastatic in 10/23 patients while CT detected lymph node metastasis in 12 patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy have been calculated to be 87.5%, 80%, 70%, 92%, 82% for PET/CT and 66%, 57%, 50%, 72%, 60% for CT respectively. PET/CT detected metastatic disease in 8 patients whereas CT detected in 4 patients. Of the 43 patients for restaging, local recurrence was detected in 24 patients on both PET/CT and CT. Histopathology report was available in 17 patients. Sensitivity, specificity, PPV, NPV and accuracy were 85%, 60%, 60%, 85%, 70% for PET/CT and 80%, 50%, 40%, 85%, 58% for CT respectively. Nineteen patients were detected to have metastatic disease by PET/CT, whereas CT detected metastases in 11 patients. F-18 FDG PET/CT is a very useful modality in pre-operative staging and monitoring after surgery, chemotherapy or radiotherapy of patients with carcinoma urinary bladder.
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11
2,880
369
Impact of
18
F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan on Initial Evaluation of Head and Neck Squamous Cell Carcinoma: Our Experience at a Tertiary Care Center in India
Satish Nair, Sharad Mohan, Ajith Nilakantan, Atul Gupta, Akshat Malik, Abhishek Gupta
January 2015, 14(1):19-24
DOI
:10.4103/1450-1147.150519
PMID
:25709540
The efficacy of the whole body (WB)
18
F-fluorodeoxyglucose (
18
F-FDG) positron emission tomography-computed tomography (PET-CT) as a part of conventional initial staging in all cases of head and neck squamous cell carcinoma (HNSCC) is still controversial with various studies in literature giving contradictory reports. We conducted this study at a government tertiary care oncology center in India to identify the impact of WB
18
F-FDG PET-CT scan on HNSCC staging and treatment. A prospective clinical study of patients of HNSCC who were evaluated and treated at our center was performed. The patients included in the study were HNSCC of the oral cavity, oropharynx, hypopharynx, larynx, nasopharynx, and carcinoma of unknown primary site (CUPS) with cervical metastasis. The study design was to evaluate the cases of HNSCC initially by staging with conventional investigations followed by staging with the information derived from WB
18
F-FDG PET-CT scan. At the end of the conventional investigations, a tumor, node, metastasis (TNM) staging as per AJCC 7
th
edition, and a detailed treatment plan as per NCCN 2012 guidelines was decided in consultation with the multidisciplinary oncology team of the hospital. WB
18
F-FDG PET-CT scan was carried out in all these patients. The findings of WB
18
F-FDG PET-CT were then interpreted with the staging with conventional investigations to identify the cases with change in staging and also those in whom the treatment protocol would be affected. Descriptive analysis of demographic data and analytical analysis of the sensitivity and specificity of WB
18
F-FDG PET-CT scan and also the change in staging and treatment plan after WB
18
F-FDG PET-CT scan was analyzed using SPSS version 18. A total of 131 patients met the inclusion criteria, which included 123 males and 8 females. The various sites involved among the study group are oral cavity 11 (8.3%), oropharyn × 39 (29.7%), hypopharyn × 31 (23.6%), laryn × 34 (25.9%), nasopharyn × 4 (3%), and CUPS 12 (9.1%). The majority of cases studied were of T2 and T3 stage, and changes in T staging after WB
18
F-FDG PET-CT scan were minimal and not statistically significant (
P
> 0.5). In the nodal staging after WB
18
F-FDG PET-CT scan, there was a statistically significant change in identification of nodal metastasis in N0 group and also identification of additional multiple/bilateral nodes (N2b and N2c). 3 (2.2%) patients had a change in M status with identification of distant metastasis in lungs (2 patients) and in the liver and lung (1 patient). Of the 131 patients, 75 (57.25%) underwent surgical management with or without adjuvant treatment (Group I) and 56 (42.74%) patients underwent nonsurgical management (Group II). There was no significant statistical difference in sensitivity and specificity of
18
F-FDG PET-CT scan in detecting cancer among the two groups. Considering all the patients in this study, WB
18
F-FDG PET-CT scan showed an overall sensitivity of 95.2% and specificity of 80%. In this study, change in TNM staging after WB
18
F-FDG PET-CT was seen in 22 (16.8%) patients and an alteration in the treatment in 21 (16.1%) patients, which were both found to be statistically significant (
P
< 0.5). In our study, WB
18
F-FDG PET-CT scan has shown to have an impact on initial staging of disease affecting the change in treatment protocol in a significant number of patients. The effect of this change in staging and treatment on the eventual morbidity and mortality rates is not known. In practice, the use of
18
F-FDG PET-CT scan is limited, owing to the high cost and low availability. A realistic evaluation of cost versus benefit needs to be undertaken to identify the impact of using
18
F-FDG PET-CT scan as a mode for initial evaluation of HNSCC.
