Anren Kuang

Influence of vitamin C on salivary absorbed dose of 131I in thyroid cancer patients: a prospective, randomized, single-blind, controlled trial.

In this study, vitamin C was administered at various times as a sour stimulant to thyroid cancer patients, and the effect on salivary absorbed dose of therapeutic radioiodine (131I) was investigated. Methods: Patients with differentiated thyroid cancer who had been prepared for thyroid remnant ablation after total thyroidectomy were prospectively recruited and, using a random-number table, were divided into 4 groups. In the hypothyroid condition, the patients in groups A, B, C, and D began sucking vitamin C (100 mg every 4 h in the daytime over 6 d) at 1, 5, 13, and 25 h, respectively, after receiving 3.7 GBq of 131I. Scintigraphic images of the head and neck were serially acquired after 131I administration to assess biokinetics in the salivary glands. Calculation of salivary absorbed dose was based on the MIRD schema of the Society of Nuclear Medicine. Results: Seventy-two patients (18, 18, 19, and 17 patients from groups A, B, C, and D, respectively) were eligible for the analysis of salivary dosimetry. Differences in absorbed doses to the parotid salivary gland (0.18 ± 0.11, 0.16 ± 0.07, 0.16 ± 0.09, and 0.16 ± 0.12 mGy/MBq in groups A, B, C, and D, respectively; P = 0.37) and submandibular salivary gland (0.19 ± 0.05, 0.17 ± 0.05, 0.18 ± 0.07, and 0.17 ± 0.06 mGy/MBq, respectively; P = 0.28) were not statistically significant among groups. Salivary cumulated activities arising from the first 24 h after 131I administration accounted for 86.08% ± 7.89% (range, 75%−98%) of total cumulated activities. Differences in salivary absorbed dose during the first 24 h were not statistically significant among the 4 groups either (P = 0.32 and 0.24, respectively, for the parotid and submandibular salivary glands). Conclusion: Salivary stimulation with vitamin C at any time after 131I administration has only a limited effect on salivary absorbed dose in thyroid cancer patients.

Performance of DWI in the Nodal Characterization and Assessment of Lung Cancer: A Meta-Analysis

OBJECTIVE The purpose of this study is to assess the diagnostic performance of DWI in the N stage assessment of patients with lung cancer. MATERIALS AND METHODS The PubMed, EMBASE, Cochrane Library, Web of Science, and EBSCO English-language databases and two Chinese-language databases were searched for eligible studies. On the basis of the data extracted from included studies, we determined the pooled sensitivity and specificity, calculated the positive and negative likelihood ratios, and constructed summary ROC curves. In addition, we also performed threshold effect analysis, metaregression analysis, subgroup analysis, and publication bias analysis to explain the source of heterogeneity. RESULTS A total of 18 articles involving 1116 patients met the inclusion criteria. On a per-patient basis, the pooled sensitivity and specificity estimates of DWI were 0.68 (95% CI, 0.63-0.73) and 0.92 (95% CI, 0.90-0.94), respectively. On a per-lesion basis, the corresponding estimates were 0.72 (95% CI, 0.69-0.75) for sensitivity and 0.96 (95% CI, 0.95-0.96) for specificity. Only the analysis method (quantitative vs qualitative) affected the diagnostic accuracy on the basis of subgroup and metaregression analysis. CONCLUSION Current evidence suggests that DWI is beneficial in the nodal assessment of patients with lung cancer, and it is necessary to conduct high-quality prospective studies regarding the use of DWI in detecting metastatic lymph nodes of lung cancer to determine its true value.

Iodine kinetics and dosimetry in the salivary glands during repeated courses of radioiodine therapy for thyroid cancer

