Euclides Timóteo da Rocha

DIAGNOSIS of REGIONAL CEREBRAL BLOOD FLOW ABNORMALITIES USING SPECT: AGREEMENT BETWEEN INDIVIDUALIZED STATISTICAL PARAMETRIC MAPS and VISUAL INSPECTION BY NUCLEAR MEDICINE PHYSICIANS WITH DIFFERENT LEVELS of EXPERTISE IN NUCLEAR NEUROLOGY

INTRODUCTION: Visual analysis is widely used to interpret regional cerebral blood flow (rCBF) SPECT images in clinical practice despite its limitations. Automated methods are employed to investigate between-group rCBF differences in research studies but have rarely been explored in individual analyses. OBJECTIVES: To compare visual inspection by nuclear physicians with the automated statistical parametric mapping program using a SPECT dataset of patients with neurological disorders and normal control images. METHODS: Using statistical parametric mapping, 14 SPECT images from patients with various neurological disorders were compared individually with a databank of 32 normal images using a statistical threshold of p<0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). Statistical parametric mapping results were compared with visual analyses by a nuclear physician highly experienced in neurology (A) as well as a nuclear physician with a general background of experience (B) who independently classified images as normal or altered, and determined the location of changes and the severity. RESULTS: Of the 32 images of the normal databank, 4 generated maps showing rCBF abnormalities (p<0.05, corrected). Among the 14 images from patients with neurological disorders, 13 showed rCBF alterations. Statistical parametric mapping and physician A completely agreed on 84.37% and 64.28% of cases from the normal databank and neurological disorders, respectively. The agreement between statistical parametric mapping and ratings of physician B were lower (71.18% and 35.71%, respectively). CONCLUSION: Statistical parametric mapping replicated the findings described by the more experienced nuclear physician. This finding suggests that automated methods for individually analyzing rCBF SPECT images may be a valuable resource to complement visual inspection in clinical practice.

Breast Hemangioma Investigation – A Rare Condition Documented by Nuclear Medicine, Radiology and Pathology

Suellen Strada Ferreira, MD, Renato Ramos Barra, MD, Monica Carboni Pereira Goncalves, MD, MSc, Cristine Norwig Galvao, MD, MSc, Gisele C Santos, MD, Artemis Alexandrino, MD, Rene Aloisio Costa Vieira, MD, PhD, Euclides Timoteo da Rocha, MD, PhD, and Sonia Marta Moriguchi, MD, PhD, Departments of Nuclear Medicine, Radiology, Mastology and, Pathology of Barretos Cancer Hospital and Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University (UNESP), Brazil

The use of Cardiac 123I-mIBG Scintigraphy in Clinical Practice: The Necessity to Standardize!

A avaliacao da atividade adrenergica cardiaca atraves de exames de imagem apresenta grande potencial em uma ampla variedade de aplicacoes clinicas. A cintilografia miocardica com 123I-mIBG desempenha papel importante na avaliacao de insuficiencia cardiaca cronica (ICC) ao estratificar o risco de pacientes para eventos cardiacos. A mIBG, um analogo da norepinefrina (NE), pode ser utilizada para avaliar a atividade simpatica cardiaca ao se analisar a diminuicao da expressao do adrenorreceptor (AR) β na ICC. Alem disso, a cintilografia miocardica com 123I-mIBG em combinacao com outros parâmetros de funcao ventricular esquerda pode ser usada para identificar o melhor respondedor a dispositivos cardiacos implantaveis, assim como avaliar cardiotoxicidade oncologica. Ainda que util, a cintilografia miocardica com 123I-mIBG nao e amplamente realizada devido a falta de padronizacao entre as diferentes instituicoes. Portanto, sua padronizacao e validacao podem contribuir para sua aceitacao na pratica clinica.Mailing Address: Euclides Timóteo da Rocha Rua Antenor Duarte Vilela, 1331. Postal Code: 14784-700 – Bairro Dr. Paulo Prata, Barretos, São Paulo, SP – Brazil. E-mail: euclidestimoteo@uol.com.br The use of Cardiac 123I-mIBG Scintigraphy in Clinical Practice: The Necessity to Standardize! Euclides Timóteo da Rocha,1 Wilson Eduardo Furlan Matos Alves,1 Derk O. Verschure2 e Hein J Verberne2 Departamento de Medicina Nuclear, Hospital do Câncer de Barretos,1 Barretos, São Paulo, Brasil; Departamento de Radiologia e Medicina Nuclear, Academic Medical Center,2 Amsterdã the Netherlands

Cerebral perfusion and automated individual analysis using SPECT among an obsessive-compulsive population

OBJECTIVE: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. METHODS: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. RESULTS: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07%. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8% of the sample. CONCLUSION: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

Importância da cintilografia com gálio-67 no linfoma cutâneo primário de células B: relato de dois casos

Os autores relatam dois casos de linfoma cutâneo de celulas B, nos quais o correto estadiamento, tratamento e seguimento foram possiveis gracas a combinacao de exames convencionais e a cintilografia com galio-67.

