Cumali Aktolun

Clinical experience with Tc-99m MIBI imaging in patients with malignant tumors. Preliminary results and comparison with Tl-201.

Tc-99m MIBI imaging was performed in 34 patients with histopathologically proven malignant tumors. The study was performed in two steps. In the first step, only Tc-99m MIBI imaging was performed (Group 1). In the second step, both Tc-99m MIBI and TI-201 imaging were performed for comparison (Group 2). Seventeen patients were studied in each step. The size of the smallest primary tumor (breast cancer) was 15 × 10 mm, and that of the largest (lung cancer) was 145 × 130 mm. Of the 34 patients, 26 showed Tc-99m MIBI uptake at the tumor site. In Group 1, 12 patients showed Tc-99m MIBI tumor uptake, but no uptake was detected in five patients (squamous cell carcinoma of the esophagus, teratoma of the testis, nonHodgkins lymphoma, and squamous cell carcinoma of the lung). In Group 2, 13 patients showed both Tc-99m MIBI and TI-201 uptake at the tumor site, but one patient with breast cancer showed only Tc-99m MIBI uptake, and three patients showed no Tc-99m MIBI and TI-201 uptake (embryonal cell carcinoma of the testis, hepatocellular carcinoma). The overall sensitivity of Tc-99m MIBI imaging was 76.4%. In Group 2, the sensitivity was 82.3% for Tc-99m MIBI and 76.4% for TI-201. Our preliminary clinical experience suggests that Tc-99m MIBI can be helpful in localizing malignant tumors and that its sensitivity is slightly higher than TI-201.

131I/123I-metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging.

The aim of this document is to provide general information about mIBG scintigraphy in cancer patients. The guidelines describe the mIBG scintigraphy protocol currently used in clinical routine, but do not include all existing procedures for neuroendocrine tumours. The guidelines should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary from one country to another and from one medical institution to another. The present guidelines have been prepared for nuclear medicine physicians and intend to offer assistance in optimizing the diagnostic information that can currently be obtained from mIBG scintigraphy. The corresponding guidelines of the Society of Nuclear Medicine (SNM) and the Dosimetry, Therapy and Paediatric Committee of the EANM have been taken into consideration, and partially integrated into this text. The same has been done with the most relevant literature on this topic, and the final result has been discussed within a group of distinguished experts.

111In-pentetreotide scintigraphy: procedure guidelines for tumour imaging.

This document provides general information about somatostatin receptor scintigraphy with 111In-pentetreotide. This guideline should not be regarded as the only approach to visualise tumours expressing somatostatin receptors or as exclusive of other nuclear medicine procedures useful to obtain comparable results. The aim of this guideline is to assist nuclear medicine physicians in recommending, performing, reporting and interpreting the results of 111In-pentetreotide scintigraphy.

Breast scintigraphy: procedure guidelines for tumour imaging

The purpose of this document is to provide general infor-mation about bone scintigraphy in oncology. Theseguidelines describe procedures currently in routine clini-cal use but should not be interpreted as excluding alterna-tive procedures also employed to obtain equivalent data.It must be remembered that the resources and facilitiesavailable to care for patients may vary from one countryto another and from one medical institution to another.This document has been prepared primarily for nuclearmedicine physicians and is intended to offer assistance inoptimising the diagnostic information that can currentlybe obtained from bone scintigraphy. The correspondingguidelines from the Society of Nuclear Medicine (SNM)have been taken into consideration, reviewed and partial-ly integrated into this text. In addition, the literature onthis topic has been reviewed and discussed by an interna-tional group of distinguished experts.

FDG-PET: procedure guidelines for tumour imaging

F]fluorodeoxyglucose positron emission tomography (FDG-PET) in oncology. These guidelinesdo not include all the existing procedures for FDG-PETbut describe only the most common FDG-PET protocolsused in the current clinical routine studies. For this rea-son, some techniques, such as dynamic tomographicstudies, and some instruments, such as gamma camerasfor coincidence imaging, are only touched upon. Theguidelines should therefore not be taken as inclusive ofall possible PET procedures or exclusive of other nuclearmedicine procedures useful to obtain comparable results.It should be remembered that the resources and the facil-ities available for patient care may vary from one coun-try to another and from one medical institution to an-other. The present guide has been prepared for nuclearmedicine physicians and is intended to offer assistance inoptimising the diagnostic information that can currentlybe obtained from FDG-PET imaging. The Guidelines ofthe Society of Nuclear Medicine (SNM), the ProceduresGuidelines for Brain Imaging Using FGD (EANM) andthe existing guidelines for PET of some European Soci-eties have been reviewed and integrated into the presenttext. The same has been done with the most relevant

Assessment of tumour necrosis and detection of mediastinal lymph node metastasis in bronchial carcinoma with technetium-99m sestamibi imaging: comparison with CT scan