PURPOSE The present study was conducted to investigate salivary iodine kinetics and dosimetry during repeated courses of radioiodine ((131)I) therapy for differentiated thyroid cancer (DTC). Such data could provide a better understanding of the mechanisms of (131)I induced salivary toxicity and help to develop appropriate methods to reduce this injury. METHODS Seventy-eight consecutive DTC patients (mean age 45 ± 17 years, 60%, female) undergoing (131)I therapy for remnant ablation or metastatic tumors were prospectively recruited. Planar quantitative scintigraphy of head-neck images was serially acquired after administration of 2.9-7.4 GBq of (131)I to assess kinetics in the salivary glands of patients. Salivary absorbed doses were calculated based on the schema of Medical Internal Radiation Dosimetry. RESULTS The maximum uptakes in percentage of administered (131)I activity per kilogram of gland tissue (%/kg) were 12.9% ± 6.5%/kg (range, 0.4%-37.3%/kg) and 12.3% ± 6.2%/kg (range, 0.4%-35.1%/kg) for the parotid and submandibular glands, respectively. Statistically significant correlations of maximum uptake versus cumulative activity (r = -0.74, P < 0.01, for the parotid glands; r = -0.71, P < 0.01, for the submandibular glands) and treatment cycle (P < 0.001, for both gland types) were found. The effective half-lives of (131)I in the parotid and submandibular glands were 9.3 ± 3.5 h (range, 1.5-19.8 h) and 8.6 ± 3.2 h (range, 0.8-18.0 h), respectively. A statistically significant correlation was observed between effective half-life with cumulative activity (r = 0.37, P < 0.01) and treatment cycle (P = 0.03) only for the parotid glands. The calculated absorbed doses were 0.20 ± 0.10 mGy/MBq (range, 0.01-0.92 mGy/MBq) and 0.25 ± 0.09 mGy/MBq (range, 0.01-1.52 mGy/MBq) for the parotid and submandibular glands, respectively. The photon contribution to the salivary absorbed dose was minimal in relation to the beta dose contribution. Photon-absorbed dose fractions of total absorbed dose were 4.9% ± 1.3% (range, 1.1%-8.7%) and 3.7% ± 2.5% (range, 0.8%-7.9%) for the parotid and submandibular glands, respectively. CONCLUSIONS The iodine uptake of salivary glands is continuously reduced during the courses of therapy. The phenomenon of hyper-radiosensitivity may to some extent account for the occurrence of salivary gland hypofunction at very low radiation doses with low dose rates in (131)I therapy. On the other hand, failure to incorporate a nonuniform and preferential uptake by salivary gland ductal cells may result in underestimating the actual dose for the critical tissue. Other methods, including (124)I voxel-based dosimetry, are warranted to further investigate the (131)I-induced salivary gland toxicity.

Cerebral infarction on 99mTc-MDP SPECT/CT imaging.

A 70-year-old man with lung cancer underwent whole-body MDP bone scintigraphy to evaluate bone metastases that showed marked tracer uptake in the right side of the head, suggestive of skull metastasis. SPECT/CT imaging was performed for further evaluation. The SPECT images demonstrated increased MDP activity in the region of the brain perfused by the right middle cerebral artery. On CT images, there was a large hypoattenuation area corresponding to elevated MDP accumulation. At the same day, magnetic resonance angiography of the brain revealed occlusion of the right middle cerebral artery.

Comparison of Presentation and Clinical Outcome between Children and Young Adults with Differentiated Thyroid Cancer

BACKGROUND The aim of the present study was to evaluate the presentation, clinical course and outcome between children and young adults with differentiated thyroid cancer (DTC) treated in our hospital. MATERIALS AND METHODS The medical records of 145 patients with DTC who underwent surgery followed by radioiodine and thyroid hormone (TSH) suppression were retrospectively reviewed. The follow up was between January 2006 and June 2012. These patients consisted of 38 children (age ≤ 18 y) and 107 young adult patients (age ≤ 30 y). The clinical characteristics and outcome were analyzed and compared, and the progression-free survival (PFS) was evaluated using the Kaplan-Meier method. RESULTS At initial diagnosis, a greater degree of extra thyroidal extension was found in children than adults patients (p<0.001). However, there was no significant difference between the two groups with regard to the tumor size and the presence of lymph node or distant metastasis (p=0.172, p=0.050 and p=0.068, respectively). The extent of surgery and the cumulative or mean dose of radioiodine were similar in both groups. During the follow up, the overall survival rate was 100% for both groups, and the PFS rate was similar in children and in young adults group (log rank test, χ2=0.126, p=0.723). CONCLUSIONS In comparison to the young adult patients, DTC in children presents with more aggressive behavior, but outcomes are similar between the two groups after the intensive management of surgery followed by radioiodine and TSH suppression therapy.

Thyroid Cancer: Radiation Safety Precautions in 131I Therapy Based on Actual Biokinetic Measurements

