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   2018| October-December  | Volume 17 | Issue 4  
    Online since October 26, 2018

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Quantitative accuracy of positron emission tomography/magnetic resonance and positron emission tomography/computed tomography for cervical cancer
Jorge Daniel Oldan, Amir Hossein Khandani, Julia R Fielding, Ellen Louise Jones, Paola Alvarez Gehrig, Tiffany Matoska Sills, Pinakpani Roy, Weili Lin
October-December 2018, 17(4):213-218
With the spread of positron emission tomography/magnetic resonance (PET/MR), the question of comparability of studies becomes important. We aim to determine whether PET/MR and PET/computed tomography (PET/CT) are comparable for the case of cervical cancer. Fifteen cervical cancer patients identified by either a radiation oncologist or an oncologic surgeon had both PET/MR and PET/CT performed for initial staging within 3 weeks. We then compared the results both quantitatively (measuring standardized uptake values [SUVs] on visible lesions) as well as qualitatively (having radiologists and nuclear medicine physicians interprets the results). While interpretations between PET/MR and PET/CT varied in many cases, SUVs of primary lesions were similar to within 25% in all but one case, and correlation coefficient was 0.92. Maximum SUV ranged between 4.9 and 25.2 for PET-MR and between 5.8 and 30.4 for PET-CT for primary tumors and between 1.5 and 18.8 for PET-MR and between 1.8 and 20.8 for PET-CT for nodes. However, clinical reads often varied significantly between PET/MR and PET/CT. This suggests that SUV is similar on PET/MR and PET/CT although the differing anatomic modalities available for correlation may make the difference in terms of qualitative interpretation.
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Evaluation of the physical and biological dosimetry methods in iodine-131-treated patients
Ayşegül Ozdal, Taner Erselcan, Öztürk Özdemir, Yıldıray Özgüven, Güler Silov, Zeynep Erdoğan
October-December 2018, 17(4):253-260
The aim of the study was to compare physical and biological dosimetry methods in iodine-131 (I-131)-receiving patients. The present study comprised of 47 patients (mean age: 47.9 ± 15.8 years), treated with I-131. Group I consisted of 17 patients with hyperthyroidism and mean administered activity of this group was 432.9 ± 111 MBq. There were 15 follow-up patients of differentiated thyroid cancer (DTC) in Group II with mean administered activity of 185 ± 22.2 MBq, who were administered scanning dose of I-131. Group III comprised of 15 patients with DTC, ablated with high-dose of I-131, and this group's mean administered activity was 4347.5 ± 695.6 MBq. The whole-body absorbed doses were calculated in all patients both with the Medical Internal Radiation Dosimetry (MIRD) method using MIRDOSE3 software and cytokinesis-block micronucleus (MN) assay-based MN analysis and were compared. The whole-body absorbed dose, calculated by MIRD method, showed very good correlation with the administered I-131 activity (r = 0.89, P < 0.001), but it was moderate in the MN method (r = 0.52, P < 0.01). Absorbed dose estimations with MIRD method were 49.2 ± 20.8 mGy in Group I, 6.5 ± 1.6 mGy in Group II, and 154.3 ± 47.8 mGy in Group III; the differences were statistically significant (P < 0.001), as expected. Pre- and posttreatment MN frequencies differed significantly in all groups (P < 0.05). The whole-body absorbed doses, based on MN method, were 68.2 ± 17.5, 46.0 ± 11.4, and 90.5 ± 26.9 mGy in Groups I–III, respectively. The difference was significant between Group II and Group III (P < 0.01). The mean absorbed dose was 74.6 ± 27.9 mGy with MN versus 68.0 ± 67.1 mGy in MIRD method (P = 0.087) in the entire study population and the correlation was moderate (r = 0.73, P < 0.001). The whole-body absorbed doses, estimated by MN method, showed moderate correlation with administered radioiodine activities in low radioiodine doses and had significantly different and fluctuating values as compared to MIRD method in patients treated with I-131.
