Mayuki Uchiyama

Strontium-89 therapy and imaging with bremsstrahlung in bone metastases

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Japanese consensus guidelines for pediatric nuclear medicine. Part 1: Pediatric radiopharmaceutical administered doses (JSNM pediatric dosage card). Part 2: Technical considerations for pediatric nuclear medicine imaging procedures.

Abstract The Japanese Society of Nuclear Medicine has recently published the consensus guidelines for pediatric nuclear medicine. This article is the English version of the guidelines. Part 1 proposes the dose optimization in pediatric nuclear medicine studies. Part 2 comprehensively discusses imaging techniques for the appropriate conduct of pediatric nuclear medicine procedures, considering the characteristics of imaging in children.

A comparative study of prostate specific antigen (PSA), C-terminal propeptide of blood type I procollagen (PICP) and urine type I collagen-crosslinked N telopeptide (NTx) levels using bone scintigraphy in prostate cancer patients

We compared the ability to diagnose skeletal metastasis between serum prostate specific antigen (PSA), C-terminal propeptide of blood type I procollagen (PICP), and urine type I collagen-crosslinked N telopeptide (NTx) in prostate cancer patients. In sixty-nine patients with prostate cancer, bone scintigraphy was performed, and serum PSA and PICP and urine NTx were measured. The median level of serum PSA in the osseous metastasis-negative group (n=33) was 0.80 ng/ml being significantly lower as compared to the osseous metastasis-positive group (n=36, 7.70 ng/ml) (p<0.0001). The serum PICP and urine NTx/Cr levels appeared lower in the osseous metastasis-negative group than the osseous metastasis-positive group, but there was no significant difference. Logistic regression analysis showed that ability to diagnose skeletal metastasis of serum PSA was 68.1% and superior to those of serum PICP (56.5%) and urine NTx/Cr (53.6%). Serum PSA improved the ability to diagnose skeletal metastasis when combined with serum PICP or urine NTx/Cr. When patients were grouped according to the extent of disease grade (EOD grade) nomenclature, Spearmans correlation coefficient by rank showed that serum PSA was most significantly correlated with EOD grade (p<0.0001). In 14 patients whose skeletal metastases progressed or regressed, the change of serum PSA more clearly separated the osseous metastasis-regression group and osseous metastasis-progression group than did serum PICP and urine NTx/Cr. Serum PSA was more reliable than bone resorption and formation markers produced by crosslinking of type I collagen.

Standardization of Administered Activities in Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative Project, Part 1—Statement of the Issue and a Review of Available Resources

The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 and consists of 13 international organizations with direct involvement in nuclear medicine. The underlying objectives of the NMGI were to promote human health by advancing the field of nuclear medicine and molecular imaging, encourage global collaboration in education, and harmonize procedure guidelines and other policies that ultimately lead to improvements in quality and safety in the field throughout the world. For its first project, the NMGI decided to consider the issues involved in the standardization of administered activities in pediatric nuclear medicine. This article presents part 1 of the final report of this initial project of the NMGI. It provides a review of the value of pediatric nuclear medicine, the current understanding of the carcinogenic risk of radiation as it pertains to the administration of radiopharmaceuticals in children, and the application of dosimetric models in children. A listing of pertinent educational and reference resources available in print and online is also provided. The forthcoming part 2 report will discuss current standards for administered activities in children and adolescents that have been developed by various organizations and an evaluation of the current practice of pediatric nuclear medicine specifically with regard to administered activities as determined by an international survey of nuclear medicine clinics and centers. Lastly, the part 2 report will recommend a path forward toward global standardization of the administration of radiopharmaceuticals in children.

The usefulness of radio-guided surgery in secondary hyperparathyroidism

Recent reports have shown that radio-guided surgery with an intraoperative gamma probe (IGP) is useful for identifying parathyroid adenomas. The aim of this study was to evaluate the usefulness of IGP mapping in patients with secondary hyperparathyroidism. Seven patients with secondary hyperparathyroidism underwent technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) scintigraphy immediately before undergoing surgical resection of all parathyroid tissues. We compared the sensitivity of Tc-99m MIBI scintigraphy alone with that of the combination of Tc-99m MIBI scintigraphy and IGP mapping. The sensitivity of the combination of Tc-99m MIBI scintigraphy and IGP mapping was 100% (28 of 28 lesions) and was significantly higher than that of Tc-99m MIBI scintigraphy alone (71.4%, 20 of 28 lesions). The combination of the Tc-99m MIBI scintigraphy and IGP mapping has increased sensitivity for identifying parathyroid lesions during parathyroidectomy in patients with secondary hyperparathyroidism.

