A study of the time of hospital discharge of differentiated thyroid cancer patients after receiving iodine-131 for thyroid remnant ablation treatment.

The aim of this study was to measure the radiation exposure rate from differentiated thyroid carcinoma (DTC) patients who had received iodine-131 ((131)I) treatment, and to evaluate hospital discharge planning in relation to three different sets of regulations. We studied 100 patients, 78 females and 22 males, aged 13 to 79 years (mean 44.40±15.83 years) with DTC, in three Groups who were treated with 3.7, 5.5 or 7.4GBq of (131)I, respectively. The external whole-body dose rates following oral administration of (131)I were measured after each one of the first three hospitalization days. A multivariant linear analysis was performed, considering exposure rates as dependent variables to the administered dose for treatment, age, gender, regional and/or distant metastases, thyroglobulin (Tg), antibodies to Tg and thyroid remnant in the three dose groups. We found that the exposure rates after each of the three first days of hospitalization were 30, 50 and 70µSvh-1 at 1m. All our DTC patients had an acceptable dose rate on days 2 and 3 that allowed their hospital discharge. After only 1 day of hospitalization, just 3/11 cases showed not permissible exposure rates above 70µSvh-1. In conclusion, it is the opinion of the authors that after measuring the exposure rates, most treated, DTC patients could be discharged after only one day of hospitalization, even some of those treated with high doses of (131)I (7.4GBq). Patients, who received the higher doses of (131)I, should not be released before their individual exposure rate is measured.

Hepatopulmonary Syndrome with Right-to-left Shunt in Cirrhotic Patients Using Macro-Aggregated Albumin Lung Perfusion Scan: Comparison with Contrast Echocardiography and Association with Clinical Data

Objectives: The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhotic patients is still subject to debate. This study investigated the association of clinical findings with HPS in cirrhotic patients using macro-aggregated albumin lung perfusion scan (99mTc-MAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography (CEE) in detection of HPS was also performed. Methods: In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison CEE and the frequency of HPS was assessed in them and also was compared across the other variables. Results: The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with cirrhosis (18.51%). HPS was mild in 40.74% (11/27) of the patients, and severe in only 2 patients. There was no relationship between gender, disease duration, having diagnosis of disease previously, pulmonary symptoms and Child-Pugh score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas analysis and laboratory indices between patients with and without HPS was also non-significant (p value >0.05). Among coagulation factors assessed in cirrhotic patients, we found only significant correlation between HPS and prothrombin time (p<0.05). Conclusion: HPS, particularly its mild form, is noted in a great number of patients with cirrhosis using 99mTc-MAA lung scintigraphy. Because of its technical ease, and possibility to obtain objective quantitative information, 99mTc-MAA lung scintigraphy can be complementary to other diagnostic methods in the evaluation of HPS assessment, although additional studies are needed.

Significance of Microalbuminuria in Predicting Silent Myocardial Ischemia in Patients with Type 2 Diabetes Using Myocardial Perfusion Imaging

Objectives: In light of increased risk of cardiovascular events and the poor prognosis of coronary artery disease (CAD) in diabetic versus non-diabetic patients and also with respect to the importance of early diagnosis of CAD in this status, the study was aimed to assess the importance of microalbuminuria in predicting silent myocardial ischemia (SMI) in patients with type 2 diabetes using myocardial perfusion imaging (MPI). Methods: This study included 120 patients with diabetes type 2, but without previously known CAD or any cardiac symptoms that were stratified into two groups based on presence/absence of microalbuminuria. All participants underwent CAD evaluation using gated myocardial perfusion single-photon emission computed tomography (MPS) imaging. Other clinical and laboratory indices were also recorded Results: Studied population consisted of 84 males (70%) and 36 females (30%), totally 120 patients with mean age of 58.61±9.90). In total, asymptomatic ischemia was detected in 78 (65%) of the included diabetic patients. Stress induced ischemia was found in 56 patients (87.5%) of albumin+ (Alb) group and in 22 patients (39.3%) of Alb- group. The frequency of stress induced ischemia was 10.81 times higher in the patients with microalbuminuria compared to Alb- ones [p<0.001, Odds ratio: 10.81, 95% confidence interval: 4.33-26.99]. On the other hand, no relationship was found between the presence of stress induced ischemia and therapy type, diabetes duration, history of evident retinopathy, history of hypertension and also serum levels of hemoglobin A1c (p>0.05). Conclusion: The current study showed that abnormal MPI findings are significantly more common in diabetic patients with microalbuminuria. With respect to low cost and availability of urine Alb detection tests, it might be as a biomarker for prediction of SMI in daibetic population.