  2,983 356 1
Initial risk stratification and staging in prostate cancer with prostatic-specific membrane antigen positron emission tomography/computed tomography: A first-stop-shop
Manoj Gupta, Partha Sarathi Choudhury, Sudhir Rawal, Harish Chandra Goel, Vineet Talwar, Amitabh Singh, Saroj Kumar Sahoo
October-December 2018, 17(4):261-269
Current imaging for prostate cancer (PCa) had limitations for risk stratification and staging. Magnetic resonance imaging frequently underestimated lymph node metastasis while bone scintigraphy often had diagnostic dilemmas. Prostatic-specific membrane antigen (PSMA) positron emission tomography-computed tomography (PET/CT) has been remarkable in PCa recurrence. Ninety-seven PSMA PET-CT scans were reanalyzed for tumor node metastases staging and risk stratification of lymph node and distant metastasis proportion. Histopathology of 23/97 patients was available as gold standard. Chi-square test was used for proportion comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overestimation, underestimation, and correct estimation of T and N stages were calculated. Kappa coefficient (κ) was derived for inter-rater agreement. Lymph node or distant metastasis detection on PSMA PET/CT increased significantly with increase in risk category. PSMA PET/CT sensitivity, specificity, PPV, and NPV for extraprostatic extension, seminal vesicle invasion, and lymph node metastases were 63.16%, 100%, 100%, 36.36%; 55%, 100%, 100%, 25%; and 65.62%, 99.31%, 87.50%, and 97.53%, respectively. Kappa coefficient showed substantial agreement between PSMA PET/CT and histopathological lymph node metastases (κ = 0.734); however, it was just in fair agreement (κ = 0.277) with T stage. PSMA PET/CT overestimated, underestimated, and correct estimated T and N stages in 8.71%, 39.13%, 52.17% and 8.71%, 4.35%, and 86.96% cases, respectively. PSMA PET/CT has potential for initial risk stratification with reasonable correct N stage estimation, however underestimates T stage. Hence, we concluded that PSMA PET/CT should be used as “ first-stop-shop” for staging and initial risk stratification of PCa with regional magnetic resonance imaging in surgically resectable cases.
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Clinical utility of 188Rhenium-hydroxyethylidene-1,1-diphosphonate as a bone pain palliative in multiple malignancies
Ajit S Shinto, Madhava B Mallia, Mythili Kameswaran, KK Kamaleshwaran, Jephy Joseph, ER Radhakrishnan, Indira V Upadhyay, R Subramaniam, Madhu Sairam, Sharmila Banerjee, Ashutosh Dash
October-December 2018, 17(4):228-235
188Rhenium-hydroxyethylidene-1,1-diphosphonate (188Re-HEDP) is a clinically established radiopharmaceutical for bone pain palliation of patients with metastatic bone cancer. Herein, the effectiveness of 188Re-HEDP for the palliation of painful bone metastases was investigated in an uncontrolled initial trial in 48 patients with different types of advanced cancers. A group of 48 patients with painful bone metastases of lung, prostate, breast, renal, and bladder cancer was treated with 2.96–4.44 GBq of 188Re-HEDP. The overall response rate in this group of patients was 89.5%, and their mean visual analog scale score showed a reduction from 9.1 to 5.3 (P < 0.003) after 1 week posttherapy. The patients did not report serious adverse effects either during intravenous administration or within 24 h postadministration of 188Re-HEDP. Flare reaction was observed in 54.2% of patients between day 1 and day 3. There was no correlation between flare reaction and response to therapy (P < 0.05). Although bone marrow suppression was observed in patients receiving higher doses of 188Re-HEDP, it did not result in any significant clinical problems. The present study confirmed the clinical utility and cost-effectiveness of 188Re-HEDP for palliation of painful bone metastases from various types of cancer in developing countries.
  2,697 344 5
Additive value of 99mTechnetium methylene diphosphonate hybrid single-photon emission computed tomography/computed tomography in the diagnosis of skull base osteomyelitis in otitis externa patients compared to planar bone scintigraphy
Jehan Ahmed Younis
October-December 2018, 17(4):286-292
The aim of this study was to evaluate the additive value of 99mtechnetium methylene diphosphonate (99mTc-MDP) hybrid single-photon emission computed tomography/computed tomography (SPECT-CT) in the diagnosis of skull base osteomyelitis (SBO) compared to planar bone scintigraphy (PBS). This was a single institution; prospective study included 23 patients with otitis externa, clinically suspected of SBO, all of them were diabetic. Three-phase bone scintigraphy and SPECT/CT were performed to all patients. The imaging modalities which had the most equivocal results were PBS (9/23) followed by SPECT (3/23). No equivocal results were detected with CT or SPECT-CT. SPECT-CT had the highest sensitivity (100%) and highest accuracy (95.7%) in diagnosis of SBO, whereas, PBS showed the lowest sensitivity (50%) and lowest accuracy (52.2%). In this study, SPECT-CT considered the best modality for accurate localization of the site of SBO involvement, followed by CT. SPECT and planar BS were less accurate in this consideration. When comparing the sensitivity of planar BS, CT, SPECT and SPECT/CT, statistical significance difference was detected between planar BS and SPECT (P = 0.057), planar BS and SPECT/CT (P = 0.001), and between CT and SPECT/CT (P = 0.031). No statistically significant difference was detected between SPECT and SPECT/CT (P = 0.250), CT and planar BS (P = 0.125), and between CT and SPECT (P = 0.508) In conclusion, 99Tc-MDP SPECT/CT has high sensitivity in the diagnosis of SBO and also provide accurate localization of the site of SBO.