Physiotherapeutic stimulation: early lymphedema prevention in axillary lymph node dissection of breast cancer

The aim of this study was to assess the correlation between SUV values on 18F‐FDG PET/CT studies with histophatological findings as polymorphonuclear (PMN) in patients with suspected non‐small cell lung cancer (NSCLC). Material and methods: 58 patients with suspected NSCLC (43 male) were studied. All had complete surgical resection and were diagnosed based on the WHO classification of NSCLC. PET imaging was performed with hybrid PET/CT scanner 60 min after 370 Mbq 18F‐FDG administrations. Tumour lesions were identified as areas of focally increased uptake in the lungs. For semi‐quantitative analysis, the maximum standardized uptake value (SUV) was calculated. Histopathological findings as polymorphonuclear, tumour infiltrating lymphocites, necrosis and vascular invasion were examinated in a section of surgically resected lung lesion. We compared SUV with these histophatological findings with two subgroups defined as the presence or not of every of these findings. Results: PET/CT showed focal uptake in primary tumour in all cases. Vascular invasion were observed in 21 patients (36,2%), PMN in 14 (24,1 %), infiltrating lymphocites in 51 (88 %) and necrosis in 34 (58,6 %). Non significant correlation was observed with 18F‐FDG PET SUV value with tumour infiltrating lymphocites, necrosis or vascular invasion. On the other hand, significant correlation was observed between SUV values with polymorphonuclear analysis (p < 0,001). PMN subgroup showed a higher SUV values (mean 14, standard error 6,3) than the non PMN subgroup (mean 9, standard error 6,7). Conclusion: We observed significant differences between SUV values on 18F‐FDG PET with the presence of PMN in NSCLC. Surgically resected lung lesion with PMN showed higher SUV in all the cases studied. PW067 Correlation of SUV on 18F-FDG PET Uptake with Ki-67/MIB-1 index in Non-small Cell Lung Cancer A. Mestre-Fusco, M. Simo, L. Pijoan, T. Baro, B. Casado, S. Mojal, A. Rodriguez; CRC Mar, Barcelona, SPAIN, Hospital del Mar. Pathology Department, IMIM, Barcelona, SPAIN, Hospital del Mar. Pathology Department, IMIM, Barcelona, SPAIN, Hospital del Mar. Pathology Department, IMIM, Barcelona, SPAIN, Hospital del Mar. AMIB, Barcelona, SPAIN, Hospital del Mar. Surgery department., Barcelona, SPAIN. Introduction: The aim of this study was to assess the correlation between SUV values on 18F‐FDG PET/CT studies with proliferative activity by the Ki‐67/MIB‐1 index in patients with suspected non‐small cell lung cancer (NSCLC). Material and methods: 58 patients with suspected NSCLC (43 male) were studied. All had complete surgical resection and were diagnosed based on the WHO classification of NSCLC ( adenocarcinomas n=29, bronchioloalveolar carcinomas n=2, squamous cell carcinomas n=16, large cell carcinomas n=7, carcinoid n=3 and mucoepidermoid carcinoma n=1). PET imaging was performed with hybrid PET/CT scanner 60 min after 370 Mbq 18F‐FDG administrations. Tumour lesions were identified as areas of focally increased uptake in the lungs. For semi‐quantitative analysis, the maximum standardized uptake value (SUV) was calculated. Proliferating cell activity as indicated by the Ki‐67 index was estimated in a section of surgically resected lung lesion. We compared SUV with their corresponding Ki‐67 using linear regression analysis, in the total group and in small subgroups: With tumour lesions size at least 2 cm, in squamous carcinoma and adenocarcinoma subgroups. Results: PET/CT showed focal uptake in primary tumour in all cases. A low correlation was observed between SUV and Ki‐67 (r=0,6; p=0.001) in the total group. A high correlation coefficient was observed in the tumour size at least 2 cm (n=35, r=0,73; p=0.001), similar to previous reports. In patients with benign pathology Ki‐67 was < 1% and SUV <2.5 showing perfect correlation. Large cell carcinomas showed high SUV and high Ki67. No correlation was observed in adenocarcinomas subgroup (n=29; r=0,30) and low correlation in squamous subgroup (r= 0,58, p=0,01). Conclusion: The results of this prospective study demonstrated significant correlation between degree of semi‐ quantitative uptake by SUV on 18F‐FDG PET with proliferative activity by the Ki‐67/MIB‐1 index in the primary tumour only in the subgroup of patients with tumour size above 2 cm in diameter. PW068 Inmunohistochemical expression of the epidermal growth factor receptor (EGFR) in patients with non-small cell lung carcinomas. Correlation with other biological parameters and the values SUV-18F-FDG-PET A. Sanchez-Salmon, M. Garrido, M. Pombo, I. Abdulkader, F. Gude, L. Leon, A. Ruibal; Hospital Clinico Santiago, Santiago de Compostela, SPAIN. The EGFR is a tyrosinekinase transmembrane receptor involved in