153Sm-EDTMP and 177Lu-EDTMP are equally safe and effective in pain palliation from skeletal metastases.

INTRODUCTION: Bone pain from multifocal blastic or mixed lytic-blastic metastatic lesions can be effectively addressed with radiopharmaceuticals with high affinity for such foci. 153Sm-ethylene diamine tetramethylene phosphonic acid (153Sm-EDTMP) and 177Lu-ethylene diamine tetramethylene phosphonic acid) (177Lu-EDTMP) are two such radiopharmaceuticals. The aim of this study was to make a comparison of efficacy between 153Sm-EDTMP and 177Lu-EDTMP in terms of palliation of commonly encountered symptoms in cancer patients, functional status, and pain intensity as measured by Edmonton Symptom Assessment System (ESAS), Eastern Cooperative Oncology Group (ECOG) performance status, and numeric rating scale (NRS) respectively. This study was a double blind randomized clinical trial conducted in a setting of three university hospitals. MATERIALS AND METHODS: In a randomized double-blind clinical trial 50 patients will with documented painful bone metastases of blastic or mixed lytic-blastic nature were randomly allocated into two groups; group receiving 153Sm-EDTMP and group receiving 177Lu-EDTMP. Radiopharmaceuticals were given at a dose of 37.0 MBq / kg body weight in both groups. Scores on ESAS, ECOG performance status and NRS were recorded before the intervention and following the intervention at 2, 4, 6, and 12 weeks. Hematologic toxicity was evaluated by monitoring hematologic parameters at the baseline and at 1, 3, 6, and 8 weeks after the intervention. RESULTS: Fifty patients, 31 (62 %) females and 19 (38 %) males with the mean age of 66.08 ± 4.53 years were recruited. The baseline means and standard deviations for pain intensity as measured by the NRS were 8.4 ± 1.47 and 8.36 ± 1.43 in 153Sm-EDTMP- and 177Lu-EDTMP-treated subjects respectively. Patients of both groups showed significant alleviation of pain observed from the 2nd week (first follow up session) and continuing to the 12th week after treatment . No difference in response to the two radiopharmaceuticals were seen regarding their efficacy in pain alleviation (P < 1.0). Baseline "symptom distress scores" drawn from the ESAS-r in 153Sm-EDTMP- and 177Lu-EDTMP-treated groups were 5.5 ± 2.1 and 5.4 ± 2.1, respectively. The scores significantly improved in both groups with the most marked rate of improvement achieved within the first two weeks after treatment. The scores continued to improve until the 12th week of follow-up (P < 1.0, non-significant [ns]). Functional status as measured by ECOG performance status scores improved in both groups over the follow up period. Baseline scores on ECOG performance status in 153Sm-EDTMP- and 177Lu-EDTMP-treated groups were 2.5 ± 1.3 and 2.5 ± 1.3 (mean ± standard deviation). At 3 months post-treatment scores improved to 1.6 ± 0.6 and 1.6 ± 0.6 respectively (P < 1.0, n.s.). CONCLUSIONS: 153Sm-EDTMP and 177Lu-EDTMP are safe and effective radiopharmaceuticals in palliation of cancer pain from multiple skeletal metastases of blastic and mixed lyticblastic nature. EINLEITUNG: Knochenschmerzen von multifokalen blastischen oder gemischten lytisch-blastischen metastatischen Läsionen können mit Radiopharmazeutika mit hoher Affinität für solche Foki wirksam adressiert werden. 