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BACKGROUND: Widespread use and misuse of antibiotics have led to a dramatic increase in the emergence of antibiotic resistant bacteria, while the discovery and development of new antibiotics is declining. This has made certain implant-associated infections such as periprosthetic joint infections, where a biofilm is formed, very difficult to treat. Alternative treatment modalities are needed to treat these types of infections in the future. One candidate that has been used extensively in the past, is the use of ionizing radiation. This review aims to provide a historical overview and future perspective of radiation therapy in infectious diseases with a focus on orthopedic infections. METHODS: A systematic search strategy was designed to select studies that used radiation as treatment for bacterial or fungal infections. A total of 216 potentially relevant full-text publications were independently reviewed, of which 182 focused on external radiation and 34 on internal radiation. Due to the large number of studies, several topics were chosen. The main advantages, disadvantages, limitations, and implications of radiation treatment for infections were discussed. RESULTS: In the pre-antibiotic era, high mortality rates were seen in different infections such as pneumonia, gas gangrene and otitis media. In some cases, external radiation therapy decreased the mortality significantly but long-term follow-up of the patients was often not performed so long term radiation effects, as well as potential increased risk of malignancies could not be investigated. Internal radiation using alpha and beta emitting radionuclides show great promise in treating fungal and bacterial infections when combined with selective targeting through antibodies, thus minimizing possible collateral damage to healthy tissue. CONCLUSION: The novel prospects of radiation treatment strategies against planktonic and biofilm-related microbial infections seem feasible and are worth investigating further. However, potential risks involving radiation treatment must be considered in each individual patient.
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Bacterias/efectos de la radiación , Infecciones Bacterianas/radioterapia , Biopelículas/efectos de la radiación , Radiación Ionizante , Antibacterianos/efectos adversos , Infecciones Bacterianas/microbiología , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Radioterapia/historia , Radioterapia/tendenciasRESUMEN
BACKGROUND: Implant associated infections such as periprosthetic joint infections are difficult to treat as the bacteria form a biofilm on the prosthetic material. This biofilm complicates surgical and antibiotic treatment. With rising antibiotic resistance, alternative treatment options are needed to treat these infections in the future. The aim of this article is to provide proof-of-principle data required for further development of radioimmunotherapy for non-invasive treatment of implant associated infections. METHODS: Planktonic cells and biofilms of Methicillin-resistant staphylococcus aureus are grown and treated with radioimmunotherapy. The monoclonal antibodies used, target wall teichoic acids that are cell and biofilm specific. Three different radionuclides in different doses were used. Viability and metabolic activity of the bacterial cells and biofilms were measured by CFU dilution and XTT reduction. RESULTS: Alpha-RIT with Bismuth-213 showed significant and dose dependent killing in both planktonic MRSA and biofilm. When planktonic bacteria were treated with 370 kBq of 213Bi-RIT 99% of the bacteria were killed. Complete killing of the bacteria in the biofilm was seen at 185 kBq. Beta-RIT with Lutetium-177 and Actinium-225 showed little to no significant killing. CONCLUSION: Our results demonstrate the ability of specific antibodies loaded with an alpha-emitter Bismuth-213 to selectively kill staphylococcus aureus cells in vitro in both planktonic and biofilm state. RIT could therefore be a potentially alternative treatment modality against planktonic and biofilm-related microbial infections.