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Its goodbye from him
John Richard Buscombe
October-December 2018, 17(4):211-212
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False-positive prostate cancer bone metastases on magnetic resonance imaging correctly classified on gallium-68-prostate-specific membrane antigen positron emission tomography computed tomography
Sofiullah Olayinka Abubakar, Yaw Ampem Amoako, Naima Tag, Tessa Kotze
October-December 2018, 17(4):305-307
Imaging in prostate cancer is important in defining the local extent of disease, nodal involvement, and identifying metastases. Bone scan is the most commonly used modality for identification of bone metastasis in prostate cancer despite its reported low sensitivity and specificity compared to magnetic resonance imaging (MRI) which is the imaging gold standard for bone metastasis. Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga PSMA PET-CT) imaging is a relatively new addition to the imaging modalities in prostate cancer. This is a report of a patient with high-risk prostate cancer with features consistent with skeletal metastases on MRI but negative for skeletal metastases on bone scan and 68Ga PSMA PET CT. Histology confirmed the absence of skeletal metastases.
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18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of unknown primary: A subgroup-specific analysis based on clinical presentation
Pradeep Thapa, Ashwini Kalshetty, Sandip Basu
October-December 2018, 17(4):219-222
The aim of this study was to explore the clinical efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in tumor detection in patients with proven or suspected carcinoma of unknown primary origin (CUP) and making a subgroup-specific analysis. This was a retrospective, cross-sectional survey of patients with CUP syndrome who were referred for 18F-FDG PET-CT studies over a 2-year period. FDG-PET-CT scans were performed in compliance with the standard whole-body protocol, i.e., at least 6 h of fasting and were carried out with injected FDG radioactivity dose between 259 MBq and 370 MBq. The time from FDG injection to PET data acquisition was between 60 and 90 min. PET/CT scanning was acquired from the skull base to the upper third of the thighs. Nonenhanced, low-dose attenuation correction CT (110/70 kV/mAs) was performed for all patients. Twenty-one patients of clinically designated with CUP (male:female = 7:14; age range: 42–70 years; mean age: 57.95 years) fulfilling the inclusion criteria were enrolled in this analysis. The patients were subdivided into two groups: A - Those with histopathological proof (n = 12); B - Those with clinical/tumor markers/radiological suspicion of malignancy (n = 9). Among the first group, the sites of metastases in decreasing order of frequency were lymph nodes (n = 9/20; 75%), brain (n = 2; 16.67%), and liver (n = 1; 8.33%). In group B, six patients (66.7%) presented with hypodense/enhancing lesions in the brain and three (33.3%) had altered marrow signal intensity of spine. Overall, hypermetabolic lesions on FDG-PET/CT indicating the primary tumor sites were identified in 14 patients (66.7%). Twelve out of 14 primary sites were subsequently proven by histopathology, whereas two patients with biopsy-proven metastatic lesions in brain, with suspicious primary site in lung had been corroborated by FDG-PET/CT revealing multiple other metastatic sites, were not biopsied and were subsequently enrolled for palliative chemotherapy. When the results were examined individually in each of the Group A and Group B, the primary tumor detection rate was 58.3% and 77.7%, respectively. The identified primary tumor sites were lung 9/14 (64.4%), uterus/cervi 2/14 (14.3%), breast 1/14 (7.1%), esophagus 1/14 (7.1%), and aryepiglottic fold 1/14 (7.1%). In conclusion, FDG-PET/CT is not only helpful in histologically proven cases of CUP (irrespective of the metastatic sites), this modality also demonstrates high tumor detection rate in patients with clinical/radiological suspicion of malignancy. Being a whole body technique, it can additionally aid in disease staging in these patients which could be potentially helpful in their clinical management.