the physiopathology of the non‐small cell lung carcinomas (NSCLC). In order to study its behaviour, we have analyzed EGFRs expression in 98 NSCLC patients (59 squamous cell type and 39 adenocarcinoma) by means of tissue‐arrays (Kit phamDX (K‐1494) of DAKO (Denmark) prediluted) and have compared it to the expression of HIF‐1alfa, p16 and p53. EGFRs expression (> 10 % positive cells) was observed in 19 adenocarcinomas and 39 squamous carcinomas (p 0,087) and there was no differences in relation to the clinical stage (I‐II: 28/46 vs III‐IV: 30/52). EGFRs expression was correlated positively (p: <0,000) with that of HIF1alfa and negatively with that of p16 (p:0,027). After multivariant analysis, the clinical stage was an outcome prediction factor (I‐II vs III‐IV; RR 2,3), but EGFRs expression was not. In 42 patients we compared EGFRs expression with the values SUV in the 18F‐FDG‐PET. These were of 9,4 +/‐5,4 in 6 cases negative EGFR; 13,9 +/‐6,3 in 11 EGFR +, 16,5 +/‐3,9 in 8 EGFR ++ and 19,6 +/‐9,7 in 17 EGFR +++, existing statistically significant differences (p:0,034). This direct correlation between both parameters could be explained by the functional relationship between the EGFR and the Na/glucose transporter (Engelman JA et to. Cancer Cell 2008; 13:375‐6) and by the relation with the HIF1a, which associates also to SUVs higher value (Ruibal A, et al. Eur J Nucl Med Mol Imaging 2008; (Suppl 2): S221). The previous results induce us to the following considerations: 1) the expression of EGFR is higher in the squamous cell carcinomas that in the adenocarcinoma and does not correlate with the clinical stage, but it does positively with the HIF1alfa and negatively with p16; 2) in the squamous cell carcinomas, EGFRs expression is correlated positively with the SUV values; 3) EGFRs expression was not a prognostic factor, but it was the clinical stage. PW069 Two-phase F-FDG PET study does not improve diagnostic accuracy in the differentiation of malignant from benign solitary pulmonary nodules T. K. Au-Yong, M. O. Kong, C. M. Tong; Nuclear Medicine Unit and PDY Clinical PET Centre, Queen Elizabeth Hospital, Kowloon, HONG KONG. Aim: To evaluate whether two‐phase FDG PET imaging improves the diagnostic accuracy in differentiating malignant from benign solitary pulmonary nodules (SPN) comparing with 1‐hour imaging. Methods: a retrospective study on patients who were referred to us for the evaluation of SPN. FDG PET studies were performed using a hybrid PET/CT scanner. Imaging was taken at 1 hour with or without delayed imaging at 3.5 hours after injection of the tracer. The maximum SUV pixel value (SUVmax) of the lung lesion in 1‐hour and delayed imaging was designated as SUVe and SUVd respectively. SUVe > 2.5 and an interval increase in SUV value (i.e. SUVd‐SUVe > 0) were considered as positive findings. Results were correlated with final diagnoses, either histologically or clinically. Results: 81 patients (46 male, 35 female, mean age 64 years) were recruited. 41 patients had two‐phase study performed. All were followed up with mean duration of 38.4 months (range 12‐72 months). 53 patients were diagnosed to have malignant SPN and 28 patients had benign nodules. The malignant nodules had significantly higher SUVe (mean 6.5 + 4.1 vs. 3.2 + 2.9; median 5.5 vs. 2.1; Mann‐Whitney test, p = 0.000). 42/53 patients with malignant SPN and 11/28 patients with benign nodules had SUVe > 2.5. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was 79.2 %, 60.7 %, 79.2 %, 60.7 % and 72.8 % respectively. 13/22 of patients with malignant nodules and 6/19 patients with benign nodules had delayed increase in SUVmax. These gave sensitivity, specificity, PPV, NPV and accuracy of 59.1 %, 68.4 %, 68.4 %, 59.1 % and 63.4 % respectively. If combining SUVmax > 2.5 AND change in SUVmax of > 0 as positive finding, the sensitivity was decreased to 50 %, while the specificity was increased to 77.3 %. The PPV, NPV and accuracy became 68.8 %, 60.7 % and 63.0 % respectively. If the diagnostic criteria of either SUVe > 2.5 OR change of SUVmax > 0 was used, the sensitivity, specificity, PPV, NPV and accuracy was 72.7 %, 62.5 %, 64 %, 62.5 % and 63.4 % respectively. Conclusions: SUVmax value at 1 hour post‐injection gives the highest sensitivity and accuracy in the diagnosis of malignant SPN. Two‐phase FDG PET provides little value in the selection of patients with SPN for further evaluation. PW070 The value of dual-phase F-FDG PET/CT in the assessment of single pulmonary nodules with an initial standard uptake value≥2.5. Z. Wu, Y. Zhang, Q. Jia, X. Sun; The PET Center of Union Hospital,Tongji Medical College,Huazhong University of Science&Technology, Wuhan, CHINA. [Aim] A cutoff standard uptake value (SUV) of 2.5 has been commonly adopted for F‐FDG PET to evaluate single pulmonary lesions(SPN),