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Staphylococcus aureus Resistente a Meticilina , Infecciones Relacionadas con Prótesis/radioterapia , Radioinmunoterapia , Infecciones Estafilocócicas/radioterapia , Actinio/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Biopelículas/crecimiento & desarrollo , Biopelículas/efectos de la radiación , Bismuto/uso terapéutico , Humanos , Técnicas In Vitro , Lutecio/uso terapéutico , Staphylococcus aureus Resistente a Meticilina/inmunología , Staphylococcus aureus Resistente a Meticilina/efectos de la radiación , Plancton/crecimiento & desarrollo , Plancton/efectos de la radiación , Prueba de Estudio Conceptual , Radioisótopos/uso terapéutico , Ácidos Teicoicos/inmunologíaRESUMEN
INTRODUCTION: Adequate suppression of physiologic myocardial glucose uptake is important to ensure the interpretability and diagnostic reliability of [18F]fluorodeoxyglucose (FDG) PET/CT studies performed in the context of cardiac inflammation and infection. This study describes our experience with 4 preparatory protocols used in our institution. METHODS: FDG PET/CT scans were performed according to 4 preparatory protocols (716 scans total), i.e. 6-h fast (group 1), low-carbohydrate diet plus 12-h fast (group 2), low-carbohydrate diet plus 12-h fast plus intravenous heparin pre-administration (15 IU/kg) (group 3), and low-carbohydrate diet plus 12-h fast plus intravenous heparin pre-administration (50 IU/kg) (group 4). Consecutive scans were retrospectively included from time frames during which the particular protocol was used. FDG uptake in normal myocardium was scored on a scale ranging from 0 (uptake less than that in the left ventricular blood pool) to 4 (diffuse uptake greater than that in the liver). Complete suppression was defined as uptake less than or equal to the blood pool (scores 0-1). RESULTS: Complete suppression was accomplished in 27% in group 1, 68% in group 2, 69% in group 3 and 81% in group 4. Complete suppression was significantly lower in group 1 compared with all other groups (P < 0.0001 for all comparisons) and significantly higher in group 4 compared with group 2 (P = 0.005) and group 3 (P = 0.007). Groups 2 and 3 did not differ significantly (P = 0.92). CONCLUSION: A total of 50 IU/kg single-dose heparin administration before FDG PET/CT in addition to a low-carbohydrate diet and prolonged fast significantly outperformed protocols with no or lower dose (15 IU/kg) heparin in completely suppressing myocardial glucose metabolism.
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Fluorodesoxiglucosa F18 , Tomografía Computarizada por Tomografía de Emisión de Positrones , Glucosa , Heparina , Humanos , Miocardio , Radiofármacos , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
INTRODUCTION: (188)Rhenium-HEDP is an effective bone-targeting therapeutic radiopharmaceutical, for treatment of osteoblastic bone metastases. It is known that the presence of carrier (non-radioactive rhenium as ammonium perrhenate) in the reaction mixture during labeling is a prerequisite for adequate bone affinity, but little is known about the optimal carrier concentration. METHODS: We investigated the influence of carrier concentration in the formulation on the radiochemical purity, in-vitro hydroxyapatite affinity and the in-vivo bone accumulation of (188)Rhenium-HEDP in mice. RESULTS: The carrier concentration influenced hydroxyapatite binding in-vitro as well as bone accumulation in-vivo. Variation in hydroxyapatite binding with various carrier concentrations seemed to be mainly driven by variation in radiochemical purity. The in-vivo bone accumulation appeared to be more complex: satisfactory radiochemical purity and hydroxyapatite affinity did not necessarily predict acceptable bio-distribution of (188)Rhenium-HEDP. CONCLUSIONS: For development of new bisphosphonate-based radiopharmaceuticals for clinical use, human administration should not be performed without previous animal bio-distribution experiments. Furthermore, our clinical formulation of (188)Rhenium-HEDP, containing 10 µmol carrier, showed excellent bone accumulation that was comparable to other bisphosphonate-based radiopharmaceuticals, with no apparent uptake in other organs. ADVANCES IN KNOWLEDGE: Radiochemical purity and in-vitro hydroxyapatite binding are not necessarily predictive of bone accumulation of (188)Rhenium-HEDP in-vivo. IMPLICATIONS FOR PATIENT CARE: The formulation for (188)Rhenium-HEDP as developed by us for clinical use exhibits excellent bone uptake and variation in carrier concentration during preparation of this radiopharmaceutical should be avoided.
