ASNM 5TH RISING PROFESSIONAL CHALLENGE
Year : 2018 | Volume
: 17 | Issue : 5 | Page : 343--349
ASNM 5th rising professional challenge
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. ASNM 5th rising professional challenge.World J Nucl Med 2018;17:343-349
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. ASNM 5th rising professional challenge. World J Nucl Med [serial online] 2018 [cited 2022 May 28 ];17:343-349
Available from: http://www.wjnm.org/text.asp?2018/17/5/343/243978
First Experience of Theranostics of Prostate Cancer in Myanmar
Thiri Kyi Phyu*1, K Myint2, T M Thein3, W Maung3
1Department of Nuclear Medicine, Mandalay General Hospital, Mandalay, 2Department of Nuclear Medicine, Yangon General Hospital, 3Perfect Molecular Imaging and Diagnostic Center, Private Center, Yangon, Myanmar
Background/Aims: Prostate cancer is the fourth most common malignancy worldwide and the third in men of old age (average 65 years) in Myanmar. Currently, serum PSA is the marker of choice with highest positive predictive value in prostate carcinoma. Regarding staging of the disease, ultrasonography, CT, MRI and 99mTc-MDP SPECT-CT bone scintigraphy are choices of investigations practicing in Myanmar. Because of the evidence-based, promising success of 68Ga-PSMA &177Lu-PSMA theranostics management of prostate cancer worldwide, we did 99mTc-PSMA-I+S &177 Lu-PSMA theranostics in Myanmar with the available facilities.
Methods: We treated a post-castrated radiation resistant prostate cancer patient with 177Lu-PSMA after 99mTc-PSMA-I+S SPECT-CT imaging at the department and 68Ga-PSMA imaging abroad. We compared the two imaging results. We treated the patient with 200 mCi of 177Lu-PSMA, three doses at interval of 4 weeks. SPECT-CT imaging was done after therapy.177 Lu-PSMA labelling, radiopharmaceutical administration, and radiation protection practice have to be trained at the center by experts from abroad. Follow-up studies up to 3 successive doses was done.
Results: The two images are comparable. The outcome of the patient after three doses was improved by disappearance of the symptoms, fall in PSA level, and improvement in 99mTc-MDP bone scan images. The results are well documented and present at the multidisciplinary conference for clinical awareness.
Conclusion: This pilot project is a stepping stone of theranostic nuclear medicine in Myanmar. Cancer is the second most common morbidity and mortality, among non-communicable diseases in Myanmar. Theranostics management in prostate cancer with available facilities is an additional boon to our health-care professionals to upgrade the health care system in Myanmar. This project will benefit both public and private sector hospitals and more importantly people of Myanmar.
Iodine-131 Meta-Iodo-Benzylguanidine Treatment in Relapsed/refractory Neuroblastoma
Yoch Anongpornjossakul*1, W Sriwatcharin1, K Thamnirat1, W Chamroonrat1, A Kositwattanarerk1, C Utamakul1, C Sritara1, P Chokesuwattanasakul1, N S Thokanit2, S Hongeng3
2Ramathibodi Comprehensive Cancer Center, Ramathibodi Hospital, Mahidol University, Departments of 1Radiology and 3Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background/Aims: 131I-MIBG had been implemented to the conventional treatment approaches for many years with promising results. We retrospectively reviewed demographic data of relapsed/refractory neuroblastoma patients treated with 131 I-meta-iodo-benzylguanidine and explored the factors attributable to overall survival.
Methods: After institutional ethical board approval, a retrospective review was obtained on twenty-two patients with high risk stage IV relapsed/refractory neuroblastoma treated at least one cycle of 131I-MIBG at the Division of Nuclear Medicine, Ramathibodi Hospital. Emphasis was made on patient's characteristics, hematologic toxicity after treatment, scintigraphic semi-quantitative scoring system and overall survival rate. The factor predicting survival was analysed.
