Lymphoscintigraphy in early-stage non-small cell lung cancer with technetium-99m nanocolloids and hybrid SPECT/CT: a pilot project.

OBJECTIVE: The goal of our study was to determine if lymph node activity could be visualized using a hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanner with two commonly used colloidal lymphatic radiotracers--99mTc-antimony sulfide colloid (ASC) and 99mTc-filtered sulfur colloid (FSC) in the setting of low-stage non-small cell lung cancer (NSCLC). METHODS: Patients undergoing CT-guided percutaneous lung biopsies for clinically suspected early-stage lung cancer were randomized to peri-lesional injection of 37 MBq (0.5 mL) of either ASC or FSC. SPECT/CT of the thorax was performed at either 1, 2, or 3 h post-injection. The images were reviewed to determine if lymph node activity separate from the injection site could be identified. RESULTS: 24 patients were included. Lymph node activity was identified in 50% of patients. A total of 15 lymph nodes with activity were visualized including 5 ipsilateral hilar, 6 ipsilateral mediastinal, and 4 distant locations. No contralateral mediastinal or hilar activity was visualized. There was a tendency to improved visualization with ASC and the longer 3 h wait time. Most patients also demonstrated significant pleural, tracheobronchial, and/or systemic activity. CONCLUSIONS: SPECT/CT imaging can demonstrate lymph node activity separate from the injection site in at least some low-stage NSCLC patients with a perilesional injection of 99mTc nanocolloid tracers. Further investigation into the role of pre-operative lymphoscintigraphy with SPECT/CT in patients with lung cancer is warranted.

Targeting tumour necrosis factor alleviates signs and symptoms of inflammatory osteoarthritis of the knee.

INTRODUCTION: Inflammation associated with synovial expression of TNFα is a recognised feature of osteoarthritis (OA), although no studies have yet reported beneficial effects of anti-TNFα therapy on clinical manifestations of inflammation in OA. METHODS: We conducted an open-label evaluation of adalimumab over 12 weeks in 20 patients with OA of the knee and evidence of effusion clinically. Inclusion criteria included daily knee pain for the month preceding study enrolment and a summed pain score of 125 to 400 mm visual analogue scale on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale. The primary outcome was the Osteoarthritis Research Society International/Outcome Measures in Rheumatology Clinical Trials (OARSI/OMERACT) response criterion at week 12. Secondary outcomes included the WOMAC pain score 20% and 50% improvement, WOMAC stiffness and function scores, patient and physician global visual analogue scale, as well as target joint swelling. RESULTS: Treatment was well tolerated and completed by 17 patients with withdrawals unrelated to lack of efficacy or adverse events. By intention to treat, an OARSI/OMERACT response was recorded in 14 (70%) patients. WOMAC pain 20% and 50% responses were recorded in 14 (70%) patients and eight (40%) patients, respectively. Significant improvement was observed in mean WOMAC pain, stiffness, function, physician and patient global, as well as target joint swelling at 12 weeks (P < 0.0001 for all). After treatment discontinuation, 16 patients were available for assessment at 22 weeks and OARSI/OMERACT response compared with baseline was still evident in 10 (50%) patients. CONCLUSION: Targeting TNFα may be of therapeutic benefit in OA and requires further evaluation in controlled trials. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00686439.

Inflammatory lesions of the spine on magnetic resonance imaging predict the development of new syndesmophytes in ankylosing spondylitis: evidence of a relationship between inflammation and new bone formation.

OBJECTIVE: To determine whether a vertebral corner that demonstrates an active corner inflammatory lesion (CIL) on magnetic resonance imaging (MRI) in patients with ankylosing spondylitis (AS) is more likely to evolve into a de novo syndesmophyte visible on plain radiography than is a vertebral corner that demonstrates no active inflammation on MRI. METHODS: MRI scans and plain radiographs were obtained for 29 patients recruited into randomized placebo-controlled trials of anti-tumor necrosis factor alpha (anti-TNFalpha) therapy. MRI was conducted at baseline, 12 or 24 weeks (n=29), and 2 years (n=22), while radiography was conducted at baseline and 2 years. A persistent CIL was defined as a CIL that was found on all available scans. A resolved CIL was defined as having completely disappeared on either the second or third scan. A validation cohort consisted of 41 AS patients followed up prospectively. Anonymized MRIs were assessed independently by 3 readers who were blinded with regard to radiographic findings. RESULTS: New syndesmophytes developed significantly more frequently in vertebral corners with inflammation (20%) than in those without inflammation (5.1%) seen on baseline MRI (P

The relationship between diffusion anisotropy and time of onset after stroke.

Diffusion anisotropy changes in stroke lesions less than 24 h after onset have been reported to be elevated, decreased, or both. To address these mixed findings, we sought to characterize temporal changes of diffusion anisotropy by analyzing anatomically distinct ischemic white matter (WM) regions at 3 time phases within the first 34 h of ischemic stroke onset in 26 stroke patients (2 to 5 h, N=7; 7 to 14 h, N=11; 18 to 34 h, N=8). Mean diffusivity (Trace/3 apparent diffusion coefficient (ADC)), fractional anisotropy (FA), and T2-weighted signal intensity were measured for major and subcortical WM in lesions defined by a >or=30% drop in Trace/3 ADC. Major WM tract lesions with mean decreases of approximately 40% in relative (r) Trace/3 ADC showed an increased rFA of 1.11+/-0.18 (P<0.01) during the hyperacute phase (2 to 5 h), whereas rFA declined to 0.90+/-0.20 (P<0.01) and 0.88+/-0.12 (P<0.01) in the acute (7 to 14 h) and subacute (18 to 34 h) phases, respectively. Of those patients with lesions in major WM, 4 of 8 patients