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Durapatita/química , Ácido Etidrónico/química , Radioquímica/métodos , Radioisótopos/química , Radiofármacos/química , Renio/química , Animales , Huesos/metabolismo , Durapatita/farmacocinética , Durapatita/uso terapéutico , Ácido Etidrónico/farmacocinética , Ácido Etidrónico/uso terapéutico , Masculino , Ratones , Ratones Endogámicos C57BL , Radiofármacos/farmacocinética , Radiofármacos/uso terapéutico , Distribución TisularRESUMEN
BACKGROUND: This study aimed to systematically review and meta-analyze published data on the diagnostic performance of (18)F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting bone marrow involvement in newly diagnosed Hodgkin lymphoma, and to determine whether FDG-PET/CT can replace blind bone marrow biopsy (BMB) in these patients. PATIENTS AND METHODS: The PubMed/Medline and Embase databases were systematically searched for relevant studies. Methodological quality of each study was assessed. Sensitivities and specificities of FDG-PET/CT in individual studies were calculated and underwent meta-analysis with a random effects model. A summary receiver operating characteristic curve (sROC) was constructed with the Moses-Shapiro-Littenberg method. The weighted summary proportion of FDG-PET/CT-negative patients with a positive BMB among all cases was calculated under the fixed effects model. RESULTS: Nine eligible studies, comprising a total of 955 patients with newly diagnosed Hodgkin lymphoma, were included. Overall, the studies were of moderate methodological quality. The sensitivity and specificity of FDG-PET/CT for the detection of bone marrow involvement ranged from 87.5% to 100% and from 86.7% to 100%, respectively, with pooled estimates of 96.9% [95% confidence interval (CI) 93.0% to 99.0%] and 99.7% (95% CI 98.9% to 100%), respectively. The area under the sROC curve was 0.9860. The weighted summary proportion of FDG-PET/CT-negative patients with a positive BMB among all cases was 1.1% (95% CI 0.6% to 2.0%). CONCLUSION: Although the methodological quality of studies that were included in this systematic review and meta-analysis was moderate, the current evidence suggests that FDG-PET/CT may be an appropriate method to replace BMB in newly diagnosed Hodgkin lymphoma.
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Neoplasias de la Médula Ósea/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/diagnóstico por imagen , Radiofármacos , Biopsia , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Neoplasias de la Médula Ósea/secundario , Enfermedad de Hodgkin/patología , Humanos , Tomografía de Emisión de Positrones , Curva ROC , Tomografía Computarizada por Rayos XRESUMEN
In patients with suspicion of lung malignancy, FDG PET/CT is frequently used as a diagnostic and staging imaging modality. However, false positive findings are not uncommon. We demonstrate a case with FDG-avid pulmonary nodules, mimicking lung cancer. After histopathological examination they appeared to be the result of persistent inflamed tissue, due to talcage pleurodesis, which occurred 48 years ago. We concluded that, nearly five decades after talcage pleurodesis, there can still be an ongoing inflammation reaction in the pleurae, which can be detected by FDG PET/CT.
RESUMEN
OBJECTIVE: To quantify radiation exposure and mortality risk from computed tomography (CT) and positron emission tomography (PET) imaging with (18)F-fluorodeoxyglucose ((18)F-FDG) in patients with malignant lymphoma (Hodgkin's disease [HD] or non-Hodgkin's lymphoma [NHL]). METHODS: First, organ doses were assessed for a typical diagnostic work-up in children with HD and adults with NHL. Subsequently, life tables were constructed for assessment of radiation risks, also taking into account the disease-related mortality. RESULTS: In children with HD, cumulative effective dose from medical imaging ranged from 66 mSv (newborn) to 113 mSv (15 years old). In adults with NHL the cumulative effective dose from medical imaging was 97 mSv. Average fractions of radiation-induced deaths for children with HD [without correction for disease-related mortality in brackets] were 0.4% [0.6%] for boys and 0.7% [1.1%] for girls, and for adults with NHL 0.07% [0.28%] for men and 0.09% [0.37%] for women. CONCLUSION: Taking into account the disease-related reduction in life expectancy of patients with malignant lymphoma results in a higher overall mortality but substantial lower incidence of radiation induced deaths. The modest radiation risk that results from imaging with CT and (18)F-FDG PET can be considered as justified, but imaging should be performed with care, especially in children.