Results: Twenty-two patients (50% was male) with mean age at the diagnosis of 3.7 years, ranging from 4.8 months to 8.3 years were enrolled to the study. Average cycle of 131I-MIBG treatment was 3.8 with mean radioactivity per cycle of 136mCi (5032MBq). Main acute haematologic toxicity was thrombocytopaenia. Overall five year survival rate of 37% (95%CI 16.3–58.0) and median survival time of 2.8 years (95%CI 1.38–6.34) were revealed. Patients with rising Curie score of >25% upon the second treatment showed poorer response as compared to non-rising ones and this contributed to overall survival. At least 3 cycles of 131I-MIBG treatments showed survival prolongation (p=0.003). In contrast to pre-treatment 131I-MIBG scan, post-treatment scan showed good inter-observer agreement between novice resident of radiology and experienced nuclear medicine physician.
Conclusion: Despite multimodal therapeutic approaches, high risk neuroblastoma possessed the propensity of treatment failure in terms of relapsed or refractory, however we found some objective responses after cycles of 131I-MIBG treatment in this group. The review also highlighted the most common hematologic issue after 131I-MIBG, which was thrombocytopenia. Decline or non-rising Curie score upon the second post-treatment total body scan provided valuable information to decide whether bone marrow transplantation would ensue.
High-Fat Diet Impaired Energy Homeostasis in Appswe/ps1de9 Mice
Y H Lee1, H C Hsu2, Skye Hsin-Hsien Yeh*3, Y J Shiao4, F S Shie5, P C Kao6, S M Hsu6, S B Yang7, H J Tsay6
1International Graduate Program, Interdisciplinary Neuroscience, National Yang-Ming University and Academia Sinica, 2Institute of Anatomy and Cell Biology, 3Brain Research Center, National Yang-Ming University, 4Division of Basic Chinese Medicine, National Research Institute of Chinese Medicine, 5Center for Neuropsychiatric Research, National Health Research Institutes, 6Institute of Neuroscience, National Yang-Ming University, 7Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
Background/Aims: Alzheimer's disease (AD), a progressive neurodegenerative disease with unknown etiology, is highly associated with metabolic syndromes. Accumulating evidence has suggested that type 2 diabetes mellitus is a common co-morbidity in AD. We sought to realize the interplay between AD and energy consumption using 18F-FDG PET.
Methods: We have shown that high fat diet (HFD) induced metabolic stresses such as obesity and insulin resistance (IR) in mice carrying a familial form of AD genes APP/PS1. In this study, APP/PS1 mice were used as an AD model and compared to its wild type (WT). Mice were fed with a normal chow diet (NCD) with 13.6% kcal from fat and water ad libitum. Mice were housed under controlled room temperature (24±1 °C) and humidity (55-65%) in 12-h dark cycle starting from 07:00 to 19:00 and 12-h light cycle. One Group of AD mice and wildtype siblings (WT) at age of 10weeks old were maintained on NCD designed as NCD WT, NCD AD mice. The other group of AD and WT mice were switched to a high fat diet with 60 % kcal from fat and designed as HFD WT and HFD AD mice. Both groups were fed with HFD and imaged with 18F-FDG micro-positron emission tomography (PET).
Results: Chronic HFD induced hyperphagia with limited effects on basal metabolic rates in APP/PS1 mice. This excessive food intake may be at least caused by the impairment of the leptin signalling in the hypothalamus, since the intraperitoneal injection of leptin failed to activate STAT3 signaling in the hypothalamic arcuate nucleus. In addition to obesity, APP/PS1 mice fed with HFD also developed IR and consequently impaired the glucose homeostasis.18F-FDG PET showed that intraperitoneal insulin injection triggered glucose uptake into the interscapular brown adipose tissue (IBAT) in HFD fed WT but not in APP/PS1 mice.
Conclusion: The pivotal roles of AD pathogenesis on impairing the insulin and hypothalamic leptin signaling and lead to aggravated HFD-induced metabolic syndromes.
Disclosure of Interest: YH Lee Conflict with: National Yang-Ming University; HC. Hsu Conflict with: National Yang-Ming University.
