Polish experience in Peptide receptor radionuclide therapy.

PATIENTS AND METHODS: During the period from April 2004 to December 2010, 358 patients underwent peptide receptor radionuclide therapy (PRRT) ((90)Y-DOTATATE, (177)Lu-DOTATATE, and (90)Y/(177)Lu-DOTATATE) in Poland. RESULTS: The majority of patients underwent (90)Y-DOTATATE therapy (n = 177) with progression-free survival (PFS)/time to progression (TTP) of 17-44 months and overall survival (OS) of 22-34.2 months. Twelve-month follow-up revealed stable disease (SD) in 46-60%, disease regression (RD) in 16-35%, disease progression (PD) in 7-17%, and complete remission (CR) in 3% of patients. In patients treated with (90)Y/(177)Lu-DOTATATE (n = 44), PFS/TTP was 24.2-28.3 months and OS was 49.8-52.8 months. Twelve-month follow-up showed SD in 62-70%, RD in 15-20%, and PD in 10-12% of patients. The treatment was well tolerated. No severe adverse events occurred. Grade 3 toxicity [in leucocytes (WBC) and thrombocytes (PLT)] was seen in 6-20% of patients treated with (90)Y-DOTATATE. In that group, renal toxicity grade 3 was seen in 5-12% and grade 4 in 3-8%. In patients treated with tandem therapy with (90)Y/(177)Lu-DOTATATE or (177)Lu-DOTATATE alone, hematological and renal toxicity grade 3 or 4 was not observed. CONCLUSIONS: The results indicate that PRRT with the procedures and isotopes used is an effective and safe therapy option for patients with metastatic or inoperable neuroendocrine tumors (NETs). Our results suggest that tandem therapy with (90)Y/(177)Lu-DOTATATE provides longer overall survival than single-isotope treatment. Hematological toxicity was rare in all treated patients. Renal toxicity grade 3 and 4 was observed only in the group treated with (90)Y-DOTATATE.

Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism.

OBJECTIVES: Clinical significance of, and the need for, treatment in subclinical hyperthyroidism (sHT) is still a matter of debate. The aim of the study was to assess the impact of sHT on echocardiographic parameters. DESIGN: Patients with endogenous sHT of nonautoimmune origin underwent full echocardiographic assessment at diagnosis and after restoring euthyroidism with radioiodine treatment. PATIENTS: Studied group consisted of 44 patients (37 women, 7 men), aged 22-65 years (mean 45·9±11·0). MEASUREMENTS: Full echocardiographic assessment included estimation of cardiac chamber diameters and volume as well as cardiac contractility, according to the guidelines of the American Society of Echocardiography. Left ventricular mass was calculated according to Penn's convention. For estimation of left ventricle diastolic function, the following echocardiographic parameters were obtained: maximal early filling wave velocity (E), maximal late filling wave velocity (A), E/A ratio, isovolumetric relaxation time and early filling wave deceleration time. RESULTS: In the studied group, phase of sHT was associated with increased volume of heart chambers, increased diameter of ascending aorta, increased left ventricle mass and disturbed left ventricle relaxation (P<0·05). The systolic function of the left ventricle was unaffected; however, the ejection time was shortened. The changes were reversible with restoring biochemical euthyroidism (P<0·05). Moreover, a significant correlation between some of the parameters and thyroid hormones concentration was demonstrated. CONCLUSIONS: sHT was associated with significant changes in echocardiographic parameters, which may contribute to increased cardiovascular risk in these patients. The alterations were reversible with restoring biochemical euthyroidism, what supports the necessity of treatment introduction in sHT.

[Fusion of pulmonary scintigraphy with Tc99m-depreotide imaging with CT scan in recognizing solitary pulmonary nodule]. / Scyntygrafia pluc z 99mTc-depreotydem i nakladanie obrazów tomografii komputerowej w rozpoznawaniu pojedynczego guza pluca.