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Linfoma/diagnóstico , Linfoma/mortalidad , Tomografía de Emisión de Positrones/mortalidad , Modelos de Riesgos Proporcionales , Radiometría/estadística & datos numéricos , Tomografía Computarizada por Rayos X/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Femenino , Enfermedad de Hodgkin/diagnóstico , Enfermedad de Hodgkin/mortalidad , Humanos , Incidencia , Lactante , Recién Nacido , Esperanza de Vida , Tablas de Vida , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Dosis de Radiación , Traumatismos por Radiación/mortalidad , Medición de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Adulto JovenRESUMEN
UNLABELLED: Measurements of thyroglobulin (Tg) levels 72 h after administration of recombinant human thyrotropin (rhTSH) are recommended by the manufacturer in the follow-up of patients with differentiated thyroid carcinoma (DTC). In our department, Tg measurements are performed both 24 h and 72 h after administration of rhTSH, together with 72 h post rhTSH 131I whole body scintigraphy (WBS). The OBJECTIVE of this study is to compare the diagnostic usefulness of Tg measurements 24 and 72 h after rhTSH administration, and 131I WBS. PATIENTS AND METHODS: 181 patients were included who had been referred to our Nuclear Medicine Department for follow-up after 131I ablation of DTC. Tg measurements 24 h (Tg24) and 72 h (Tg72) after rhTSH, and 131I WBS, were done in all patients. The lower detection limit of Tg was 0,2 microg/l. RESULTS: 47 patients (26%) had detectable Tg levels: in 4/47 cases (8%) only Tg24 was detectable (always <1 microg/l), and in 6/47 cases (11%), only Tg72 was detectable. In 10/47 patients with detectable Tg-levels, Tg24 and Tg72 tested equally. In 27/47 cases, Tg24 was lower, and in 10/47 higher, than Tg72. Two patients with one or two positive Tg-test results also had a positive 131I WBS. In 8 patients (14%) only the 131I WBS was positive; an anatomical substrate for such a Tg-negative positive WBS was confirmed in only 2 patients. CONCLUSION: Tg-measurement 72 hours after rhTSH injection reveals all clinically relevant detectable Tg-levels. Diagnostic 131I scintigraphy may be omitted, even in high-risk patients.
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Radioisótopos de Yodo , Proteínas Recombinantes/farmacología , Tiroglobulina/sangre , Tirotropina/farmacología , Carcinoma Papilar/sangre , Carcinoma Papilar/cirugía , Femenino , Humanos , Masculino , Proteínas Recombinantes/administración & dosificación , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/cirugía , Tirotropina/administración & dosificación , Tiroxina/uso terapéuticoRESUMEN
UNLABELLED: The radiation exposure to bystanders from 89SrCl2, 186Re-HEDP and 153Sm-EDTMP, is generally thought to be caused by "bremsstrahlung" and gamma-radiation, with negligible contribution from beta-radiation. The latter assumption may be erroneous. The aim of this prospective study was the investigation of radiation safety after treatment with these radiopharmaceuticals. The radiation field around treated patients was characterized and the magnitude estimated. PATIENTS, METHODS: 33 patients (30 prostate carcinoma, 3 breast carcinoma) were treated with 150 MBq 89SrCl2 (9 patients), 1295 MBq 186Re-HEDP (12 patients) or 37 MBq/kg 153Sm-EDTMP (12 patients). External exposure rates at 30 cm from the patient were measured at times 0 to 72 h post-injection. To evaluate the respective contribution of Bremsstrahlung, beta- and gamma-radiation, a calibrated survey meter was used, equipped with a shutter. For each patient, the measured exposure rate-versus-time data were fit to a curve and the curve integrated (area under the curve) to estimate the total exposure. RESULTS: For 29/33 patients the total ambient equivalent doses (mean+/-1 standard deviation [SD]) based on the integral of the fitted curve were 2.1+/-1.2 mSv for 89SrCl2, 3.3+/-0.6 mSv for 186Re-HEDP and 2.8+/-0.6 mSv for 153Sm-EDTMP. Beta-radiation contributes significantly to these doses (>99% for 89SrCl2, 87% for 186Re-HEDP and 27% for 153Sm-EDTMP). The effective doses (at 30 cm) are <0.1 mSv for 89SrCl2, 0.3 mSv for 186Re-HEDP and 1.6 mSv for 153Sm-EDTMP. CONCLUSION: Patients treated with 89SrCl2, 186Re-HEDP or 153Sm-EDTMP emit a spectrum of radiation, including non-negligible beta-radiation. With specific instructions effective doses to bystanders are acceptable.
