9 research outputs found
Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT
No full textRATIONALE : F-18 Fluoro Deoxyglucose positron emission tomography and computed tomography (F-18 FDG PET/CT) is a useful
modality in the evaluation of patients with malignancies. Increased incidence of lympho-proliferative disorders has been reported in
individuals with long-standing end-stage renal disorders treated with renal replacement therapy.
PATIENT CONCERNS : A 30-year-old male on peritoneal dialysis on account of end-stage renal disease. He had acute rejection of an
earlier transplanted renal allograft. He was referred for an F-18 FDG PET/CT based on a clinical suspicion of lymphoma on account of
bilateral inguinal lymphadenopathy associated with bilateral pedal swelling.
DIAGNOSIS : Renal osteodystrophy was diagnosed based on diffusely intense F-18 FDG uptake in the axial skeleton, focal uptake in
the costochondrial junctions and linear cortical uptake in the appendicular skeleton. No findings suggestive of lymphoma was seen.
INTERVENTIONS : A diagnosis of renal osteodystrophy with no evidence of a lymphoma prevented futile biopsy of inguinal
lymphadenopathy. Patient continued with peritoneal dialysis with no further intervention
OUTCOMES : Regular follow-up of patient to monitor calcium, phosphate and parathyroid hormone levels. Treatment will be
indicated when laboratory results as well as clinical signs and symptoms are suggestive.
LESSON : Metabolic bone disorder such as is seen in renal osteodystrophy should be considered in the differential diagnoses in
patients with diffusely increased bone uptake on F-18 FDG PET/CT scan.
ABBREVIATIONS : CT = computed tomography, DOTANOC = 1-NaI3-octrotide 1,4,7,10-tetraazacyclododecane-N,N’,N”,N”’-
tetraacetic acid, F-18 FDG = fluorine-18 2-fluoro-2-deoxyglucose, Ga-68 = gallium 68, HIV = human immunodeficiency virus, MDP
= methylene diphosphonate, PET = positron emission tomography, PSMA = prostate specific membrane antigen, PTH =
parathyroid hormone, Tc-99m = technetium 99 metastable.https://journals.lww.com/md-journal/pages/default.aspxam2018Nuclear Medicin
213Bi-PSMA-617 targeted alpha-radionuclide therapy in metastatic castration-resistant prostate cancer
No full textProstate-specific membrane antigen radioligand therapy
(PSMA-RLT) with 177Lu-PSMA holds great promise as a
safe treatment option in patients with metastasized
castration-resistant prostate cancer (mCRPC) with appropriate
selection. This approach, together with 68Ga-PSMA PET/CT, is an excellent example of theranostic
nuclear medicine. However, more structured data have
recently shown that despite a marked response to PSMARLT,
some patients are refractory to 177Lu-radioligand
therapy. Fortunately recent studies have demonstrated
that targeted α-radiation therapy with 225Ac-PSMA can
significantly benefit mCRPC patients. Similarly, 213Bi-DOTATOC may be able to break the radioresistance to β-emitters while simultaneously reducing haematological
toxicity in patients with diffuse red marrow infiltration
by neuroendocrine tumour.https://link.springer.com/journal/259am2018Nuclear Medicin
68Ga-PSMA-HBED-CC PET imaging in breast carcinoma patients
No full textBACKGROUND : To report on imaging findings using 68Ga-PSMAHBED-
CC PET in a series of 19 breast carcinoma patients.
METHODS : 68Ga-PSMA-HBED-CC PET imaging results obtained
were compared to routinely performed staging examinations
and analyzed as to lesion location and progesterone
receptor status.
RESULTS : Out of 81 tumor lesions identified, 84% were identified
on 68Ga-PSMA-HBED-CC PET. 68Ga-PSMA-HBED-CC
SUVmean values of distant metastases proved significantly
higher (mean, 6.86, SD, 5.68) when compared to those of primary
or local recurrences (mean, 2.45, SD, 2.55, p = 0.04) or
involved lymph nodes (mean, 3.18, SD, 1.79, p = 0.011).
SUVmean values of progesterone receptor-positive lesions
proved not significantly different from progesterone receptornegative
lesions. SUV values derived from FDG PET/CT, available
in seven patients, and 68Ga-PSMA-HBED-CC PET/CT
imaging proved weakly correlated (r = 0.407, p= 0.015).