UNLABELLED: At present also radionuclide methods are used to diagnose pulmonary malignancies. One of them is solitary pulmonary nodule (SPN) scintigraphy using 99mTc-depreotide. 99mTc-depreotide is a somatostatin analogue with affinity to 3 out of 5 subtypes of somatostatin receptors. AIM OF THE STUDY: was to confirmed the usefulness of 99mTc-depreotide in detecting malignancy in SPN; finding lymph nodes metastases; and overlapping scintigraphic scans and CT in precise localizsation of malignancy and its lymph nodes metastases. MATERIAL AND METHODS: The group studied comprised 50 patients with radiologically diagnosed SPN. Forty patients had a high resolution CT scan done with a GE Light Speed equipment-device. The acquired CT scans were sent via LAN (Local Area Network) to an ARPACS server in the Department of Nuclear Medicine, and thence to a Hermes Nuclear Diagnostics workstation. CT examinations were followed by scintigraphy with 99mTc-depreotide. RESULTS: In 32 patients 99mTc-depreotide was found to have accumulated excessively in SPN: in 23 cases malignancy was found, in the 9 remaining cases they were other abnormalities. In the 23 lung cancer patients, 99mTc-depreotide was found in 24 foci, including 18 in the mediastinum and axillary region. CT revealed affected lymph nodes only in 7 cases. The calculated sensitivity, specificity and accuracy in SPN were 89%, 60%, 82%, respectively. The tumour/background index in malignancies confirmed histologically was 2.58 +/- 0.89. Where lymph nodes metastases were suspected in the diagnosed malignancies, the lymph node/background index was 2.60 +/- 0.85. In 25 cases lesion localization was more accurate when scans were overlapped. CONCLUSIONS: 99mTc-depreotide based examination is a sensitive method in the evaluation of SPN malignancy. Overlapping SPECT and CT scans in diagnosing SPN enables both pathological and physiological changes to be localized precisely. This method seems particularly valuable in imaging lymph nodes where metastases are suspected, especially when CT scans revealed no abnormalities.

[Beating myocardial cross sections and polar maps techniques in assessment of myocardial perfusion disturbances with gated single photon emission tomography]. / Analiza ruchomych przekrojów i map biegunowych w ocenie zaburzen perfuzji serca za pomoca bramkowanej tomografii emisyjnej pojedynczego fotonu.

UNLABELLED: In modern world the risk of circulatory system diseases is increasing. Effective techniques are sought of prevention and detection of coronary artery disease. The development of diagnostic modalites is directed to reduction of invasiveness and risk for patients with providing as much information from a single examination, as possible. Gated scintigraphy examinations by single photon emission method (GSPET) seem to meet these requirements. They combine information that could be obtained as yet only with two separated examinations. They provide data on left ventricular perfusion and function. AIM OF THE STUDY: The aim of the study was application of gated single photon emission tomography (GSPET) technique by means of polar maps and beating cross-sections in the assessment of parameters describing left ventricular function in various degrees of myocardial perfusion disturbances. A comparison was also done of GSPET processing by polar map and beating cross-section methods in the diagnosis of perfusion disturbances. MATERIAL AND METHODS: The study group included 142 patients (mean age 55.8 +/- 10.9 years), in whom myocardial scintigraphic examination was carried out by GSPET method using Tc99m-MIBI complex according to two-day protocol. The examinations were performed using a two-head Varicam gamma camera. For study data processing Xpert Pro software for workstation was used. The examinations were analysed using both polar maps and beating cross-sections. Additional values were considered offered by gated GSPET examinations. In all, 284 examinations were analysed. The patients were divided into groups according to gender and changes in perfusion both in the maps and cross-sections. RESULTS: The total number of 112 consistent results of perfusion changes were obtained both in the polar maps and cross-sections (71%). Most differences were observed in the group with effort perfusion disturbances. During processing of GSPET examination by the method of polar maps were obtained more reversible perfusion disturbances then in the beating cross-sections, differences were found which required further studies and comparison with clinical data. CONCLUSIONS: On the basis of the obtained results the conclusions were drawn that processing of gated single photon emission tomography (GSPET) by methods of both polar maps and mobile cross-sections makes possible to assess the parameters describing left ventricular function at rest and during exercise in various degrees of myocardial perfusion disturbances.

[Radionuclide cisternography in the diagnosis of normal pressure hydrocephalus]. / Cysternografia radioizotopowa w rozpoznawaniu wodoglowia z prawidlowym cisnieniem plynu mózgowo-rdzeniowego.

An overview of significant research results of the last four decades as well as the author's own experience have served as a basis for the presentation of the radioisotope method and the radiopharmaceuticals in the diagnostics of normal pressure hydrocephalus (NPH). Also the physiology of the formation of PM-R its flow and absorption have shortly been discussed. Hydrocephalus is a major clinical, diagnostic and therapeutical problem. In the initial diagnosis of that pathology, methods like CT and MRI play an important role, which has also been the subject of this article. A clear and useful classification of hydrocephalus has been presented as well as NPH in adults as a clinical pathological syndrome together with its etiology, diagnostics and the differentiation in relation to other forms of hydrocephalus. Hydrocephalus and the atrophy of the brain have been illustrated by images taken by the author. In the assessment of the NPH in terms of a patient's qualification for a shunting operation a number of diagnostic factors are of particular importance. These are: the infusion test using PM-R pressure measurement of the ventricle system or the subarachnoid space on the spinal cord level, the neuropsychological evaluation as well as the brain imaging using emission tomography SPECT or the measuring of the brain metabolism by PET technique. None of these methods has been universal in diagnostic terms. Radionuclide cisternography seems to be the most physiological method that allows to gain more direct insight into the dynamics and the PM-R flow and its absorption. The results of the radioisotope examination turn out to be the most reliable criterion in the diagnostics of NPH.