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Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Huesos/efectos de la radiación , Neoplasias de la Mama/radioterapia , Metástasis de la Neoplasia/radioterapia , Compuestos Organometálicos/efectos adversos , Compuestos Organofosforados/efectos adversos , Neoplasias de la Próstata/radioterapia , Traumatismos por Radiación/prevención & control , Radioisótopos/efectos adversos , Renio/efectos adversos , Seguridad , Radioisótopos de Estroncio/efectos adversos , Estroncio/efectos adversos , Adulto , Anciano , Ácido Etidrónico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/patología , Samario/efectos adversosRESUMEN
UNLABELLED: Radioiodine plays an important role in the treatment of thyroid cancer. It is used for thyroid remnant ablation as well as for treatment of metastatic disease. Despite the fact that it is used all over the world for these indications, the exact administered dose is still a subject for DISCUSSION: Two methods are widely available: the so-called fixed empiric method and the dosimetric one. This review will highlight the aspects of radioiodine in treatment of thyroid cancer and discuss the advantages and disadvantages of the several methods for the calculation of the administered dose.
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Carcinoma/secundario , Radioisótopos de Yodo/uso terapéutico , Radiofármacos/uso terapéutico , Neoplasias de la Tiroides/secundario , Adulto , Anciano , Carcinoma/radioterapia , Carcinoma/cirugía , Femenino , Humanos , Hipotiroidismo/inducido químicamente , Radioisótopos de Yodo/administración & dosificación , Radioisótopos de Yodo/efectos adversos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/radioterapia , Neoplasia Residual/radioterapia , Radiometría , Radiofármacos/administración & dosificación , Radiofármacos/efectos adversos , Dosificación Radioterapéutica , Radioterapia Adyuvante , Proteínas Recombinantes/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Tirotropina/administración & dosificación , Tirotropina/uso terapéuticoRESUMEN
AIM: The aim of this study was to assess the efficacy of treatment of patients with papillary thyroid carcinoma (PTC) and lymph node metastases at the time of diagnosis and its influence on the course of the disease. METHODS: It is a retrospective review of all 51 patients with PTC and histologically proven lymph node metastases treated with I-131 ablation in our center between January 1990 and January 2003. Patients were considered disease-free if during follow-up thyroglobulin levels were undetectable and scintigraphy with 370 MBq (131)I was negative during thyroid-stimulating hormone stimulation. Staging of patients was in accordance with the 5th edition of the TNM system. RESULTS: After a median follow-up of 84 months, 33 (65%) patients were never free of detectable disease; and 3 of these patients had died of the PTC. In total, 22 patients still showed persistent activity in the neck outside the thyroid bed, which was suspect to be cervical lymph node metastasis on postablation scintigraphy; it was not related to the initial clinical presentation (lymph node metastasis or a thyroid nodule without suspicion of metastatic disease) or to the extent of surgery. Altogether, 34 patients required additional treatment. Patients presenting with clinically overt lymph node metastasis showed a significantly (p = 0.022) lower rate of becoming disease-free than those in whom microscopic lymph node involvement was unexpectedly found upon pathologic examination. There was no significant association of the eventual outcome with the extent of surgical treatment, TNM staging, or age. CONCLUSIONS: Patients with lymph node metastasis are considerably less likely to become disease-free. If the initial treatment does not result in a disease-free status, chances are low that additional treatment will succeed in achieving it.