Incidence and Severity of the Femoral Head Avascularity in the Patients With Femoral Neck or Intertrochanteric Fracture: Bone Single Photon Emission Computed Tomography/computed Tomography Analysis
Yeon-Hee Han*1, H J Jeong1, M H Sohn1, S J Yoon2, S T Lim1
Departments of 1Nuclear Medicine and 2Orthopedic Surgery, Chonbuk National University, Jeonju, Republic of Korea
Background/Aims: The aim of this study was to evaluate the incidence and degree of femoral head avascularity depending on the types of femoral neck or intertrochanteric fractures using preoperative 99mTc-diphosphono-1,2-propanedicarboxylic acid (99mTc-DPD) bone single photon emission computed tomography/computed tomography (SPECT/CT).
Methods: From May 2012 to December 2016, 131 patients (M:F=49:82, mean age: 78.0±9.73 years, range: 41-97 years) with femoral neck or intertrochanteric fractures who underwent preoperative 99mTc-DPD bone SPECT/CT were enrolled in the study. Femoral head avascularity was evaluated by visual and quantitative analyses of preoperative bone SPECT/CT images. Visual scores ranged from 1 to 5 based on visually assessed diagnostic confidence: 1 = definitely avascular femoral head, 2 = likely avascular femoral head, 3 = equivocal, 4 = likely not an avascular femoral head, and 5 = definitely not an avascular femoral head. In quantitative analysis, contralateral, ipsilateral, and size ratios were measured.
Results: Among 131 patients, 39 of 54 (72.22%) with femoral neck fractures and 23 of 77 (29.87%) with intertrochanteric fractures showed avascular femoral heads. The incidence of femoral head avascularity was significantly higher in patients with femoral neck fracture than in patients with intertrochanteric fracture. Whereas the incidence and severity of femoral head avascularity increased with higher Garden stage in femoral neck fracture, neither was related to AO/OTA classification in intertrochanteric fracture. In addition, the number of bony fragments around intertrochanteric fractures was not a significant predictor of femoral head avascularity.
Conclusion: Although avascular femoral head on preoperative bone SPECT/CT does not directly indicate avascular necrosis, assessing the incidence and severity of femoral head avascularity in patients with femoral neck or intertrochanteric fractures using qualitative and quantitative parameters could give clinically useful information related to clinical classification. Additional studies with larger sample sizes that correlated clinical outcomes would be a next step to expand the clinical role of bone SPECT/CT.
Hepatocellular Carcinoma: Meta-Analyses on 18F-Fluorodeoxyglucose Positron Emission Tomography
Tak Kwong Chan*1, J Wong1, F Choi1, W T Ngai1
1Department of Nuclear Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
Background/Aims: A systematic review with meta-analyses is undertaken to determine (i) the diagnostic accuracy of 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) in detection of primary hepatocellular carcinoma (HCC), (ii) prognostic value of pre-transplantation FDG PET, and (iii) prognostic value of post-treatment FDG PET.
Methods: We searched MEDLINE, PreMEDLINE, Embase, Web of Science Core Collection and Cochrane Library databases from inception to 16 November 2017, and selected original research papers which reported sufficient information to compile two-by-two table of true and false positives and negatives, or survival rates as hazard ratios by multivariate cox regression analyses. The search yielded 1550 papers.
Results: Pooled patient-based sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of FDG PET for detection of primary HCC using random effects Reitsma model were 61.0% (95%CI 52%-69.3%), 62.9% (95%CI 51.9%-72.7%), 1.64 (95%CI 1.08–2.54) and 0.620 (95%CI 0.422–0.925) respectively. Pooled hazard ratio for pre-transplantation FDG PET using fixed effects model was 5.28 (95%CI 3.27–8.53) with insignificant heterogeneity (I 2=0%, Cochran's Q [Q]=1.88, p=0.760). Pooled hazard ratio for post-treatment FDG PET after transarterial chemoembolization (TACE) or selective internal radionuclide therapy (SIRT) using fixed effects model was 2.84 (95%CI 1.84–4.39) with insignificant heterogeneity (I 2=11.4%, Q=1.90, p=0.387).