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11
3,435
538
A 3D Monte Carlo method for estimation of patient-specific internal organs absorbed dose for
99m
Tc-hynic-Tyr
3
-octreotide imaging
Mehdi Momennezhad, Shahrokh Nasseri, Seyed Rasoul Zakavi, Ali Asghar Parach, Mahdi Ghorbani, Ruhollah Ghahraman Asl
May-August 2016, 15(2):114-123
DOI
:10.4103/1450-1147.174700
PMID
:27134562
Single-photon emission computed tomography (SPECT)-based tracers are easily available and more widely used than positron emission tomography (PET)-based tracers, and SPECT imaging still remains the most prevalent nuclear medicine imaging modality worldwide. The aim of this study is to implement an image-based Monte Carlo method for patient-specific three-dimensional (3D) absorbed dose calculation in patients after injection of
99m
Tc-hydrazinonicotinamide (hynic)-Tyr
3
-octreotide as a SPECT radiotracer.
99m
Tc patient-specific
S
values and the absorbed doses were calculated with GATE code for each source-target organ pair in four patients who were imaged for suspected neuroendocrine tumors. Each patient underwent multiple whole-body planar scans as well as SPECT imaging over a period of 1-24 h after intravenous injection of
99m
hynic-Tyr
3
-octreotide. The patient-specific
S
values calculated by GATE Monte Carlo code and the corresponding
S
values obtained by MIRDOSE program differed within 4.3% on an average for self-irradiation, and differed within 69.6% on an average for cross-irradiation. However, the agreement between total organ doses calculated by GATE code and MIRDOSE program for all patients was reasonably well (percentage difference was about 4.6% on an average). Normal and tumor absorbed doses calculated with GATE were slightly higher than those calculated with MIRDOSE program. The average ratio of GATE absorbed doses to MIRDOSE was 1.07 ± 0.11 (ranging from 0.94 to 1.36). According to the results, it is proposed that when cross-organ irradiation is dominant, a comprehensive approach such as GATE Monte Carlo dosimetry be used since it provides more reliable dosimetric results.
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11
4,044
411
Can
18
F-Fluoroestradiol positron emission tomography become a new imaging standard in the estrogen receptor-positive breast cancer patient: A prospective comparative study with
18
F-Fluorodeoxyglucose positron emission tomography?
Manoj Gupta, Anupama Datta, Partha S Choudhury, Maria Dsouza, Ullas Batra, Anil Mishra
April-June 2017, 16(2):133-139
DOI
:10.4103/1450-1147.203071
PMID
:28553180
Correct staging is the most crucial for the treatment outcome in cancer management. Molecular imaging with
18
F-fluoroestradiol (FES) positron emission tomography-computed tomography (PET-CT) targets estrogen receptor (ER) and may have a higher incremental value in diagnosis by aiding specificity. We enrolled 12 female breast cancer patients prospectively and did
18
F-FES PET-CT and
18
F-fluorodeoxyglucose (FDG) PET-CT within 1 week interval time. Lesion detection sensitivity was compared for a total number of lesions and for nonhepatic lesions only by McNemar test.