153Sm-EDTMP (Ethylendiamin-tetra[methylenphosphonsäure]) und 153Lu-EDTMP sind zwei dieser Radiopharmazeutika. Das Ziel der Studie war es, einen Vergleich der Wirksamkeit zwischen 153Sm-EDTMP und 177Lu-EDTMP im Hinblick auf die Linderung häufig auftretender Symptome bei Krebspatienten, den funktionellen Status und die Schmerzintensität, gemessen mit dem Edmonton Symptom Assessment System (ESAS), der Eastern Cooperative Oncology Group, durchzuführen (ECOG) Leistungsstatus bzw. numerische Bewertungsskala (NRS). Diese Studie war eine doppelblinde, randomisierte klinische Studie, die in drei Universitätskliniken durchgeführt wurde. MATERIAL UND METHODEN: In einer randomisierten doppelblinden klinischen Studie wurden 50 Patienten mit dokumentierten schmerzhaften Knochenmetastasen blastischer oder gemischter lytisch-blastischer Art auf zwei Gruppen randomisert: eine Gruppe erhielt 153Sm-EDTMP und eine Gruppe 177Lu-EDTMP. Radiopharmazeutika wurden in einer Dosis von 37,0 MBq / kg Körpergewicht in beiden Gruppen verabreicht. Die Ergebnisse zu ESAS, ECOG-Leistungsstatus und NRS wurden vor der Intervention und nach der Intervention nach 2, 4, 6 und 12 Wochen aufgezeichnet. Die hämatologische Toxizität wurde durch Überwachung von hämatologischen Parametern zu Beginn und nach 1, 3, 6 und 8 Wochen nach dem Eingriff bewertet. ERGEBNISSE: Fünfzig Patienten, 31 (62 %) Frauen und 19 (38 %) Männer mit einem Durchschnittsalter von 66,08 ± 4,53 Jahren wurden rekrutiert. Die Grundlinienmittelwerte und Standardabweichungen für die Schmerzintensität, gemessen durch die NRS, betrugen 8,4 ± 1,47 und 8,36 ± 1,43 in 153Sm-EDTMP-bzw. 177Lu-EDTMP-behandelten Patienten. Die Patienten beider Gruppen zeigten eine signifikante Schmerzlinderung, die von der 2. Woche (erste Nachuntersuchung) bis zur 12. Woche nach der Behandlung beobachtet wurde. Hinsichtlich ihrer Wirksamkeit bei der Schmerzlinderung wurde kein Unterschied in Bezug auf die zwei Radiopharmazeutika festgestellt (P < 1,0). Baseline "Symptom Distress Scores" aus dem ESAS-r in 153Sm-EDTMP- und 177Lu-EDTMP-behandelten Gruppen waren 5,5 ± 2,1 bzw. 5,4 ± 2,1. Die Werte verbesserten sich in beiden Gruppen signifikant, wobei innerhalb der ersten zwei Wochen nach der Behandlung die deutlichste Besserung erzielt wurde. Die Werte verbesserten sich bis zur 12. Woche der Nachuntersuchung (P < 1,0, nicht signifikant [n.s.]). Der funktionelle Status, gemessen anhand der ECOG-Leistungsstatuswerte, verbesserte sich in beiden Gruppen im Follow-up-Zeitraum. Die Baseline-Werte für den ECOG-Leistungsstatus in 153Sm-EDTMP- und 177Lu-EDTMP-behandelten Gruppen betrugen 2,5 ± 1,3 und 2,5 ± 1,3 (Mittelwert ± Standardabweichung). Nach 3 Monaten verbesserten sich die Ergebnisse auf 1,6 ± 0,6 bzw. 1,6 ± 0,6 (P < 1,0, n.s.). SCHLUSSFOLGERUNGEN: : 153Sm-EDTMP und 177Lu-EDTMP sind sichere und wirksame Radiopharmaka zur Linderung von Tumorschmerzen bei multiplen skelettalen Metastasen blastischer und gemischter lytisch-blastischer Natur.

Factors That Impact Evaluation of Left Ventricular Systolic Parameters in Myocardial Perfusion Gated SPECT with 16 Frame and 8 Frame Acquisition Models.