  2,467 323 2
How comprehensive are nuclear medicine residency websites?
Taylor L. Vander Plas, Sherwin A Novin, Paul H Yi
October-December 2018, 17(4):223-227
Our goal for this study was to evaluate the comprehensiveness of nuclear medicine (NM) residency websites from the USA and Canada. The authors searched all the existing NM residency programs as listed in the Fellowship and Residency Electronic Interactive Database and the Canadian Residency Matching Service. We analyzed each website for the presence or absence of 44 elements previously identified as important considerations for medical students applying to residency. We compared criteria prevalence between regions and program size using t-tests and analysis of variance. Our results showed that, of 47 NM residencies, 9 did not have a dedicated website, leaving a total of 38 websites available for evaluation. The individual websites in the USA had a mean of 15 of 44 elements sought; in contrast, Canadian programs had 26 of 44 elements sought. The most common elements included contact e-mail, mailing address, and comprehensive faculty listings. Information about resident hometown, academic interests, and extracurricular interests was only included in 3% of the websites. Only 3% of websites included case description and 11% included rotation schedule. Courses attended were included in 5%, educational resources in 8%, and resident education was included in 5% of the websites. In conclusion, about one in five NM residency programs do not have a publicly available website. The websites that do exist are incomprehensive, containing an average of only 32% of elements sought for the USA programs and 41% of elements sought in Canadian programs. Residency program websites are an important tool in recruiting medical students. Addressing the lack of available websites as well as the gap in content of the websites that does exist may improve recruitment of students to NM residency programs.
  2,478 287 3
The assessment of radio-adaptive response in graves' hyperthyroidism patients following radioactive iodine uptake
Zahra Fazeli, Ali Shabestani Monfared, Seyed Rasoul Zakavi, Mehrangiz Amiri, Ebrahim Zabihi, Sajad Borzoueisileh, Amir Gholami, Kourosh Ebrahimnejad Gorji
October-December 2018, 17(4):270-274
Low doses of radiation affect the response of cells to higher doses; this phenomenon is called radio-adaptive response, which leads to increased resistance to subsequent higher doses. We have investigated the adaptive response using 0.37 MBq priming dose of I-131 followed by 296–444 MBq challenging dose in peripheral human lymphocyte cells. The study was performed on 42 patients with Graves' disease and 29 healthy adult persons as a control group. The patients were divided into two groups. In the first group, patients were referred for radioactive iodine therapy with a specific dose, and iodine was given to them on the day of referral. In the second group, patients were referred for radioactive iodine uptake and radioactive iodine therapy, and iodine uptake was initially performed, then 24 h later, iodine therapy was done. In both groups, 1 month after treatment, blood samples were taken to cytokinesis-block micronucleus (MN) assay. The number of MN in binuclear lymphocyte cells was counted as an end point test. The mean frequency of MN in first, second, and control groups was 75.86 ± 12.68, 71.45 ± 12.56, and 20.06 ± 7.30, respectively. Our results showed that the frequency of total chromosome aberration in both radiation groups was higher than controls. However, in the first group was higher than another group, but their difference was not statistically significant. According to the results, we cannot approve the hypothesis that 0.37 MBq I-131 administration before iodine therapy could induce a radio-adaptive response in lymphocytes of Graves' patients.
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Scintigraphic evaluation of colonic transit in children with constipation using 67Ga-citrate
José Ulisses Manzzini Calegaro, João Batista Monteiro Tajra, Janaína França De Magalhães Souto, Flávia Ribeiro Marciano, Danielle Cicarini De Landa, Sung Boon Bae, Hélio Buzon Filho
October-December 2018, 17(4):249-252
The aim of this study was to assess the colonic transit in children and teenagers with chronic constipation. Twenty patients from 1.5 to 16 years old were included (mean age = 6.9 years). Chronic constipation etiologies were as follows: congenital megacolon in 6; surgical treatment in 5 (imperforate anus 2, hip dysplasia 1, sacral teratoma 1, and paraspinal neuroblastoma 1); idiopathic chronic constipation in 5; sacral myelomeningocele in 3; and intestinal duplication in 1. Static images on the anterior projection of the abdomen were performed 1, 6, 24, 48, and 72 h after the radiotracer oral administration. Doses were 3.7 MBq of 67Ga-citrate. The images were visually analyzed and classified by the observers as normal, diffuse slow transit, right slow transit, and left slow transit. Patients' dosimetric estimation was performed also. There were four cases of diffuse slow transit that responded well to the clinical treatment, 3 of them being chronic idiopathic constipation. From five patients with right slow transit, 4 were submitted to appendicostomy (Malone surgery) with good results. There were 11 cases of left slow transit (ten at the rectosigmoid level). Five of the 6 patients with congenital megacolon had left slow transit. Patients' dose estimation was 1.9 mSv to the whole body, 1.8 mSv to the ovaries, and 1.4 mSv to the testicular. This method is simple, safe, noninvasive, provides helpful functional information, and allows therapeutic decision regarding chronic constipation.
