Abdominal lymph node metastasis by lymphatic spread through the thoracic duct in patients with non-small-cell lung cancer.

BACKGROUND: Abdominal lymph node metastasis (ALNM) is common in patients with metastatic non-small-cell lung cancer (NSCLC). However, its mechanism of spread remains to be elucidated. We investigated whether thoracic duct has the role as a pathway for ALNM in NSCLC using clinical data. METHODS: We classified ALNM into subgroups by their location and evaluated its prevalence and association with clinical characteristics in 892 patients with metastatic NSCLC. The abdominal lymph nodes were classified into direct or indirect groups depending on whether they drain directly into the trunk (intestinal trunk or lumbar trunks) connected to the cisterna chyli. RESULTS: One hundred-five patients (11.8%) had ALNM. The paraaortic lymph node was most commonly involved, followed by the aortocaval, left gastric, paracaval, and celiac lymph nodes. After grouping the patients by location of ALNM, 56 patients (53.3%) with ALNM were in the "direct only" group, only seven patients (6.7%) were in the "indirect only" group, and 42 patients (40.0%) were in "both" groups. In patients whose intrathoracic lesions were limited to the right thorax, there was a significantly lower prevalence of ALNM (3.4% vs. 14.3%, p < 0.001). On multivariate logistic regression analysis of clinical variables, higher N category was associated with increased risk of ALNM. CONCLUSIONS: This study suggests that the thoracic duct is one of the potential routes of lymphatic spread to the abdominal lymph nodes. Clinicians should assess for the presence of ALNM during staging work-up and follow-up for NSCLC patients with intrathoracic lesion in left thorax and with high N category.

Age dependency of mGluR5 availability in 5xFAD mice measured by PET.

The major pathologies of Alzheimer's disease (AD) are amyloid plaques and hyperphosphorylated tau. The deposition of amyloid plaques leads to synaptic dysfunction, neuronal cell death, and cognitive impairment. Among the neurotransmitters, glutamate is the most abundant in the mammalian brain and plays an important role in synaptic plasticity. With respect to synaptic transmission, metabotropic glutamate receptor 5 (mGluR5) is highly affected by amyloid pathology. However, the neuropathologic changes in the protein expression of mGluR5 in AD remain unclear. Therefore, to elucidate the alteration in mGluR5 expression with the progression of AD, we performed serial behavioral tests, longitudinal imaging studies, and histopathological immunoassay for both 5xFAD (n = 14) mice and age-matched wild-type mice (n = 14). The 5xFAD mice started showing severe hyperactivity and memory impairment from 7 months of age. In addition, mGluR5 positron emission tomography revealed that while the binding values in the wild-type mice were similar over time, those in 5xFAD mice fluctuated from 5 months of age. Furthermore, the 5xFAD mice presented a 35% decrease in the binding values of their cortical and subcortical areas at 9 months of age compared with those at 3 months of age. Magnetic resonance spectroscopy and histopathological studies showed similar changes. In conclusion, mGluR5 availability changes with age, and mGluR5 positron emission tomography could successfully detect this synaptic change in the 5xFAD mice.

Characteristics, trend, and methodological quality of systematic reviews and meta-analyses in nuclear medicine: A bibliometric analysis of studies published between 2005 and 2016.

To evaluate the characteristics, trend, and quality of systematic reviews and meta-analyses in nuclear medicine.We performed a PubMed search to identify systematic reviews and meta-analyses published between 2005 and 2016 in the field of nuclear medicine. The following data were extracted: journal name, impact factor, type of study, topics with cancer type, imaging modalities, authors (number, country, affiliation, presence of nuclear medicine specialists and statisticians, discordance between the first and corresponding authors), funding, methodological quality, methods used for quality assessment, and statistical methods.We included 185 nuclear medicine articles. Meta-analyses (n = 164; 88.6%) were published about 7 times more frequently than systematic reviews. Oncology was the most commonly studied topic (n = 125, 67.6%). The first authors were most frequently located in China (n = 73; 39.5%). PET was the most commonly used modality (n = 150; 81.1%). Both the number of authors and the ratio of discordance between the first and corresponding authors tended to progressively increase over time.The mean AMSTAR score increased over time (5.77 in 2005-2008, 6.71 in 2009-2012, and 7.44 in 2013-2016). The proportion of articles with quality assessment increased significantly (20/26 in 2005-2008, 54/65 in 2009-2012, and 79/94 in 2013-2016). The most commonly used assessment tool was quality assessment of diagnostic accuracy studies (n = 85; 54.9%).The number and quality of systematic reviews and meta-analyses in nuclear medicine have significantly increased over the review period; however, the quality of these articles varies. Efforts to overcome specific weaknesses of the methodologies can provide opportunities for quality improvement.