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Adenocarcinoma Papilar/radioterapia , Adenocarcinoma Papilar/cirugía , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Adenocarcinoma Papilar/patología , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Radioterapia Adyuvante , Estudios Retrospectivos , Neoplasias de la Tiroides/patología , Tiroidectomía , Resultado del TratamientoRESUMEN
Differentiated thyroid carcinoma is a rare disease. Appropriate diagnosis, treatment and follow-up are complex but greatly influence treatment outcomes and patient quality of life. Patients with differentiated thyroid carcinoma present in many hospitals throughout the Netherlands, underscoring the need for uniformity in diagnosis and treatment. This prompted the Dutch Society of Nuclear Medicine and the Dutch Endocrine Society to develop an evidence-based guideline that emphasises not only new scientific developments but also the organisation of care. Thyroid-stimulating hormone (TSH) assessment and fine needle aspiration cytology play a central role in the diagnostic assessment of a patient with a thyroid nodule. Ablation of residual thyroid tissue with radioiodine (1-131) is recommended for all patients who have undergone total thyroidectomy. Follow-up protocols distinguish between patients with a low risk of thyroid-carcinoma recurrence and those with a non-low risk of recurrence.
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Radioisótopos de Yodo/uso terapéutico , Guías de Práctica Clínica como Asunto , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Biopsia con Aguja Fina , Humanos , Recurrencia Local de Neoplasia , Países Bajos , Calidad de Vida , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Tirotropina , Resultado del TratamientoRESUMEN
Many patients with cancer develop symptomatic skeletal metastases at an advanced stage of their disease. Skeletal metastases are often complicated by pain. They cause considerable morbidity and mortality. Besides analgesics, treatment options include external beam radiotherapy, bisphosphonates, chemotherapy, surgery and bone seeking radiopharmaceuticals. Pain palliation with bone seeking radiopharmaceuticals has proved to be an effective treatment modality in patients with metastatic bone pain. Radiopharmaceuticals bind to the bone matrix in areas of increased bone turnover, due to a metastatic response. Beta rays from the specific radionuclide, bound to its carrier ligand, result in the therapeutic effect. Various radiopharmaceuticals have been developed for this purpose. All have their own characteristics. The radiopharmaceuticals Samarium-153-ethylenediaminetetramethylenephosphonic acid ((153)Sm-EDTMP) and Strontium-89-Chloride, which are approved in the USA and Europe, as well as the not universally approved Rhenium-186-hydroxyethylidenediphosphonic acid ((186)Re-HEDP), will be discussed in greater detail. Depending on the half-life and radiation energy of the specific radionuclide, they exert a different effect and toxicity profile. In most cases, bone marrow toxicity is limited and reversible, which makes repetitive treatment relatively safe. Several studies have shown encouraging clinical results of palliative therapy using bone seeking radiopharmaceuticals, with an overall reported pain response rate in the order of +/- 70-80% of patients. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. Additionally, new therapeutic strategies hold the promise of enhancement of the palliative and anticancer effects of this form of therapy.