  2,225 329 -
Comparison of hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging and positron emission tomography/computed tomography for evaluation of peripheral nerve sheath tumors in patients with neurofibromatosis type 1
Roy A Raad, Shailee Lala, Jeffrey C Allen, James Babb, Carole Wind Mitchell, Ana M Franceschi, Kaleb Yohay, Kent P Friedman
October-December 2018, 17(4):241-248
Rapidly enlarging, painful plexiform neurofibromas (PN) in neurofibromatosis type 1 (NF1) patients are at higher risk for harboring a malignant peripheral nerve sheath tumor (MPNST). Fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been used to support more invasive diagnostic and therapeutic interventions. However, PET/CT imparts an untoward radiation hazard to this population with tumor suppressor gene impairment. The use of FDG PET coupled with magnetic resonance imaging (MRI) rather than CT is a safer alternative but its relative diagnostic sensitivity requires verification. Ten patients (6 females, 4 males, mean age 27 years, range 8–54) with NF1 and progressive PN were accrued from our institutional NF Clinic. Indications for PET scanning included increasing pain and/or progressive disability associated with an enlarging PN on serial MRIs. Following a clinically indicated whole-body FDG PET/CT, a contemporaneous PET/MRI was obtained using residual FDG activity with an average time interval of 3–4 h FDG-avid lesions were assessed for both maximum standardized uptake value (SUVmax) from PET/CT and SUVmax from PET/MR and correlation was made between the two parameters. 26 FDG avid lesions were detected on both PET/CT and PET/MR with an accuracy of 100%. SUVmax values ranged from 1.4–10.8 for PET/CT and from 0.2-5.9 for PET/MRI. SUVmax values from both modalities demonstrated positive correlation (r = 0.45, P < 0.001). PET/MRI radiation dose was significantly lower (53.35% ± 14.37% [P = 0.006]). In conclusion, PET/MRI is a feasible alternative to PET/CT in patients with NF1 when screening for the potential occurrence of MPNST. Reduction in radiation exposure approaches 50% compared to PET/CT.
  2,254 237 7
Prostate-specific antigen cutoff value for ordering sodium fluoride positron emission tomography/computed tomography bone scan in patients with prostate cancer
Ismet Sarikaya, Ali Sarikaya, Abdelhamid H Elgazzar, Vuslat Yurut Caloglu, Prem Sharma, Ali Baqer, Murat Caloglu, Mahmoud Alfeeli
October-December 2018, 17(4):281-285
The use of F-18 sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) bone scan is increasing because of its higher sensitivity and specificity over standard bone scintigraphy (BS). Studies previously reported a prostate-specific antigen (PSA) cutoff value for ordering standard BS. However, this has not been determined for NaF PET yet. In this study, our goal was to determine a PSA cutoff level for ordering NaF PET/CT bone scan. Newly diagnosed and previously treated prostate cancer patients who had NaF PET/CT scan and PSA measurements within 2 mos of PET study were selected for analysis. When available, other parameters, such as Gleason score (GS), clinical stage, alkaline phosphatase levels, skeletal symptoms, and correlative image findings, were recorded. Receiver operating characteristic (ROC) analysis was performed to determine PSA cutoff values. Sixty-two patients (32 newly diagnosed and 30 previously treated) met the inclusion criteria. Near half of previously treated patients were on hormone therapy. NaF PET/CT was positive in 9 newly diagnosed (PSA mean: 91.6 ng/ml, range: 6.2–226 ng/ml) and in 6 previously treated patients (PSA mean: 146.4 ng/ml, range: 6.6–675 ng/ml). ROC analysis indicated that PSA cutoff value for NaF PET/CT positivity was >20 ng/ml in newly diagnosed and >6 ng/ml in previously treated patients. PSA cutoff value for ordering NaF PET/CT in newly diagnosed patients does not seem significantly different than the previous results for BS (>20 ng/ml). However, we found a lower PSA cutoff value of >6 ng/ml in previously treated patients.