CONCLUSIONS : 68Ga-PSMA-HBED-CC PET/CT imaging in
breast carcinoma confirms the reported considerable variation
of PSMA expression on human solid tumors using
immunohistochemistry.Department of Nuclear Medicine at University
Pretoria and NECSA.https://link.springer.com/journal/259am2018Nuclear Medicin
Fluorine-18-Fluoroethylcholine PET/CT in the detection of prostate cancer : a South African experience
No full textOBJECTIVE : Imaging with fluorine-18-fluoro-2-deoxy-D-glucose positron emission tomography/computed
tomography (18F-FDG PET/CT) has, until recently provided disappointing results with low sensitivity ranging
from 31%-64% in patients with well-differentiated prostate cancer (PC) at all prostatic specific antigen
(PSA) levels while fluorine-18-fluoroethylcholine (18F-FECh) PET/CT showed about 85% sensitivity in restaging
patients after relapse. We present our experience of the sensitivity of 18F-FECh PET/CT in the early
stages of PC. SUBJECT AND METHODS : Fifty patients were prospectively recruited and imaged, of which 40
fulfilled all inclusion criteria. Our patients had an average age of 65.5 years. Fifteen patients were referred
for initial staging, with the remaining 25 referred for restaging and all patients had histologically confirmed
adenocarcinoma. Patients were imaged by 18F-FECh PET/CT. Findings were evaluated qualitatively and
quantitatively and compared to the results of histology, PSA, Gleason score and bone scintigraphy. The
prostate SUV max was also used. RESULTS : Thirty-one patients demonstrated abnormal pelvic- and or extrapelvic
findings on 18F-FECh PET/CT, which was consistent with malignant or metastatic involvement. The
prostate SUVmax could not be used to predict the presence or absence of metastatic disease. CONCLUSION :
Findings of this paper suggest that 18F-FECh PET/CT in 30/40 cases (estimated as 75%) was helpful in the
initial staging, restaging and lymph node detection of patients with PC. The SUVmax was not helpful. We
diagnosed more PC cases in our African-American patients as compared to the Caucasian patients.http://nuclmed.web.auth.gr/hb2016Nuclear MedicineUrolog
Development of a single vial kit solution for radiolabeling of 68Ga-DKFZ-PSMA-11 and its performance in prostate cancer patients
No full textProstate-specific membrane antigen (PSMA), a type II glycoprotein, is highly
expressed in almost all prostate cancers. By playing such a universal role in the disease,
PSMA provides a target for diagnostic imaging of prostate cancer using positron emission
tomography/computed tomography (PET/CT). The PSMA-targeting ligand Glu-NH-CONH-
Lys-(Ahx)-HBED-CC (DKFZ-PSMA-11) has superior imaging properties and allows
for highly-specific complexation of the generator-based radioisotope Gallium-68 (68Ga).
However, only module-based radiolabeling procedures are currently available. This study
intended to develop a single vial kit solution to radiolabel buffered DKFZ-PSMA-11 with 68Ga. A 68Ge/68Ga-generator was utilized to yield 68GaCl3 and major aspects of the kit
development were assessed, such as radiolabeling performance, quality assurance, and
stability. The final product was injected into patients with prostate cancer for PET/CT imaging
and the kit performance was evaluated on the basis of the expected biodistribution, lesion
detection, and dose optimization. Kits containing 5 nmol DKFZ-PSMA-11 showed rapid,
quantitative 68Ga-complexation and all quality measurements met the release criteria
for human application. The increased precursor content did not compromise the ability of
68Ga-DKFZ-PSMA-11 PET/CT to detect primary prostate cancer and its advanced lymphaticand
metastatic lesions. The 68Ga-DKFZ-PSMA-11 kit is a robust, ready-to-use diagnostic
agent in prostate cancer with high diagnostic performance.The Department of Science and Technology, The South
African Nuclear Energy Corporation and the Nuclear Technologies in Medicine and the Biosciences Initiative.www.mdpi.com/journal/moleculesam201
The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma
No full textBackground: To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemotherapy in patients with Hodgkin lymphoma. Methods: A total of 136 patients with classical Hodgkin lymphoma were studied (mean age +/- SD = 32.31 +/- 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTVand TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard regimen of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system. Results: The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUVmax, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained an independent predictor of therapy outcome in the presence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease. Conclusions: HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, however, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD
Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19
No full textBACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation
Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)
No full textBackground: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p < 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures
Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)
No full textObjectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p<0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p<0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology