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Neoplasias Óseas/secundario , Oncología Médica/métodos , Neoplasias/diagnóstico por imagen , Neoplasias/tratamiento farmacológico , Dolor/diagnóstico por imagen , Dolor/tratamiento farmacológico , Radiofármacos/uso terapéutico , Ensayos Clínicos como Asunto , Ácido Etidrónico/farmacología , Humanos , Modelos Químicos , Metástasis de la Neoplasia , Neoplasias/patología , Compuestos Organometálicos/farmacología , Compuestos Organofosforados/farmacología , Radiometría , Cintigrafía , Estroncio/farmacología , Resultado del TratamientoRESUMEN
PURPOSE: In our clinic, patients with occult breast lesions are treated with a sentinel node biopsy combined with wire-guided tumour excision. The aim of this retrospective study was to determine the influence of the sequence of wire localisation and sentinel node procedure on visualisation of the sentinel node. METHODS: A total of 136 patients had a wire-guided tumour excision combined with a sentinel node procedure. Sixty-six patients had guide wire localisation prior to the sentinel node procedure. Seventy patients had sentinel node visualisation before insertion of the guide wire. RESULTS: The sentinel node was visualised in 41 (62%) of the patients who first underwent guide wire localisation. In the group of patients who underwent visualisation of the sentinel node before placement of the guide wire, the sentinel node was visualised in 62 (89%). This is a significant difference in visualisation (p<0.001). CONCLUSION: This study shows that guide wire localisation prior to the sentinel node procedure negatively influences visualisation of the sentinel node.
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Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Aumento de la Imagen/instrumentación , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Femenino , Humanos , Aumento de la Imagen/métodos , Ganglios Linfáticos/cirugía , Metástasis Linfática , Persona de Mediana Edad , Cintigrafía , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Biopsia del Ganglio Linfático Centinela/métodosRESUMEN
In two women with Hodgkin's disease, 36 and 34 years of age, the PET-scan showed increased FDG-uptake in regions where the CT-scan did not reveal any abnormalities. Integration of the PET-CT images visualised bone marrow localisations in both patients. One patient underwent a CT-guided bone biopsy that confirmed this localisation. In both cases, the results of the integrated PET-CT images altered the therapy that would have been given on the basis ofthe standard staging technique. Both patients underwent radiotherapy. After 6 months, one patient had no visible lesions. The other patient died due to progression ofthe disease. Integrated PET-CT images can play an important role, not only in the precise classification and staging of lymphoma but also at the start of therapy, as an initial scan, in the evaluation of the response to treatment, and in the early detection of recurrence.
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Enfermedad de Hodgkin/diagnóstico , Estadificación de Neoplasias/métodos , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Diagnóstico Diferencial , Progresión de la Enfermedad , Resultado Fatal , Femenino , Fluorodesoxiglucosa F18 , Enfermedad de Hodgkin/radioterapia , Humanos , Procesamiento de Imagen Asistido por Computador , RadiofármacosRESUMEN
To investigate the usefulness of thyroglobulin mRNA (Tg-mRNA) detection in peripheral blood in the follow-up of papillary and follicular (differentiated) thyroid cancer, a literature study was performed. Both evidence for and evidence against the usefulness of Tg-mRNA detection were found. Also, evidence for the expression of Tg-mRNA in cells other than normal or neoplastic thyroid follicular cells was found. It is concluded that currently Tg-mRNA detection is not a useful tool in the follow-up of differentiated thyroid carcinoma, but that the concept of using RT-PCR measurements during follow-up still warrants further research.
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Adenocarcinoma Folicular/sangre , Carcinoma Papilar/sangre , Células Neoplásicas Circulantes/patología , ARN Mensajero/sangre , ARN Neoplásico/sangre , Tiroglobulina/genética , Neoplasias de la Tiroides/sangre , Adenocarcinoma Folicular/patología , Carcinoma Papilar/genética , Carcinoma Papilar/patología , Estudios de Seguimiento , Perfilación de la Expresión Génica , Humanos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Neoplasias de la Tiroides/patologíaRESUMEN
Liver metastases cause the majority of deaths from colorectal cancer, and response to chemotherapy and external radiotherapy is poor. An alternative is internal radionuclide therapy using (90)Y labeled microspheres. These microspheres are very stable and have a proven efficacy in the field of treatment of primary or metastatic hepatic cancer. Whilst these glass spheres showed encouraging results in patients, their high density is a serious drawback. Currently, other materials with lower densities and other radioisotopes are being investigated in order to optimize this promising new therapy. Three major radiolabeled microsphere materials, viz. glass, resin-based and polymer-based, are now available for therapy or are being tested in animals. In this review the preparation, stability and degradation of these spheres are discussed.