Conclusion: While FDG PET has a limited role in the diagnosis of primary HCC, it can be used to independently predict a better survival outcome for pre-transplantation selection of patients and post-TACE/SIRT prognostication.
131I-Labelled Copper Sulfide-Loaded Microspheres to Treat Hepatic Tumours Via Hepatic Artery Embolization
Qiufang Liu*1, P Li1, J Liu1, G Huang2, S Song1
1Department of Nuclear Medicine, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, 2Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
Background/Aims: Transcatheter hepatic artery embolization therapy is a minimally invasive alternative for treating inoperable liver cancer but recurrence is frequent. Multifunctional agents, however, offer an opportunity for tumour eradication.
Methods: We synthesized poly (lactic-co-glycolic acid) (PLGA) microspheres encapsulating hollow CuS nanoparticles (HCuSNPs) and paclitaxel (PTX) that were then labeled with radioiodine-131 (131I) to produce 131I-HCuSNPs-MS-PTX. This compound combines the multi-theranostic properties of chemotherapy, radiotherapy and photothermal therapy. In addition, it can also be imaged with single-photon emission computed tomography (SPECT) imaging and photoacoustic imaging. We used 18F-Fluorodeoxyglucose (FDG) micro-positron emission tomography/computed tomography (micro-PET/CT) to evaluate the effects of therapy in rats bearing Walker-256 tumour transplanted in liver.
Results: We found that embolization therapy in combination with chemotherapy, radiotherapy and photothermal therapy offered by 131I-HCuSNPs-MS-PTX completely ablated the transplanted hepatic tumours at a relatively low dose. In comparison, embolization monotherapy or combined with one or two other therapies had less effective anti-tumour efficacy. The combination of SPECT/CT and photoacoustic imaging effectively confirmed microspheres delivery to the targeted tumours in vivo and guide the near-infrared laser irradiation.
Conclusion: Our study suggests that there is clinical theranostic potential for imaging-guided arterial embolization with 131I-HCuSNPs-MS-PTX for the treatment of liver tumours.
Role of 18F-Fdg Pet-Ct in Prognostication of Different Molecular Subtypes of Breast Cancer
Avercilicia Passah*1, S Arora1, C S Bal1, R Kumar1
1Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
Background/Aims: Receptor status in breast cancer is an important prognostic factor, which may change in up to 40% of cases on repeated biopsies.18F-FDG PET/CT is well established for the management of breast cancer.
Methods: 103 diagnosed cases of breast cancer who underwent PET/CT scan with available receptor status were included in this retrospective analysis. Patients were followed till at least 1 year after their last PET/CT study. The patients were divided into 3 subgroups, group 1 (ER+, PR+/-, Her 2neu-), group 2 (ER+/-, PR+/-, Her 2neu+) and group 3 (ER-, PR-, Her 2neu-)- triple negative breast cancer (TNBC).
Results: Overall scan was abnormal in 37/42 (88%) in group 1, 33/44 (75%) in group 2 and 17/17 (100%) in group 3 (TNBC) patients. Lymph nodal metastases was seen in 26/42 (61.9%) in group 1, 25/44 (56%) in group 2 and 16/17 (94%) in group 3 which was significantly higher in group 3 (p=0.02). On evaluation of distant metastases, liver and bone involvement was significantly less (p=0.02) in group 2 (6.8%, 29%) as compared to group 1 (28%, 59%) and group 3 (23%, 41%). All 17 patients in group 3 had lung metastases (100%) as compared to group 1 (88%) and group 2 (75%). SUV ratios of primary, skeletal and lung lesions of group 3 patients were higher as compared to other groups. However, in group 2, lymph node and liver lesions showed higher SUV ratio values. On follow up of these patients, 22/42 (52%) in group 1, 15/44 (34%) in group 2 and 10/17 (58%) in group 3 patients have expired.
Conclusion: 18F-FDG PET/CT plays an important role in prognostication of different molecular subtypes of breast cancer. TNBC patients had more abnormal scans, more extent of metastatic involvement as well as death than the other molecular types.
Utility of Prostate Specific Membrane Antigen Pet/ct for Staging of Primary Prostate Carcinoma
Charles Goh*1, J Tan2, M Chua2, W Lam1
1Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, 2Division of Radiation Oncology, National Cancer Center Singapore, Singapore
Background/Aims: Prostate Specific Membrane Antigen (PSMA) PET has been demonstrated to have high sensitivity and specificity in the evaluation of prostate cancer.While its utility in biochemical recurrence has been well described, its role in primary staging is less well established. Our study aimed to evaluate the performance of PSMA PET in the primary staging of prostate cancer and identify predictors of scan positivity.
Methods: This retrospective study was approved by our Institutional Review Board. The 68Ga-PSMA-11 PET/CT scans of 63 consecutive patients referred to our institution for staging of primary prostate cancer were reviewed. Scans were evaluated for the presence of PSMA-avid nodal and distant metastases. Results were correlated with the patients' Prostate Specific Antigen (PSA) levels and Gleason scores (GS).
Results: 24 out of 63 (38%) of patients showed evidence of PSMA-avid metastatic disease. 20 (32%) patients had nodal metastases while 10 (16%) had bony metastases (6 patients had both nodal and bony metastases). The detection rate for metastatic disease was greater in patients with higher PSA values (40% at PSA >10 ng/ml vs 15% at PSA ≤10 ng/ml) and higher Gleason scores (43% with GS >7 vs 29% with GS ≤7).
Conclusion: Staging PSMA PET identified a significant number of lymph node and bony metastases, especially in patients with PSA >10 and GS >7. Detection of metastatic disease has important treatment and prognostic implications and our results highlight the value of PSMA PET for staging of patients with intermediate- to high-risk primary prostate cancer.
Perera M, Papa N, Christidis D, Wetherell D, Hofman MS, Murphy DG, et al. Sensitivity, specificity, and predictors of positive 68Ga-prostate-specific membrane antigen positron emission tomography in advanced prostate cancer: A systematic review and meta-analysis. Eur Urol 2016;70:926-37.
SPECT Myocardial Perfusion Imaging in Patients with History of Thrombolysis after Myocardial Infarction
Azmal Kabir-Sarker*1, F Nasreen1, L Nisa1, T Mandal1, S M F Begum1, R Hussain1
1National Institute of Nuclear Medicine and Allied Sciences, Dhaka, Bangladesh
Background/Aims: A timely thrombolytic therapy with streptokinase (STK) after an acute myocardial infarction (MI) is associated with reduction of infarct size and improvement of left ventricular ejection fraction (LVEF). This study describes the attributes of patients who received STK with diagnoses of an acute MI and then underwent SPECT myocardial perfusion imaging (MPI) at National Institute of Nuclear Medicine and Allied Sciences (NINMAS).
Methods: This cross-sectional retrospective study was conducted in 2017 on a group of patients who were referred to Nuclear Cardiology Division of NINMAS from February 2005 to October 2016 for SPECT MPI. Patient record files from the archive were reviewed to select all patients who received STK with diagnoses of an acute MI. Data were analysed using SPSS v.20.
Results: Among 1347 patients, 59 patients (56M:3F) had received STK after an acute MI. Mean age was 51.2±9.5 years (range: 34-72). While 36 patients underwent pharmacological stress, 15 underwent treadmill exercise and only rest imaging was performed on eight. Seventeen patients had previous coronary revascularization (CR). Coronary angiogram (CAG) revealed normal epicardial coronaries in 11, single vessels disease in 20, double vessels disease in 12 and triple vessel disease in 16. SPECT MPI revealed normal perfusion in 16 (27%) who had mean rest LVEF of 49.6±18.2%. Perfusion defects were seen in 43 (73%) with mean rest LVEF of 40.1±15.0 and mean total LV infarct size 48.0±17.8%. CAG was abnormal in 12 of 16 who had normal perfusion and in 42 of 43 who had abnormal perfusion (Pearson Chi-Square 7.73, p=0.005). Six among the 12 with abnormal CAG and normal perfusion had previous CR.
Conclusion: In this study group, 27% patients who had received STK had normal follow up perfusion while 75% of these patients who had normal perfusion, had an earlier abnormal CAG.
Prognostic Value of Left Ventricular Eccentricity Index Measured with Gated Myocardial Perfusion Single Photon Emission Computed Tomography
1Department of Nuclear Medicine, Philippine Heart Center, Quezon City, Philippines
Background/Aims: Left ventricular (LV) eccentricity index (EI) is a measure of the sphericity of the LV, and may reflect remodelling. Several studies on LV shape, measured mostly using two-dimensional echocardiography, showed that alteration in chamber configuration is associated with poorer outcome. EI is routinely measured with commonly available quantitative software for cardiac single photon emission computed tomography (SPECT). However, there is little information on the prognostic value of EI obtained with SPECT.
Methods: Sestamibi stress myocardial perfusion scintigraphy (MPS) was done using a conventional dual-head gamma camera. MPS LV parameters including EI were computed using AutoQuant®. The patients were observed for the occurrence of major adverse cardiac events (MACE) with a mean follow up period of 38 months.
Results: A total of 353 patients were included in the study. Spearman's rho revealed that rest EI among males has statistically significant negative correlation with summed stress score (SSS) (rS = -0.182), transient ischaemic dilatation (rS = -0.172), rest LV end-diastolic volume (EDV) (rS = -0.291), rest LV end-systolic volume (ESV) (rS = -0.316), post-stress LVEDV (rS = -0.278), and post-stress LVESV (rS = -0.331). There was positive relationship with rest LV ejection fraction (EF) (rS = 0.297) and post-stress LVEF (rS = 0.336). MACE was observed in 33 out of the 129 patients who were followed-up. Mean rest and post-stress EI were significantly lower in those with MACE compared to those without, with a p-value of 0.02 and 0.009, respectively. Among patients with normal SSS, those with MACE had lower EI, although the difference was not statistically significant (p = 0.09).
Conclusion: This study demonstrated that EI may be a potential predictor of future cardiac events. EI has been demonstrated to correlate with other MPS markers of prognosis.
Comparison between Standardised Uptake Value and Retention Index Images using 11C-PiB PET for Assessment of Cardiac Amyloidosis
Takani Norikane*1, Y Yamamoto1, T Noma2, Y Nishiyama1
Departments of 1Radiology and 2Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kita-gun, Kagawa, Japan
Background/Aims: The PET tracer 11C-Pittsburgh compound B (PiB) has been used with very good results for imaging β-amyloid in the evaluation of brain amyloidosis and is believed to bind to myocardial amyloid. The purpose of this study was to investigate PiB uptake for detection of cardiac amyloidosis by comparison of standardised uptake value (SUV) and retention index (RI) images.
Methods: This study was approved by our institutional ethics review board. Six patients with cardiac amyloidosis and two healthy volunteers were examined with PiB PET. A 60-min dynamic scan of the heart was started immediately after bolus injection of PiB. The RI was calculated as the mean PiB radioactivity concentration between 15 and 25 minutes after injection divided by the integral of the arterial time-activity curve between 0 and 20 minutes after injection. The RI images were visually compared with SUV images (at 10-20 min, 20-30 min, 30-40 min, 40-50 min, and 50-60 min: summed 10-min image). On SUV images, the maximal myocardium to blood pool ratio (MBR) was calculated by region-of-interest analysis.
Results: PiB uptake in lesions peaked at 20 min after injection. Among SUV images, the SUV image at 10-20 min was visually most evident for detection of amyloidosis. PiB uptake in lesions was visually seen in all 6 patients on 10-20 min SUV image and RI image. PiB uptake in normal myocardium was not seen in 2 healthy volunteers on both SUV and RI images. The mean (±SD) MBR in lesions (2.01±0.82) was higher than the MBR in normal myocardium (0.98±0.04).
Conclusion: These preliminary results indicate that PiB PET seems to be a useful imaging modality for cardiac amyloidosis. In addition, the SUV at 10-20 min might be useful for assessment of cardiac amyloidosis as well as RI image.
131I Treatment of Hyperthyroidism: Is Bigger that Much Better?
Alla Turlakow*1, M Tempest1, S Callea1, D Warwick1
1Department of Nuclear Medicine, Western Health, Melbourne, Australia
Background/Aims: Controversy remains as to optimal 131I dosing schedule for disease remission in relapsed benign hyperthyroidism whilst considering the ALARA (as low as reasonable achievable) maxim. At our centre, clinicians are favouring higher over conventional 131I doses aimed at achieving certain early hypothyroidism. Our aim was to assess the value of higher over conventional doses of 131I for treatment of benign relapsed hyperthyroidism at 12 months.
Methods: We retrospectively reviewed histories of 168 patients treated for hyperthyroidism from 2010 to 2016. 69 patients were excluded. Of 99 patients (F:M 77:22, 16-74 years) 60 patients had Graves' disease (GD) and 39 hyperfunctioning nodule(s) (HN). 98/99 had pre-treatment thyroid uptake calculated. 131I dose ranged from 6.1-15.9mCi. Pre- and post-treatment thyroid function testing was performed. TSH at 1 year was correlated with administered 131I dose and disease state.
Results: Of 99 patients, 42 (42%) became hypothyroid, 41 (41%) euthyroid and 16 (16%) remained hyperthyroid at 12 months. 39/42 (93%) of hypothyroid patients had GD. 30/39 (77%) of euthyroid patients had HN. Clinical remission as either hypothyroidism or euthyroidism occurred in 50/60 (83%) of GD and 33/39 (85%) of HN patients. In GD this occurred in 27/32 (84%) and 23/28 (82%) patients, and in HN in 21/26 (81%) and 12/13 (92%) of patients at 2 dose ranges of 6.1-12mCi and 12-15.9mCi respectively. Hyperthyroidism persisted in 10/60 (17%) GD and 6/39 (15%) HN patients.
Conclusion: Most patients treated with 131I for hyperthyroidism became similarly hypothyroid or euthyroid at high and low dose levels at one year, compatible with successful disease remission. Lower doses of administered 131I have the benefit of limiting unnecessary patient radiation exposure whilst still achieving the desired treatment outcome.
The Role of Somatostatin Analogues as a Combination with 177Lu-Octreotate and Maintenance Therapy in Metastatic Neuroendocrine Tumours
Anna Yordanova*1, M Wicharz1, K Mayer2, M Gonzalez-Carmona3, R Fimmers4, M Essler1, H Ahmadzadehfar1
Departments of 1Nuclear Medicine, 2Internal Medicine and 3University Hospital Bonn, 4Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
Background/Aims: Although somatostatin analogs (SSA) and peptide receptor radionuclide therapy (PRRT) are validated therapies in patients with advanced metastatic neuroendocrine tumours (NET), it remains unclear whether SSA combined with PRRT or as a maintenance therapy can provide prolonged survival compared to patients treated with PRRT alone. In this retrospective study, we aimed to investigate whether there is a survival benefit of adding SSA to PRRT as a combination therapy or maintenance therapy.
Methods: The investigation included 210 patients with metastatic, unresectable gastroenteropancreatic neuroendocrine tumours treated from April 2004 to June 2017 at the University Hospital of Bonn, Germany. The patients were divided into three groups: PRRT monotherapy (N=107, group 1), SSA maintenance therapy after PRRT (N=53, group 2), and combined therapy with PRRT and SSA, followed by a maintenance therapy with SSA (N=50, group 3).
Results: Data for overall survival (OS) was available from 210 patients, of which 193 had data for the progression-free survival (PFS). The median PFS was 25 months in group 1 vs. 48 and 30 months in groups 2 and 3 (log rank p=0.013). The median OS rates were 45 months (group 1), 110 months (group 2), and 63 months (group 3) (log rank p<0.001). The lowest death event rates were in group 2 (28.3%) and group 3 (36%) and the highest in group 1 (69.8%). SSA as a maintenance therapy also showed the highest clinical benefit rate (objective response plus stable disease) of 98%.
Conclusion: SSA may play a significant role in tumour control in patients with NET, who underwent a PRRT, especially as a maintenance therapy.
Disclosure of Interest: A Yordanova Conflict with: Research funding by Novartis Pharma: H Ahmadzadehfar Conflict with: Research funding by Novartis Pharma.
18F-FDG PET/CT Metabolic Parameters in Evaluating the Effects of Human Immunodeficiency Virus Infection on Tumour Volume and Response to Chemotherapy in Patients with Hodgkin Lymphoma
Ismaheel Lawal*1, A Ankrah1,2, N Nyakale3, N Mokgoro1, T Boshomane1, C Kaoma1, C Van de Wiele1,4, M Sathekge1
1Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, 3Department of Nuclear Medicine, Inkosi Albert Luthuli Central Hospital, Durban, South Africa, 2Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, 4Department of Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
Background/Aims: To evaluate the impact of Human Immunodeficiency Virus (HIV) infection on tumour burden and therapy outcome following treatment with Adriamycin, Bleomycin, Vinblastine and Dacarbazine (ABVD) 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:Female=86:50). HIV infection was present in 57 patients, while 79 patients were HIV-negative. Standardized uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were obtained on 18F-FDG PET/CT done for initial staging. All patients completed standard regimen of ABVD. After a median period of 8 weeks (range: 6 to 17 weeks), a repeat 18F-FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system. Approval was obtained from the institution's review board.
Results: The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The SUVmax, MTV and TLG of lesions were not significant different between the two groups (p>0.05). Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure (40.4% in the HIV-positive patients versus 17.7% in the HIV-negative patients, p=0.0034). HIV infection was a significant predictor of poor response to chemotherapy (p<0.001). 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 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 (OR=2.930, 95% CI 1.197-7.172, p=0.023).
Conclusion: HIV infection is not associated with a higher tumour 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.
68Ga-DOTATATE PET/CT in the Guidance of Surgical Management in Neonatal Hyperinsulinism
V Luis Salazar*1, Juan Carlos Pattillo2, Pilar Orellana3, Claudia Godoy4
1Department of Nuclear Medicine, Nuclear Medicine, Hospital Regional de Antofagasta, Antofagasta, 2Department of Pediatric Surgery, Division of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 3Department of Radiology, Nuclear Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, 4Department of Pediatric Endocrinology, Division of Pediatrics, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
Background/Aims: Congenital hyperinsulinism (HC) is the most frequent cause of persistent hypoglycemia in the newborn and it is characterized by an inappropriately elevated insulin level in presence of hypoglycemia. The initial management is medical treatment, but if it fails, partial pancreatectomy is the surgical procedure of choice. Two main subtypes are described: diffuse and focal. They share most of the clinical features but require different surgical approaches. Genetic testing and molecular biomarkers with 18F-DOPA PET/CT may suggest focal or diffuse subtype of HC, but they are not available worldwide.
Methods: Six 68Ga-DOTATATE PET/CT scans were performed in newborns with congenital hyperinsulinism.
Results: There were 3 positives cases, of which 2 were diffuse forms and 1 was focal subtype. In one patient, genetic study was consistent with focal CH. Ultrasonography and abdominal MRI were normal, 68Ga-DOTATATE PET/CT showed uptake in the body of the pancreas. Laparoscopic corporocaudal pancreatectomy was performed. The patient resolved hypoglycemia and was discharged without incidents. The diagnosis was confirmed later by biopsy.
Conclusion: We conclude that PET/CT with 68Ga-labeled peptide somatostatin analogues is a reasonable alternative to 18F-DOPA in guiding surgical approach in patients with HC if the latter radiopharmaceutical is not available.