Standardization of Administered Activities in Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative Project, Part 2—Current Standards and the Path Toward Global Standardization

The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 and consists of 13 international organizations with direct involvement in nuclear medicine. The underlying objectives of the NMGI are to promote human health by advancing the field of nuclear medicine and molecular imaging, encourage global collaboration in education, and harmonize procedure guidelines and other policies that ultimately lead to improvements in quality and safety in the field throughout the world. For its first project, the NMGI decided to consider the issues involved in the standardization of administered activities in pediatric nuclear medicine. It was decided to divide the final report of this project into 2 parts. Part 1 was published in this journal in the spring of 2015. This article presents part 2 of the final report. It discusses current standards for administered activities in children and adolescents that have been developed by various professional organizations. It also presents an evaluation of the current practice of pediatric nuclear medicine specifically with regard to administered activities as determined by an international survey of 313 nuclear medicine clinics and centers from 29 countries. Lastly, it provides recommendations for a path toward global standardization of the administration of radiopharmaceuticals in children.

Brain perfusion and upper limb motor function: A pilot study on the correlation between evolution of asymmetry in cerebral blood flow and improvement in Fugl–Meyer Assessment score after rTMS in chronic post-stroke patients

BACKGROUND AND PURPOSE Few studies have explored the refinement of asymmetry in regional cerebral blood flow in relation to behavioral improvement after treatment. The purpose of this retrospective pilot study was to identify cerebral cortical regions with improved perfusion that correlated with improvement of upper limb motor function after repetitive transcranial magnetic stimulation (rTMS). MATERIALS AND METHODS The study subjects were 33 post-stroke patients with upper limb hemiparesis who underwent rTMS combined with intensive occupational therapy (mean ± SD age: 64.9 ± 11.2 years; time since onset of stroke: 57.3 ± 45.9 months). Fugl-Meyer Assessment (FMA) and the Wolf Motor Function Test (WMFT) were applied before and after treatment to evaluate motor function in the affected upper limb. Regional brain perfusion was measured by single-photon emission computed tomography, and the percentages of asymmetry values (asymmetry index [AI]) for 52 bilateral regions of interest were calculated. The change in AI was calculated as the post-intervention minus pre-intervention values. RESULTS Changes in AI in the superior and middle frontal areas correlated significantly and negatively with changes in FMA score (superior: r = -0.406, P = 0.03, R(2) = 0.251; middle: r = -0.437, P < 0.001, R(2) = 0.306), but not with changes in WMFT log performance time. CONCLUSION Changes in AI less than zero reflect improved perfusion, suggesting that upper limb motor function improvement in post-stroke patients reflects evolution of brain perfusion in the superior and middle frontal areas.

Influence of hilar deposition in the evaluation of the alveolar epithelial permeability on 99mTc-DTPA aerosol inhaled scintigraphy

PurposeWe investigated whether hilar radioaerosol deposition affects the clearance rate of technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) from peripheral alveolar regions.Materials and methodsA total of 38 patients underwent 99mTc-DTPA inhalation lung scintigraphy. Six region of interest (ROI) patterns were adopted: ROI 1 was outlined around the entire hemithorax, and ROIs 2–6 were outlined around the hemithorax but excluded square ROIs of different size in the hilar region. Half-times (T½) were calculated with time-activity curves using onecompartment and two-compartment analyses. The T½ of ROIs 1–5 were plotted against the T½ of ROI 6, and regression lines were obtained with the least-squares method. The absolute values of the differences between surveyed values and regression line were calculated. The Wilcoxon test for trend and a single linear regression model were used to determine statistical significance.ResultsThere were significant reductions in the absolute values of the differences between surveyed values and regression line from ROIs 1–5 by one-component analysis and the fast component of two-compartment analysis (P < 0.001).ConclusionOur results suggest that the deposition of radioaerosol in the hilar region affects the clearance rate of 99mTc-DTPA from the alveoli in damaged lungs. The hilar region should be excluded from ROIs when alveolar epithelial permeability is evaluated.

A case of isolated retrograde amnesia following brain concussion

Retrograde amnesia is typically accompanied by anterograde amnesia. However, several recent reports describe isolated retrograde amnesia in which associated anterogarde amnesia was not present. 1–7 In fact, retrograde amnesia has various etiologies (e.g. encephalitis, traumatic, psychiatric) and likely represents a heterogeneous entity that is dependent on multiple memory systems within discrete neural structures. 2,4

Use of digirad 2020tc Imager, a multi-crystal scintillation camera with solid-state detectors in one case for the imaging of autografts of parathyroid glands.

Abstract99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy with Digirad 2020tc ImagerTM (2020tc), which was a multi-crystal scintillation camera with solid-state detectors was performed for patients with secondary hyperparathyroidism having autografts of parathyroid glands in the right arm. With the 2020tc camera, three abnormal accumulations were found in the right arm. The images obtained with this camera were superior in resolution to those obtained with a conventional NaI crystal gamma camera (ZLC7500, Siemens, Germany). The next day, resection of autografts of parathyroid glands was done. Four hyperplastic parathyroid glands were resected and all were hyperplastic in pathological findings.