OBJECTIVE: Evaluating the effects of heart cavity volume, presence and absence of perfusion defect, gender and type of study (stress and rest) on the difference of systolic parameters of myocardial perfusion scan in 16 and 8 framing gated SPECT imaging. METHODS: Cardiac gated SPECT in both 16 and 8 framing simultaneously and both stress and rest phases at one-day protocol was performed for 50 patients. Data have been reconstructed by filter back projection (FBP) method and left ventricular (LV) systolic parameters were calculated by using QGS software. The effect of some factors such as LV cavity volume, presence and absence of perfusion defect, gender and type of study on data difference between 8 and 16 frames were evaluated. RESULTS: The differences in ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) in both stress and rest were statistically significant. Difference in both framing was more in stress for EF and ESV, and was more in rest for EDV. Study type had a significant effect on differences in systolic parameters while gender had a significant effect on differences in EF and ESV in rest between both framings. CONCLUSION: In conclusion, results of this study revealed that difference of both 16 and 8 frames data in systolic phase were statistically significant and it seems that because of better efficiency of 16 frames, it cannot be replaced by 8 frames. Further well-designed studies are required to verify these findings.

Value of Sentinel Lymph Node (SLN) Mapping and Biopsy using Combined Intracervical Radiotracers and Blue Dye Injections for Endometrial Cancer

Background: Lymphadenectomy, as part of the initial surgical staging of patients with endometrial carcinoma, remains a controversial topic in gynecologic oncology. Sentinel lymph node (SLN) mapping has become a well-accepted procedure for melanomas and breast cancer; a number of investigators have begun to explore the utility and accuracy of this technique with regard to endometrial cancer. Aim: This study was conducted to evaluate SLN mapping of early stage endometrial cancer with blue dye in conjunction with a radioactive tracer. Subjects and methods: In this prospective cross-sectional study, patients with stage I and II endometrial cancer who were candidates for systemic lymph node dissection during surgery were enrolled, some underwent lymph node mapping and SLN biopsy using combined intra cervical radiotracer and blue dye injections and some applying only an intra cervical radiotracer. SLNs and other lymph nodes were sent for pathological assessment. Sensitivity, specificity, the positive predictive value, and the negative predictive value were calculated as predictive values for the radiotracer and blue dye. Results: Pre-operative lymph node mapping showed SLN in 29 out of 30 patients. Intra operations in 29/30 patients, SLNs were harvested by gamma probe; in 13 out of 19 patients SLNs were detected by blue dye. The median number of SLNs per patient was 3 and the total number of SLNs detected was 81. Four patients had positive pelvic lymph nodes. All of the positive nodes were SLNs. Using this technique (radiotracer and blue dye) an overall detection rate of 96.7%, an NPV of 100%, a sensitivity of 100% and a specificity of 3.85% were achieved. Conclusion: Results of SLN research for endometrial cancer are promising and make feasible the possibility of avoiding unnecessary aggressive surgical procedures in near future by advances in SLN mapping.

Evaluation of Prognostic Factors Associated With Differentiated Thyroid Carcinoma With Pulmonary Metastasis.

BACKGROUND: Because one of the major sites for metastasis of thyroid cancers is the lung, studying the pattern of pulmonary metastasis may provide useful information for the effective treatment of these patients. In this study, by assessing the metastasis pattern, we aimed to identify the factors that may affect prognosis and response to treatment in patients with differentiated thyroid carcinoma (DTC) with pulmonary metastasis. METHODS: This retrospective study included 75 patients with DTC with pulmonary metastasis who were referred to our nuclear medicine section over a period of 10 years. The data obtained were analyzed with regard to response to treatment to assess the effects of the included factors on prognosis. RESULTS: Of the 1746 patients referred to our section, 75 (4.3%) had pulmonary metastasis. According to the pattern of pulmonary metastasis, they were divided into 4 groups: nodular, diffuse, combined, and other. The mean age of the patients was 43.8 ± 18.5 years. After the follow-up, 58 patients survived, 14 of whom responded to the treatment. The mean number of radioiodine therapy sessions that the patients received was 3.2 ± 2, and the mean cumulative dose was 554.7 ± 387.8 mCi. Statistical analysis of the data revealed that there was no significant difference in the response to treatment between patients with different patterns of pulmonary metastasis (P > 0.3). However, significant differences were reported in the response to treatment between patients with papillary thyroid carcinoma and those with follicular thyroid carcinoma (P < 0.03). The 1-, 5-, and 9-year survival rates were reported as 98%, 76%, and 51%, respectively. CONCLUSIONS: Patients with DTC with pulmonary metastasis have a relatively favorable prognosis and response rate, as well as longer survival. The type of DTC is the only factor that affects the response to treatment.