18
F-FES PET-CT was taken as reference in case of indeterminate lesions. The incremental value reported by identifying
18
F-FES exclusive lesions and by characterization of
18
F-FDG indeterminate lesions. Spearman rank test was used to correlate ER expression and maximum standardized uptake value (SUVmax). Two ER-negative patients with no
18
F-FES uptake were excluded. Ten ER-positive patients with 154 disease lesions were finally analyzed.
18
F-FDG picked-up 142 lesions (sensitivity 92.21%), whereas
18
F-FES picked-up 116 lesions (sensitivity 75.32%) and this difference was statistically significant. For nonhepatic lesions (
n =
136) detectability,
18
F-FDG picked-up 124 (sensitivity 91.18%), whereas
18
F-FES picked-up 116 (sensitivity 85.29%) lesions and this difference was not statistically significant. Beside 12 exclusive lesions,
18
F-FES characterized 41 (27.5%)
18
F-FDG indeterminate lesions. Overall
18
F-FES impacted 20% patient management. The positive trend was also seen with
18
F-FES SUVmax with ER expression and negative with
18
F-FDG SUVmax. We conclude,
18
F-FDG has overall better sensitivity than
18
F-FES PET-CT, however for nonhepatic metastasis difference was not significant.
18
F-FES PET-CT better-characterized lesions and impacted 20% patient management. Therefore,
18
F-FES PET-CT should be used with
18
F-FDG PET-CT in strongly ER expressing patients for better specificity.
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446
REVIEW ARTICLES
A tribute to Dr. Saul Hertz: The discovery of the medical uses of radioiodine
Barbara Hertz
January-March 2019, 18(1):8-12
DOI
:10.4103/wjnm.WJNM_107_18
PMID
:30774539
Dr. Saul Hertz was Director of The Massachusetts General Hospital's Thyroid Unit, when he heard about the development of artificial radioactivity. He conceived and brought from bench to bedside the successful use of radioiodine (RAI) to diagnose and treat thyroid diseases. Thus was born the science of theragnostics used today for neuroendorine tumors and prostate cancer. Dr. Hertz's work set the foundation of targeted precision medicine.
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569
CASE REPORTS
18
F-FDG PET-CT for Staging of Conjunctival Melanoma
Andres Damian, Javier Gaudiano, Henry Engler, Omar Alonso
January-March 2013, 12(1):45-47
DOI
:10.4103/1450-1147.113965
PMID
:23961257
The value of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (
18
F-FDG PET-CT) for the evaluation of cutaneous melanoma has been demonstrated previously. However, there are few reports regarding the use PET-CT for the staging of conjunctival melanoma (CM). We report here a case, a 34-year-old male with a six-month history of a pigmented nodule at the palpebral conjunctiva of the left eye, and a firm left preauricular lymph node detected on physical examination. Biopsy of the ocular lesion confirmed CM, and fine needle aspiration cytology of the preauricular node was positive for malignancy. CT showed three pulmonary nodules. An
18
F-FDG PET-CT was performed to restage the patient. The study showed hypermetabolic lesions in the left eye, and in the left preauricular node. The scan was negative for metastasis. These findings were important in guiding management of the disease in this patient. Future prospective studies should further evaluate the role of
18
F-FDG PET-CT for the staging of CM.
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9
3,807
338
Inflammatory Myofibroblastic Tumor of the Lung: Unusual Imaging Findings
K Pavithran, P Manoj, G Vidhyadharan, P Shanmughasundaram
September-December 2013, 12(3):126-128
DOI
:10.4103/1450-1147.136739
PMID
:25165425
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, most commonly seen in children and adolescents. It can occur in nearly every part of the body. Imaging properties and the clinical presentation of IMT can mimic malignant process. A 41-year-old female presented with cough of 3 months duration. Chest X-ray showed a coin shadow in the right upper lobe. Positron emission tomography/computed tomography scan showed a 3.2 × 2.4 cm lesion with homogeneous appearance with a very high fluorodeoxyglucose uptake value, suggesting a neoplastic process. She underwent lobectomy and the final diagnosis was IMT.
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9
3,262
354
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