Thirty-eight patients with four major types of bronchial carcinoma were studied to evaluate technetium-99m sestamibi imaging in the assessment of tumour necrosis and the detection of hilar and mediastinal lymph node metastasis. Quantitative analysis was also performed to ascertain whether tumour uptake values correlate with histological types of bronchial carcinoma. Of the patients, 34 showed tumour uptake on planar imaging (n = 38) and 27 on single-photon emission tomography (SPET) (n = 29), the overall sensitivity in the localisation of primary tumour being 89% with planar imaging and 93% with SPET. Four types of tumour uptake pattern were identified: (1) focal uptake, (2) focal uptake with a central hypoactive focus, (3) ring-like uptake and (4) no uptake (negative uptake). Tumour necrosis was diagnosed in 12 patients based upon histopathology (n = 2) and density measurements and type of contrast enhancement on computed tomography (CT) scan (n = 12). Defective tumour uptake was seen in 11 of these patients on planar images (focal uptake with a central hypoactive focus, n = 7; ring-like uptake, n = 2; and no tumour uptake, n = 2) and in 12 patients on SPET (focal uptake with a central hypoactive focus, n = 7, ring-like uptake, n = 3, and no uptake, n = 2). Hilar and mediastinal lymph node involvement was detected in ten patients on CT scan, nine on planar images and 11 on SPET. A total of 26 metastatic lymph nodes were detected on CT scan; 24 of these were seen on planar, and all 26 on SPET images. SPET disclosed five further lymph nodes with metastasis, all of which were confirmed by histopathological examination of the surgical material (n = 3). The sensitivity in establishing the hilar and mediastinal disease was 90% on planar images, and 100% on SPET slices, but when the number of lymph nodes was taken into account, these values were 62% and 100%, respectively. Also, brain metastases were detected with SPET in three patients. The results of quantitative analysis of tumour uptake did not differentiate between squamous cell carcinoma and adenocarcinoma. We conclude that 99mTc-sestamibi, particularly with SPET imaging, is potentially useful in the follow-up of patients with bronchial carcinoma by differentiating residual or recurrent disease from postradiotherapy necrosis, and is as sensitive as CT scan in the detection of hilar and mediastinal lymph node metastasis.

Diagnosis of complete ectopic lingual thyroid with Tc-99m pertechnetate scintigraphy

The authors present four cases of ectopic lingual thyroid disease diagnosed by Tc-99m pertechnetate scanning, which is an efficient diagnostic tool that yields high-quality images in this clinical setting.

Why the European Association of Nuclear Medicine has declined to endorse the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer

Recently the American Thyroid Association (ATA) released the third version of one of the most cited differentiated thyroid cancer (DTC) guidelines under the title B2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer^ [1]. Compared to the earlier versions [2, 3], these guidelines are a major departure, as the volume of the text, the number of recommendations and the number of references have increased considerably. We fully understand the effort involving many hours of work that must have been required for the rigorous screening of the literature to produce the evidence tables and the eventual definitions of the recommendations. The document consists of roughly 73,000 words which make up the 101 recommendations and the explanatory text and comments. In the current ATA guidelines, most of the text appears eminently sensible and represents a significant advance from previous DTC-related guidelines published by the ATA as well as other societies, including the 2008 European Association of Nuclear Medicine (EANM) guidelines on I therapy of DTC [4–7]. For instance, we welcome the clear division of indications for initial I treatment of DTC patients after total thyroidectomy into ablation, adjuvant therapy and therapy. Furthermore, this change in terminology which we strongly support much more clearly delineates the role of I in the care of patients with DTC in other disciplines, especially medical oncology. Considering all the factors that have to be weighed in formulating recommendations this is a huge dedicated effort that has come to fruition.

Tc-99m MIBI uptake in pulmonary sarcoidosis: preliminary clinical results and comparison with Ga-67

&NA; During tumor imaging research, the authors incidentally discovered that Tc‐99m MIBI is taken up by pulmonary sarcoidosis. In order to evaluate this uptake, they performed Tc‐99m MIBI planar and SPECT imaging in 7 patients and compared it with Ga‐67. Six out of 7 patients showed evident uptake of Tc‐99m MIBI in enlarged hilar lymph nodes. One of the patients, who had been on corticosteroid treatment, showed only faint uptake (negative result), in whom Ga‐67 uptake was seen in hilar lymph nodes although it was less evident than the uptake in the other patients. The lymph nodes were better demonstrated with Tc‐99m MIBI. The fact that enlarged hilar lymph nodes in a patient on corticosteroid treatment showed faint uptake suggests that Tc‐99m MIBI could be helpful for assessing the response to treatment. The preliminary experience in a limited number of patients showed that Tc‐99m MIBI is taken up by pulmonary sarcoidosis and it appears to be a potential alternative to Ga‐67. Further study is necessary to evaluate its ultimate role in pulmonary sarcoidosis imaging.

Hepatic and splenic uptake of Tc-99m HDP in multiple myeloma: Additional findings on Tc-99m MIBI and Tc-99m sulfur colloid images

The authors present a case of multiple myeloma with intense hepatic and spienie uptake on Tc-99m HDP bone scan and discuss its clinical implications and possible uptake mechanisms. Tc-99m MIBI and Tc-99m sulfur colloid were used to demonstrate bone marrow involvement and focal lesions of multiple myeloma.