The electromagnetic interference of mobile phones on the function of a γ-camera.

PURPOSE: The aim of the present study is to evaluate whether or not the electromagnetic field generated by mobile phones interferes with the function of a SPECT γ-camera during data acquisition. METHODS: We tested the effects of 7 models of mobile phones on 1 SPECT γ-camera. The mobile phones were tested when making a call, in ringing mode, and in standby mode. The γ-camera function was assessed during data acquisition from a planar source and a point source of Tc with activities of 10 mCi and 3 mCi, respectively. A significant visual decrease in count number was considered to be electromagnetic interference (EMI). RESULTS: The percentage of induced EMI with the γ-camera per mobile phone was in the range of 0% to 100%. The incidence of EMI was mainly observed in the first seconds of ringing and then mitigated in the following frames. CONCLUSIONS: Mobile phones are portable sources of electromagnetic radiation, and there is interference potential with the function of SPECT γ-cameras leading to adverse effects on the quality of the acquired images.

Assessment of radioiodine clearance in patients with differentiated thyroid cancer.

Radioiodine ((131)I iodide) has long been a safe, effective and widely used treatment in the management of differentiated thyroid cancer (DTC). Concerns regarding stochastic radiogenic risks have led to regulatory criteria for the release from medical confinement of patients who receive such radionuclide therapy. Over a 6-y period, the external whole-body dose rates at 1 m from 562 DTC patients were measured with an ionisation chamber calibrated in microsieverts per hour out to 5-d post-administration. Patients were stratified into four administered activity groups: 3.7 GBq (36.8 %), 5.55 GBq (47.3 %), 7.4 GBq (12.8 %) and 9.25 GBq (3 %). Consistent with previously published data, the current study demonstrated that a bi-phasic model accurately described (131)I-iodide kinetics up to at least 5-d post-administration in DTC patients, providing data that would be useful in formulating radiation safety guidelines for staff and other individuals coming into contact with such patients after treatment.

Role of 99mTc-ubiquicidin 29-41 scintigraphy to monitor antibiotic therapy in patients with orthopedic infection: a preliminary study.

INTRODUCTION: Ubiquicidin (UBI) 29-41 is a cationic synthetic antimicrobial peptide fragment that binds preferentially with anionic microbial cell membranes at the site of infection. This study evaluated the potential ability of Tc-UBI 29-41 to assess response to antibiotic therapy in orthopedic infection. METHODS: A total of 12 patients, 10 men and two women (mean age, 41.6 years; range, 23-75 years), with suspected orthopedic infection (bone, soft tissue, or prosthesis) and positive Tc-UBI scan for infection were included in the study. One day after the Tc-UBI scan, a bone scan was performed as well. After this evaluation, eight of the nine treated cases responded to the treatment. Then, one nonresponder patient and two nontreated patients of three cases underwent antibiotic therapy and were evaluated again 10-14 days later. After this, one of the two patients not treated the first time responded to therapy and two patients did not. Moreover, one patient refused to undergo therapy both the first and second time. Thus, 11 treated cases were analyzed in this study and divided in two groups: (a) nine treated responders and (b) two treated nonresponders. In all patients, erythrocyte sedimentation rate and C-reactive protein were measured and also wound cultures were assessed. RESULTS: Quantitative analysis of erythrocyte sedimentation rate, C-reactive protein, and bone scan before and after the 10-14-day interval showed no significant change in either group, but a quantitative Tc-UBI scan at 30, 60, and 120 min after tracer injection indicated significant reduction in radiotracer uptake after the 10-14-day interval compared with the Tc-UBI scan before this interval in the responder group, and no significant change in the nonresponder group. CONCLUSION: The Tc-UBI scan can determine response to antibiotic therapy in orthopedic infection in humans.