PURPOSE To formulate radiation precautions for patients with thyroid cancer who are undergoing thyroid hormone withdrawal-induced hypothyroidism and iodine 131 ((131)I) therapy through actual biokinetic measurements. MATERIALS AND METHODS Informed consent and institutional review board approval were obtained. From October 2008 to December 2011, consecutive patients with differentiated thyroid cancer who had been prepared for (131)I ablation treatment or (131)I treatment for metastatic disease during follow-up were prospectively recruited. Calculations based on deduced whole-body retention and measured iodine biokinetics in thyroidal tissue were derived to determine the thyroidal and extrathyroidal compartment uptake fractions and effective half-lives. Precaution times necessary to avoid close contact with family members and the general public were derived from these parameters and regulatory dose limits. RESULTS Seventy-seven patients (36 with ablation treatments, 41 with follow-up treatments) were eligible for the analysis. Actual dose rates from patients after therapeutic (131)I administration were greatly lower than those described in the American Thyroid Association (ATA) and Nuclear Regulatory Commission (NRC) models: The mean initial dose rate at 0.3 m for patients with ablation treatment was only 28% (0.183/0.655 µSv/h/MBq) ± 2.9 (standard deviation) (range, 12.1%-38.3%) and 36% (0.183/0.511 µSv/h/MBq) ± 3.7 (range, 15.5%-49.1%) of that described in the NRC and ATA models, respectively; the equivalent values for patients with follow-up treatment were only 30% (0.195/0.655 µSv/h/MBq) ± 3.5 (range, 12.5%-45.3%) and 38% (0.195/0.511 µSv/h/MBq) ± 4.5 (range, 16.0%-58.1%), respectively. The actual mean effective (131)I half-life in the thyroid remnant tissue was greatly lower than that described in the ATA and NRC models: 47.6 versus 175.2 hours. CONCLUSION On the basis of the current dose limits, typically administered activities of 3.7 GBq to a patient with ablation treatment or 7.4 GBq to a patient with follow-up treatment required 3 days of sleeping apart for keeping the doses to pregnant women and children below 1 mSv. No precautions were required for non-cosleeping nonpregnant adult family members.

Coexistence of Papillary Thyroid Carcinoma With Thyroid MALT Lymphoma in a Patient With Hashimoto's Thyroiditis: A Clinical Case Report.

AbstractPapillary thyroid carcinoma (PTC) is the most common type of thyroid neoplasias; however, primary thyroid gland lymphoma (PTL) is uncommon and their simultaneous occurrence is very rare.Herein, we reported a 25-year-old female patient with Hashimotos thyroiditis (HT), who developed a small goiter with a palpable 1.2-cm nodule in the right lobe. A fine-needle aspiration (FNA) biopsy revealed atypical follicular epithelial cells and lymphoid cells in a background of lymphocytic thyroiditis. A total thyroidectomy was performed. The pathology showed multicentric papillary thyroid carcinoma, concomitant thyroid mucosa-associated lymphoid tissue (MALT) lymphoma, and Hashimotos thyroiditis. Postoperatively, he received chemotherapy and radioactive iodine ablation treatment. Nowadays the thyroglobulin of the patient is undetectable, without recurrences at 2 years of follow-up.It is concluded that the PTC and MALT lymphoma can exist concomitantly, especially in patients with HT. For the diagnostic workup and optional management of this rare coexistence, a multidisciplinary approach and close surveillance are needed.

Adult-onset hypophosphatemic osteomalacia associated with Sjogren syndrome: Clinical case report

Rationale: Hypophosphatemic osteomalacia (HO) is a metabolic bone disease, exhibiting different etiologies such as genetic mutation, tumor induction, dysimmunity, or renal disease. Sjogrens syndrome (SS) is a connective tissue disorder commonly involving exocrine glands; however kidney involvement is also encountered, leading to abnormal phosphorus metabolism, even HO. Patient concerns: A 47-year-old female patient presented progressively worsening pain in the chest wall, back and bilateral lower extremities as well as muscle weakness was referred to our department. Diagnoses, interventions and outcomes: Due to the laboratory test results, radiographic findings and pathologic results, she was diagnosed with adult-onset HO associated with SS. She was then treated with alkalinization, steroids, neutral phosphate, calcium supplements together with activated vitamin D. So far, she recovered uneventfully with relieved pain and increased serum phosphorus level. Lessons: HO may be secondary to renal tubular acidosis of SS patients, and it might be a diagnostic challenge when the kidney involvement in SS is latent and precede the typical sicca symptoms.

Capillary Hemangioma of Thoracic Spinal Cord: Pet/ct and Mr Findings

Capillary hemangiomas are frequently encountered superficially in the cutaneous, subcutaneous, or mucosal tissues during the childhood and early adulthood, but the occurrence of spinal intradural capillary hemangioma is relatively rare. Herein, we report a case with capillary hemangioma of the thoracic spine. MR and PET/CT features of this lesion are presented, and awareness of this entity may help differentiate it from other spinal intradural tumors.

False-positive Uptake of Radioiodine in Renal Hamartoma in a Patient With Differentiated Thyroid Cancer

A 46-year-old woman with a history of papillary thyroid cancer status post total thyroidectomy underwent the second I radioiodine ablation therapy for lung metastases. Posttherapeutic whole-body I planar images showed diffuse uptake in the lungs and intense focal activity in both sides of the upper abdomen. SPECT/CT of the abdomen localized the uptake in the upper pole of the left kidney and the lower pole of the right kidney. The patient received bilateral partial nephrectomy with pathology demonstrating that these 2 renal lesions were renal hamartomas.