Detection of splenic tissue by 99mTc-labelled Sn-colloid SPECT/CT scintigraphy.

This paper presents a case of an 80-year-old man with idiopathic thrombocytopenic purpura after splenectomy performed many years ago, which normalized platelet count, presented with severe thrombocytopenia with no response to treatment. A SPECT/CT study was performed using 99mTc-labelled Sn-colloid. The histology confirmed the presence of splenic tissue in those foci. Spleen examination (SPECT/CT) using 99mTc-labelled Sn-colloid is able to detect splenic tissue and in our opinion is a simpler and less time-consuming procedure than using 99mTc DRBC.

Impact of [18F]fluorodeoxyglucose PET-CT staging on treatment planning in radiotherapy incorporating elective nodal irradiation for non-small-cell lung cancer: a prospective study.

PURPOSE: To evaluate prospectively how positron emission tomography (PET) information changes treatment plans for non-small-cell lung cancer (NSCLC) patients receiving or not receiving elective nodal irradiation (ENI). METHODS AND MATERIALS: One hundred consecutive patients referred for curative radiotherapy were included in the study. Treatment plans were carried out with CT data sets only. For stage III patients, mediastinal ENI was planned. Then, patients underwent PET-CT for diagnostic/planning purposes. PET/CT was fused with the CT data for final planning. New targets were delineated. For stage III patients with minimal N disease (N0-N1, single N2), the ENI was omitted in the new plans. Patients were treated according to the PET-based volumes and plans. The gross tumor volume (GTV)/planning tumor volume (PTV) and doses for critical structures were compared for both data sets. The doses for areas of potential geographical misses derived with the CT data set alone were compared in patients with and without initially planned ENI. RESULTS: In the 75 patients for whom the decision about curative radiotherapy was maintained after PET/CT, there would have been 20 cases (27%) with potential geographical misses by using the CT data set alone. Among them, 13 patients would receive ENI; of those patients, only 2 patients had the PET-based PTV covered by 90% isodose by using the plans based on CT alone, and the mean of the minimum dose within the missed GTV was 55% of the prescribed dose, while for 7 patients without ENI, it was 10% (p = 0.006). The lung, heart, and esophageal doses were significantly lower for plans with ENI omission than for plans with ENI use based on CT alone. CONCLUSIONS: PET/CT should be incorporated in the planning of radiotherapy for NSCLC, even in the setting of ENI. However, if PET/CT is unavailable, ENI may to some extent compensate for an inadequate dose coverage resulting from diagnostic uncertainties.

Co-registration of cardiac MRI and rest gated SPECT in the assessment of myocardial perfusion, function and viability.

PURPOSE: Myocardial perfusion is routinely measured by SPECT--this technique has a rather low spatial resolution but covers the whole myocardium and is equipped with efficient image analysis software. Cardiac MRI has higher spatial resolution than SPECT and excellent sequences for myocardial function and viability detection but the lack of easy-to-use methods of acquisition and post-processing of perfusion images prevents this method from being used for perfusion evaluation in clinical practice. The aim of the study was to explore whether the 3-D co-registration of "cine" MRI (cine MRI), delayed enhancement MRI (DE MRI) and gated SPECT (GSPECT) images might be used for differentiating all reversible and irreversible effects of ischemia in anatomically matched myocardial regions. METHODS: We analyzed 685 segments of the heart (6 segments in each short axis slice)-obtained as a result of MRI and GSPECT studies performed in 18 patients. In each segment, myocardial function, perfusion and viability were analyzed. Myocardial wall function was evaluated using the matched images of diastolic and systolic phases of cine MRI. Perfusion as MIBI uptake per volume (MIV) (counts/mm3) in each myocardial segment was evaluated by co-registration of diastolic phases of cine MRI and GSPECT. Transmural extent of infarction was determined by co-registration of DE MRI and diastolic phase of cine MRI. RESULTS: We have found a close correlation between regional perfusion and function at rest in matched MRI and SPECT images: dysfunctional segments had significantly less MIV (MIV = 4.63 SD 1.58) than normal segments (MIV = 8.86 SD 2.77) (p < .05). There was no significant difference in MIV between viable and non-viable dysfunctional segments defined by DE MR due to a small number of nonviable segments in our study (18/685). CONCLUSION: Matching rest perfusion and function in anatomically co-registered myocardial segments in our study confirms that 3-D image co-registration of cine MRI, DE MRI and gated SPECT could be a precise method of integrated visualization of perfusion, function and viability helping in differentiating all forms of reversible and irreversible effects of myocardial ischemia.