PET/MRI-guided GTV delineation during radiotherapy planning in patients with squamous cell carcinoma of the tongue.

PURPOSE: The aim of the study was to evaluate the usefulness and accuracy of 18-fluorine-labeled fluorodeoxyglucose (PET) and magnetic resonance imaging (MRI) hybrid in gross tumor volume (GTV) delineation during radiotherapy planning in patients with carcinoma of the tongue. METHODS: Ten patients with squamous cell carcinoma (SCC) of the tongue underwent computed tomography (CT) and PET/MRI examination. The GTV for primary tumor and lymph nodes (nGTV) were defined on CT (GTV-CT) and compared to GTVs obtained from PET (GTV-PET) and MRI (GTV-MRI) images. Two methods of GTV determination were used: visual interpretation of CT, PET (GTV-PETvis) and MRI images and quantitative automatic method (Syngovia, Siemens) based on a chosen threshold value (20%, 30%, 40%, 50%) of standardized uptake values (SUVmax) from PET examination (GTV-PET20%, GTV-PET30%, etc.). Statistical analysis of differences in GTV values obtained from CT, PET and MRI studies was performed. GTV-CT was used as a reference. RESULTS: In all, 80% of GTV-MRI and 40% of GTV-PETvis were larger than GTV-CT. Respectively, 20% of GTV-MRI and 60% of GTV-PETvis were smaller than GTV-CT. Taking into account all threshold measurements, 70% of volumes were smaller than GTV-CT. GTV-PET30% were the most closely related volumes to GTV-CT from all threshold methods in 50% of patients. GTV-PETvis generated the most similar volumes in relation to GTV-CT from all PET measurements. Statistical analysis confirmed those results. Compared to nGTV-CT, 70% of nGTV-MRI and 20% of nGTV-PETvis were larger. The remaining nGTV-MRI and nGTV-PETvis measurements were smaller than nGTV-CT. Measurements of all thresholds nGTVs were smaller than nGTV-CTV in 52.5% of cases. nGTV-PET20% were the most closely related volumes to nGTV-CT in 40% of the cases. Statistical analysis showed that nGTV-PET20% (p = 0.0468), nGTV-PETvis (p = 0.0166), and nGTV-PET50% (p = 0.0166) diverge significantly from nGTV-CT results. nGTV-MRI (p = 0.1141), nGTV-PET30% (p = 0.2845), and nGTV-PET40% (p = 0.5076) were significantly related with nGTV-CT. CONCLUSION: Combination of PET/MRI provides more information during target tumor mass delineation in radiotherapy planning of patients with SCC of the tongue than other standard imaging methods. The most frequently matching threshold value was 30% of SUVmax for primary tumor delineation and 30-40% of SUVmax for nGTV determination.

[Contemporary role of scintigraphy in diagnosis, and evaluation of radioiodine therapy for treatment of thyroid diseases]. / Wspólczesna rola badan scyntygraficznych w diagnostyce i ocenie skutecznosci radioizotopowego leczenia chorób tarczycy.

The paper presents a short historical outline and contemporary use of scintigraphic studies of thyroid gland. Appropriate recommendations and correct interpretations of the results of routine thyroid scans and the usefulness of other scintigraphic studies with 111In-octreoscan, 99mTc-MIBI, 99mTc-DMSA, 18FDG and radiolabeled monoclonal anti-carcinoembryonic antigen antibodies were discussed in the light of the present thyroid diagnostic studies. Particular attention was paid to the dependence of the scintigraphic thyroid images upon the thyroid-stimulating hormone (TSH) level in the patient's serum. The chosen examples of scintigraphic studies show the advantages of scintigraphic evaluation of efficacy of radioiodine therapy. The most often mistakes of the scintigraphy interpretations were showed.

E-selectin, L-selectin, ICAM-1 and IL-6 concentrations changes in the serum of patients with hyperthyroidism in the early period of radioiodine I-131 therapy.

BACKGROUND: Among cytokines- interleukins: -6 and -8 (IL-6, IL-8) and E-selectin (E-sel.), L-selectin (L-sel.) and intercellular cell adhesion molecule-1 (ICAM-1) are the most important links in the initiation of the inflammatory process. Taking into account that the inflammatory process is the basic stage of effective radioiodine therapy, we tried to compare the behaviour of the initial inflammatory factors in the early period of I-131 therapy (RAI) of hyperthyroidism. The aim of the study was to estimate the behaviour of IL-6, ICAM-1, E-selectin and L-selectin concentrations in the serum of patients with hyperthyroidism before and during I-131 therapy. MATERIAL AND METHODS: The groups of 26 patients with Graves' disease (GD) and 18 patients with toxic nodular goiter (TNG), aged 34-77, were studied. Control group (C) consisted of 10 healthy volunteers. For estimation of thyroid function serum concentrations of TSH, free T4 and free T3 were measured by IRMA or RIA kits (Polatom, Poland). IL-6, ICAM-1, E-selectin and L-selectin serum concentrations were determined using ELISA method by Bender kits (USA). Blood samples for all estimations were taken 10-12 days before and in 6th week after I-131 administration. Treatment dose of radioiodine was calculated, basing on modified equation for absorbed dose. RESULTS: Compared to control, no statistical differences in the levels of E-selectin (C--44.4 +/- 11 ng/ml) and L-selectin (C--842 +/- 168.9 ng/ml) were observed before treatment in the patients with GD (E-sel.--59.8 +/- 19.6 ng/ml; L-sel.--1288.2 +/- 273.5 ng/ml) and with TNG (E-sel.--61.5 +/- 18.4 ng/ml, L-sel.--1247.0 +/- 273.5 ng/ml) as well as in the 6th week after I-131 administration; values in GD group were: E-sel.--57.3 +/- 19.5 ng/ml, L-sel.--1142.4 +/- 193.4 ng/ml; in TNG group: E-sel.--62.1 +/- 20.6 ng/ml, L-sel.--1113.5 +/- 236.3 ng/ml. In comparison to control there was no difference in initial IL-6 levels either in GD or in TNG group, but a statistically important decrease was observed in the 6th week after I-131 administration in GD patients (C--2.07 +/- 0.2 ng/ml v. 1.79 +/- 0.16 ng/ml). ICAM-1 serum concentrations before treatment were elevated compared to control group (C--190.2 +/- 34.7 ng/ml) in both groups (GD--263.6 +/- 24.6 ng/ml, p < 0.05; TNG--251.4 +/- 36.1 ng/ml, p < 0.05). In GD patients a statistically significant increase of ICAM-1 was observed in the 6th week (301.1 +/- 33.2 ng/ml, p < 0.05) of RAI whereas in TNG group there was no statistical difference compared to initial values (249.7 +/- 42.6 ng/ml, N.S.). CONCLUSION: We conclude that ICAM-1 and IL-6 may be important factors in the estimation of the inflammatory processes in the thyroid gland during radioiodine therapy, especially GD disease. E- and L-selectins seem to be not helpful in the monitoring of the thyroid inflammatory changes during the early period of I-131 therapy.