Asunto(s)
Neoplasias/radioterapia , Radiofármacos/uso terapéutico , Radioterapia/métodos , Animales , Excipientes , Humanos , Microesferas , Radioisótopos/administración & dosificación , Radioisótopos/uso terapéutico , Radiofármacos/administración & dosificación , Radiofármacos/farmacocinéticaRESUMEN
Technetium-99m mercaptoacetylglycine (99mTc-MAG3) renography is a successful non-invasive method for the evaluation of renal transplants. In this study we prospectively studied 256 patients after renal transplantation, using the MAG3 uptake capacity in the first 10 min (MUC10), which is an index of renal function representing kidney activity as a fraction of the injected dose. Renal scintigraphy was performed in all patients within 48 h of transplantation. Renograms were obtained over 20 min, after bolus injection of +/-100 MBq 99mTc-MAG3. MUC10 ranged between 0.0 and 94.9. The patients were divided into five groups: group 1, MUC10 <1; group 2, 1< or =MUC10 < 5; group 3, 5 < or = MUC10 <10; group 4, 10 < or = MUC10 < 30; group 5, MUC10 > or =30. In 235 patients, follow-up for 5 years was completed. Considering all the renal transplants, 30% of the grafts ceased functioning within the first 5 years. Six grafts showed a MUC10 of < 1, and none survived the first year. After 5 years, 43% of the grafts with a MUC10 of 1-5 still functioned, as compared with 63% of those with a MUC10 of 5-10, 72% of those with a MUC10 of 10-30 and 83% of those with a MUC10 of > or =30. Kaplan-Meier survival analysis showed significant differences between the five different patient groups based on MUC10 in terms of the percentage of kidneys that ceased to function within 5 years. The period of cold ischaemia and the donor age were known in 178 patients. In contrast to cold ischaemia time, the MUC10 and the donor age showed a significant effect (P<0.05) on graft survival. This study indicates that the MUC10 early after renal transplantation is useful as a prognostic factor in the evaluation of kidney transplants and that a MUC10 of <1 indicates a dismal prognosis for the renal transplant.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Renografía por Radioisótopo , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Radiofármacos , Tecnecio Tc 99m MertiatidaRESUMEN
BACKGROUND: Captopril renography (CR) has been shown to improve the effectiveness of renal scintigraphy in renovascular hypertension, by inhibiting angiotensin-converting enzyme. CR is particularly sensitive and specific in unilateral renal artery stenosis (RAS), but results in patients with bilateral RAS are less favourable. The aim of this study was to investigate the meaning of abnormal but identical renographic curves in the diagnosis of RAS. PATIENTS AND METHODS: One hundred and fifty-eight patients clinically suspected for renovascular hypertension underwent CR, using 50 MBq (99)Tc(m)-mercaptoacetyltriglycine ((99)Tc(m)-MAG(3)), prior to performing renal angiography. CR was performed 1 h after captopril administration. Renograms were analysed according to the consensus criteria. All patients underwent angiography, considered as the "gold standard" in the detection of the presence of RAS (stenosis >50% was defined as significant). All kidneys were categorized into three groups, scintigraphically as well as angiographically: no stenosis, unilateral stenosis and bilateral stenosis. RESULTS: Out of 158 patients 100 (63%) showed a RAS on angiography (58 (37%) unilateral, 42 (26%) bilateral). The sensitivity and specificity of CR evaluated by patient was 83% and 75%, respectively. Thirty patients with completely identical curves were identified, 21 patients with normal curves and nine patients with abnormal identical curves. All but one patient showed no RAS on the angiogram. In this single patient a unilateral stenosis was found. CONCLUSION: Identical curves on the renogram generally suggest no RAS and are probably due to intrinsic parenchymal disease.