The Role of SPECT/CT of Foot and Ankle in the Evaluation of Heel Pain.

Heel pain is a common symptom in foot and ankle disorders. Typical heel pain can be assessed according to the patient's history and the location of pain. In some atypical inconclusive cases, bone SPECT/CT is the upcoming imaging modality for the detection of causes of heel pain. We present the case of 57-year-old man with atypical heel pain, plantar and Achilles spurs. SPECT/CT images demonstrated increased bony activity in arthritis of midfoot, not plantar and Achilles spurs. It suggests potential role of SPECT/CT in the evaluation and management of heel pain by showing hidden pathology of foot and ankle.

Intense 18F-FDG activity in aortoiliac bypass graft mimicking infection: A case report.

RATIONALE: F-fluorodeoxyglucose (F-FDG) positron emission tomography/computed tomography (PET/CT) has the potential to become an important imaging tool for the diagnosis of suspected aortoiliac bypass graft infection (AGI). PATIENT CONCERNS: A 76-year-old man presented with incidental findings of intense F-FDG activity in previous operation site of aortobiiliac bypass graft in the initial staging of small cell lung cancer (SCLC). DIAGNOSES: Based on F-FDG PET/CT examination, preliminary differential diagnosis was AGI. INTERVENTIONS: We performed laboratory tests and Galliun-citrate (Ga) single photon emission computed tomography/computed tomography (SPECT/CT). OUTCOMES: He had no constitutional symptoms and abnormal laboratory test results suggesting AGI. CT scan of the abdomen and pelvis showed no abnormal findings. Also, Ga planar scintigraphy and SPECT/CT imaging of the abdomen and pelvis failed to show abnormal Ga uptake in the same site of aortobiiliac bypass graft with F-FDG uptake. LESSONS: We present a case with postoperative inflammatory aortobiiliac bypass graft which was misdiagnosed as AGI based on intense F-FDG activity seen at PET/CT imaging.

Aß pathology downregulates brain mGluR5 density in a mouse model of Alzheimer.

The aim of the present study was to evaluate functional changes of mGluR5 expression in advanced Alzheimer's disease (AD) using positron emission tomography (PET) with an mGluR5 specific radiotracer ([18F]FPEB) in 5xFAD AD model. Subsequently, in the same animal, mGluR5 expression was quantified by immunoassay techniques. The non-displaceable binding potential values for mGluR5 was estimated by the Logan's graphical analysis. Brain PET imaging revealed that radioactivities in the hippocampus and the striatum were significantly lower in 5xFAD mice compared to control animals. Binding values were also significantly lowered in 5xFAD mice. This decline was validated by immunoblotting of protein isolates from brain tissues, as the mean band density for 5xFAD mice had a lower mGluR5 intensity than for wild type mice. These results indicated that mGluR5 levels in 5xFAD mice were down regulated in the limbic system.

Salivary gland function after sialendoscopy for treatment of chronic radioiodine-induced sialadenitis.

BACKGROUND: The purpose of this study was to determine whether sialendoscopy could ameliorate radioactive iodine-induced obstructive sialadenitis and restore the salivary gland dysfunction in recalcitrant radioactive iodine sialadenitis. METHODS: Ten patients with 15 parotid glands of chronic radioactive iodine sialadenitis who did not respond to medical treatment were enrolled in this prospective study. We assessed subjective symptom scores and evaluated the objective salivary gland functions before and 3 months after sialendoscopy. RESULTS: The post-sialendoscopic obstructive symptoms were significantly improved relative to pre-sialendoscopy (p = .009). Xerostomia-related symptom scores post-sialendoscopy did not differ significantly from the pre-sialendoscopy scores. Stimulated salivary flow rate post-sialendoscopy tended to increase relative to pre-sialendoscopy. No pre-sialendoscopic parameters associated with salivary uptake and secretion by salivary gland scintigraphy were significantly improved post-sialendoscopy. CONCLUSION: These results show that sialendoscopy can improve obstructive symptoms; however, it seems to have some limitations for relief of xerostomia and improvement of salivary gland dysfunctions in recalcitrant chronic radioactive iodine sialadenitis.