  2,124 245 2
Giant simple biliary cyst infection treated with minimally invasive percutaneous drainage
Rafael Dahmer Rocha, Priscila Mina Falsarella, Andre Arantes Pereira De Azevedo, Rodrigo Gobbo Garcia
October-December 2018, 17(4):293-295
We describe a minimally invasive alternative approach in a patient with infected hepatic cyst to stabilize the patient before definitive surgery. A 58-year-old man presented with fever and hypotension after 2 weeks of asthenia, chills, weight loss, slight abdominal pain, and a previous asymptomatic simple hepatic cyst. On ultrasound, a giant heterogeneous hepatic cyst with thick wall was noted. A positron emission tomography-computed tomography scan was indicated and demonstrated high uptake (standardized uptake value = 7.6) in the wall of the cyst, suggestive of infection. He underwent percutaneous drainage guided by the tomography. A 12 Fr drain was positioned inside the collection and 5 L of purulent material was aspirated from the cyst, and at day 12th, surgical resection was performed. Histopatological analysis confirmed a simple biliary cyst. The patient remains asymptomatic on 1-year follow-up. Percutaneous drainage before surgical treatment allowed the definitive approach to be performed with the patient in better clinical conditions.
  2,096 223 -
Prognostic factors in breast cancer patients evaluated by positron-emission tomography/computed tomography before neoadjuvant chemotherapy
Mark K Farrugia, Sinjen Wen, Geraldine M Jacobson, Mohamad Adham Salkeni
October-December 2018, 17(4):275-280
Neoadjuvant chemotherapy (NAC) is a significant modality in breast cancer therapy. We sought to characterize prognostic factors in patients scheduled for NAC who had a pretreatment positron-emission tomography paired with diagnostic quality contrast-enhanced computed tomography (CT) (positron-emission tomography/CT [PET/CT]). A total of 118 breast cancer patients were analyzed through chart review who underwent pretreatment PET/CT imaging and received NAC from 2008 to 2014. We collected information on molecular markers, PET/CT, pathologic complete response (pCR), survival, and disease status. Pretreatment standard uptake value (SUV) max of the primary breast tumor showed no relationship to pCR; however, there was a statistically significant relationship with relapse-free survival (RFS) using univariate cox regression (P = 0.03, odds ratio (OR) = 1.06 [1.01–1.12]) with comparable findings observed with overall survival (OS). Multivariate analysis revealed SUV max to be significantly correlated with shortened OS (P = 0.022, OR = 1.08 [1.01–1.16]), with a similar trend reported for RFS. By pathological subtype, this correlation was the strongest within hormone receptor (HR+)/human epidermal growth factor receptor 2 (HER2−) tumors. In addition, Kaplan–Meier estimates demonstrated a significant difference between the RFS of triple-negative tumors and HER2 positive tumors (P = 0.001). Interestingly, within this cohort, multivariate Cox regression analysis showed HER2 positivity to be associated with favorable outcome (P = 0.04, HR = 0.22 [0.05–0.94]). These findings demonstrate a significant association between SUV max of HR+/HER2−− tumors and relapse-free and OS. Furthermore, highlighted here is the favorable survival in the once classically aggressive HER2+ breast cancer subgroup.