The usefulness of combined axial and coronal computed tomography for the evaluation of metastatic supraclavicular lymph nodes.

The purpose is to assess the value of adding coronal images for the identification of metastatic supraclavicular lymph nodes (LNs). Two radiologists reviewed axial images and combined axial and coronal images using thoracic computed tomography (CT) of 386 patients whose maximum standardized uptake value measured in a supraclavicular LN was ≥2.0 on a positron emission tomography. We compared sensitivity and agreement between readers before and after the addition of coronal images. For combined images, agreement was almost perfect (κ=0.982), and sensitivity was significantly higher (90.4%, P<.001). Interpreting both axial and coronal images improves the diagnostic accuracy for supraclavicular metastasis.

Effects of Salivary Secretion Stimulation on the Treatment of Chronic Radioactive Iodine-Induced Sialadenitis.

BACKGROUND: The aim of this prospective study was to investigate the effect of salivary stimulation therapy using pilocarpine (a cholinergic agent) on chronic radioactive iodine (RAI)-induced sialadenitis. METHODS: Sixty-one patients with a diagnosis of chronic RAI-induced sialadenitis after thyroidectomy and RAI therapy were enrolled in this prospective study. Patients received salivary stimulation therapy with pilocarpine (5 mg, 3 times daily) over a 3-month period. Subjective symptom scores were assessed using self-reported questionnaires. Salivary flow rates (SFRs) were measured and salivary gland scintigraphy (SGS) was performed to evaluate objective salivary gland functions. RESULTS: After salivary stimulation therapy, subjective symptom scores were significantly improved (p=0.002), but posttreatment unstimulated and stimulated SFRs did not differ significantly from pretreatment values. SGS parameters, that is, uptake ratio (UR), maximum accumulation (MA), Tmin, and maximum secretion (MS) of parotid and submandibular glands were nonsignificantly different after salivary stimulation therapy. CONCLUSION: The study shows that salivary stimulation therapy may reduce the subjective symptoms of RAI-induced chronic sialadenitis but does not significantly induce functional restoration.

Chronic bacterial seminal vesiculitis as a potential disease entity in men with chronic prostatitis.

OBJECTIVES: To investigate bacterial infection in the seminal vesicles by bacteriological examination and radionuclide imaging in men with chronic prostatitis. METHODS: The study included 50 patients with chronic prostatitis who showed hot uptake in seminal vesicles on Tc-99m ciprofloxacin imaging and eight patients who did not show hot uptake. The evaluation included the National Institutes of Health Chronic Prostatitis Symptom Index and four-glass test. In all participants, transperineal aspiration of seminal vesicle fluid under the guidance of transrectal ultrasonography and bacteriological examination was carried out. RESULTS: Of the 50 patients who showed hot uptake in the seminal vesicles on the isotope study, microorganisms were isolated from the seminal vesicle fluid in 17 patients (positive predictive value, 34%). The most common causative organisms were Escherichia coli in 13 patients (26%), followed by coagulase-negative Staphylococcus species in two patients (4%), Enterococcus faecalis in one patient (2%) and Chlamydia trachomatis in one patient (2%). No microorganisms were isolated in the eight patients who did not show hot uptake in the seminal vesicles (negative predictive value, 100%). However, there were no significant differences in National Institutes of Health Chronic Prostatitis Symptom Index total scores and subscores between the study groups. CONCLUSIONS: Chronic bacterial seminal vesiculitis might simultaneously affect a considerable portion of patients with chronic prostatitis, although the clinical implication of the disease remains to be further investigated.

67Ga SPECT/CT of infected bladder stones and pyelitis.

A 64-year-old male patient diagnosed with amyotrophic lateral sclerosis 2 years ago was admitted with fever and chills. The patient had complex medical history and several indwelling catheters/tubes in his body. To identify the infection focus, 67Ga whole-body scintigraphy and SPECT/CT were obtained. 67Ga whole-body scintigraphy demonstrated focal 67Ga uptake in the lower pelvic cavity and the right kidney. Additional Ga SPECT/CT images were obtained, and it enabled characterization of these uptakes as infection of bladder stones that result in pyelitis.