  2,108 203 1
Discordant interpretation of serial bone mineral density measurements by dual-energy X-ray absorptiometry using vendor's and institutional least significant changes: Serious impact on decision-making
Nosheen Fatima, Maseeh Uz Zaman, Sadaf Saleem, Noureen Hameed, Jamila Bano
October-December 2018, 17(4):236-240
Meaningful change in bone mineral density (BMD) should be equal or higher than institutional least significant change (LSC). But some facilities use vendor's LSC which is discouraged by International Society for Clinical Densitometry (ISCD). The aim of this study was to find the impact of scan interpretation upon interval BMD changes using vendors and institutional LSCs. This prospective study was conducted at Joint Commission International-accredited facility of Pakistan from April–June 2017 using Hologic Discovery-A scanner. As per ISCD recommendations, precision error and LSC of two technologists were measured. Serial BMD changes such as deterioration or improvement interpreted based on vendor's and institutional LSCs were compared. Serial BMD changes in 102 patients were included, having a mean age, male:female ratio, and mean body mass index of 63 years, 94%:06%, and 29.274 kg/m2, respectively. Mean menopausal age was 47 years and mean duration between two dual X-ray absorptiometry (DXA) studies was 3 years. BMD changes over hip were found significant in 55% and 53% cases against vendor's and institutional LSCs, respectively (nonsignificant discordance in 2%). BMD changes using vendor's and institutional LSCs were found significant over L1-4 (62% vs. 46%; discordance: 14%) and distal forearm (77% vs. 35%; discordance: 41%), respectively. Interpretations based on vendor's LSCs revealed significantly overestimated deterioration over forearm and improvement over L1-4 BMD values. We conclude that vendor's provided LSC for interpretation of serial DXA is misleading and has a significant negative impact upon patients' management. Every DXA facility must use its own LSC as per ISCD guidelines. Furthermore, ISCD must consider publishing cutoff values for LSC for distal forearm measurement.
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Academic Proceedings - 18th Biennial Congress of the South African Society of Nuclear Medicine (SASNM) 10th – 12th August 2018

October-December 2018, 17(4):308-348
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First case on fluorodeoxyglucose positron emission tomography/computerized tomography of a distant skip metastases to parotid node from esophageal adenocarcinoma
Vincenzo Militano, Sivakumar Muthu, Naheed Farooq, Rakesh Sajjan
October-December 2018, 17(4):302-304
We are presenting the first case of a gastro-oesophageal junction adenocarcinoma with metastasis only to the intraparotid lymph node simulating Warthin's tumor. A 66-year-old man underwent an esophagogastroduodenoscopy that found circumferential ulcerated esophageal tumor beginning 40 cm from incisors resulting in stricture and two discrete erosions in the proximal third of esophagus. Biopsies from the stricture have demonstrated a poorly differentiated gastric adenocarcinoma. Computerized tomography (CT) confirmed the site of primary without evidence of distant metastasis. Positron emission tomography/CT showed high uptake in the known carcinoma in distal esophagus involving the gastro-oesophageal junction extending into the cardia of the stomach, the maximum standardized uptake value (SUVmax) 7.4. Furthermore, there was a focus of high-grade tracer activity, SUVmax 6.2, in the left intraparotid nodule which was initially thought to represent Warthin's tumor rather than metastasis; there was no evidence to suggest metastases elsewhere. Fine needle aspiration and biopsy from the enlarged intraparotid lymph node revealed that the histology was consistent with a poorly differentiated adenocarcinoma, metastasis from upper gastrointestinal tract.
  1,991 174 -
False-positive technetium-99m methylene diphosphonate bone scan activity in the orbit in a patient with a history of breast carcinoma
Sarah E Bonnet, Joel R Palko
October-December 2018, 17(4):299-301
Metastasis of breast carcinoma to the orbit is an uncommon entity and carries a poor prognosis. This case report presents false-positive technetium-99m methylene diphosphonate activity in the right orbit of a patient with a history of a primary breast neoplasm. Orbital computed tomography imaging was obtained to further characterize the radiotracer uptake identified on the bone scan and demonstrated diffuse right globe intraocular calcifications secondary to degenerative intraocular changes. A brief literature review of orbital metastasis from breast carcinoma and causes of intraocular calcification in the context of chronic vision loss are provided.
  1,898 211 -
Fluroine-18 fluorodeoxyglucose-positron emission tomography/computer tomography in staging of renal cell carcinoma arising from a native kidney with liver and bone metastasis in a renal transplant patient
Koramadai Karuppusamy Kamaleshwaran, Bharat Rangarajan, Raghi Paramben Jose, Ajit Sugunan Shinto
October-December 2018, 17(4):296-298
Renal cell carcinoma (RCC) of the native kidney accounts for <5% of all malignancies found in transplant recipients. There have been only a few reported cases comprising of few renal transplant patients with RCC of native kidneys due to the relative rarity of the condition. Fluorine-18 Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is used in the staging of RCC. Prognosis of metastatic RCC is poor. We report the first case of 55-year-old postrenal transplant recipient diagnosed with RCC of the native kidney with liver and bone metastases imaged using F-18 FDG PET/CT.
  1,915 161 -