Detection of an Infected N-butyl-2-cyanoacrylate Plug by F-18 FDG PET/CT Scan in a Patient Who Received Endoscopic Intervention for Gastric Variceal Bleeding.

Injection of N-butyl-2-cyanoacrylate has been used successfully for treatment of gastric variceal bleeding. Bacteremia after injection of N-butyl-2-cyanoacrylate is well known, however, the method for diagnosis of infected endovascular injected material has remained uncertain. This is the first case reporting use of F-18 FDG PET/CT in detection of the source of infection after control of endoscopic bleeding with N-butyl-2-cyanoacrylate.

Diagnosis and follow-up of chronic bacterial prostatitis with recurrent urinary tract infection detected by 67Ga scintigraphy and SPECT/CT.

Half of male populations will have symptoms and signs of prostatitis in their lifetime. There is controversy concerning diagnosis of prostatitis with (67)Ga scintigraphy because the focal midline pelvic uptake is usually considered to be physiologic uptake in colon. The authors describe (67)Ga scintigraphy and SPECT/CT findings of a 58-year-old man with right flank pain and fever. The examination demonstrated abnormal uptake of Ga within the prostate and right kidney upper pole, suggesting prostatitis and acute pyelonephritis (APN) contemporary. After completion of antibiotic treatment, follow-up scintigraphy and SPECT/CT showed complete resolution of APN, but uptake remained within the prostate.

Case of uterine leiomyoma showing fludeoxyglucose uptake on F-18 fludeoxyglucose positron emission tomography/computed tomography.

In order not to over treat uterine leiomyoma and to avoid overlooking uterine leiomyosarcoma, a highly reliable diagnostic method has been thought. Occasionally, it is difficult to discriminate uterine leiomyoma from uterine leiomyosarcoma. Recently positron emission tomography/computed tomography (PET/CT) has been proved useful in assessing pelvic malignancies. We experienced a case of uterine leiomyoma showing increased F-18 fludeoxyglucose uptake on PET/CT in a postmenopausal woman. However, histological analysis demonstrated benign leiomyoma by the hysterectomy. Immunohistochemical analysis of glucose transporter-1 showed negative in leiomyoma. Our case indicates that uterine leiomyoma in a postmenopausal woman may show false positive result of PET/CT.

Diagnosis of Raynaud's phenomenon by (99m)Tc-hydroxymethylene diphosphonate digital blood flow scintigraphy after one-hand chilling.

OBJECTIVE: We introduce the use of (99m)Tc-hydroxymethylene diphosphonate (HDP) digital blood flow scintigraphy to diagnose Raynaud's phenomenon (RP). METHODS: Fifty-seven patients with RP and 60 healthy controls were recruited. One hand was chilled by immersion into water at 4 degrees C, and then an intravenous bolus of 740 MBq of (99m)Tc-HDP was injected. The radioactivity from the second to the fifth fingers of both hands was recorded. Acquisition was performed at a rate of one frame per 2 seconds until 155 frames. We calculated 4 ratios by comparing the activity curves of the chilled hand with those of the ambient hand. RESULTS: The chilled to ambient hand ratio of the initial slope was significantly lower in the patients with RP (0.28 +/- 0.18) than in the controls (0.78 +/- 0.20) (p < 0.001). The chilled to ambient hand ratio of the first peak height, 30-second area under the curve, and blood pool uptake were also lower in the patients with RP than in controls (p < 0.001 for each). The initial slope ratio of 0.51, used as a cutoff value, showed a sensitivity of 91.2% and specificity of 93.3%. The loss of the initial spike curve, the presence of a slowly progressing radioactivity curve, and the inhomogeneous radioactivity uptake in the blood pool image in either hand were characteristic findings of the patients with RP (p < 0.001). CONCLUSION: (99m)Tc-HDP digital blood flow scintigraphy after one-hand chilling is a noninvasive, accurate, and quantitative method to evaluate RP.

F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to Salmonella.

Mycotic aneurysm is a rare and life-threatening disorder. Computed tomography (CT) is considered to be the best diagnostic imaging modality that can detect an abdominal aortic aneurysm and changes in the surrounding structures. More recently, F-18 fluorodeoxyglucose (FDG) PET would seem to hold promise for the diagnosis of focal infection and during the follow-up after antibiotic treatment. We present a case of an infected abdominal aortic aneurysm due to Salmonella enteritidis. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of the infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution for monitoring response to antibiotic therapy.