Torjan Haslerud

Significance of Oral Administration of Sodium Perchlorate in Planning Liver-Directed Radioembolization

99mTc-macroaggregated albumin (99mTc-MAA) scanning precedes radioembolization of the liver to detect extrahepatic shunting to the lung or gastrointestinal tract. Despite strict preventive measures in the production of 99mTc-MAA and in scanning protocols, the images frequently show a gastric concentration of free 99mTc-pertechnetate, hindering accurate evaluation of the gastroduodenal region. Our aim was to evaluate whether oral administration of sodium perchlorate (NaClO4) before 99mTc-MAA scanning will improve its accuracy by blocking free 99mTc-pertechnetate gastric uptake. Methods: In 144 patients, 171 diagnostic hepatic angiograms combined with a 99mTc-MAA scan were performed; 86 angiograms were performed after oral administration of NaClO4, and 85 were performed without this premedication. Clinical follow-up, esophagogastroduodenoscopy, and angiography served as reference standards. Results: 99mTc-MAA studies showed tracer uptake in the gastric region of 25 patients who did not receive NaClO4. The uptake was interpreted as a free 99mTc-pertechnetate concentration in 21 studies and as a 99mTc-MAA accumulation in 4 studies. In 5 patients with a free 99mTc-pertechnetate concentration, aberrant vessels were detected in angiographic reexamination, and 3 patients developed gastrointestinal ulcer. In 7 studies, gastric findings viewed pretherapeutically as free 99mTc-pertechnetate were retrospectively classified as equivocal. Of the patients receiving NaClO4, 2 showed gastric accumulation of 99mTc-MAA but no equivocal or free 99mTc-pertechnetate. Oral administration of NaClO4 increased the negative predictive value and accuracy of the test concerning the detection of gastric perfusion from 68% and 69%, respectively, to 93% and 94%, respectively. Conclusion: Oral administration of NaClO4 before the test angiogram with 99mTc-MAA resulted in effective avoidance of free 99mTc-pertechnetate concentration and, consequently, of equivocal findings in the gastroduodenal region. This technique increased test accuracy and reporter confidence, saved time in reviewing the angiograms, and can improve treatment planning and reduce therapeutic side effects.

F18-FDG-PET for recurrent differentiated thyroid cancer: a systematic meta-analysis

Background Positron emission tomography (PET) with fluor-18-deoxy-glucose (FDG) is widely used for diagnosing recurrent or metastatic disease in patients with differentiated thyroid cancer (DTC). Purpose To assess the diagnostic accuracy of FDG-PET for DTC in patients after ablative therapy. Material and Methods A systematic search was conducted in Medline/PubMed, EMBASE, Cochrane Library, Web of Science, and Open Grey looking for all English-language original articles on the performance of FDG-PET in series of at least 20 patients with DTC having undergone ablative therapy including total thyroidectomy. Diagnostic performance measures were pooled using Reitsma’s bivariate model. Results Thirty-four publications between 1996 and 2014 met the inclusion criteria. Pooled sensitivity and specificity were 79.4% (95% confidence interval [CI], 73.9–84.1) and 79.4% (95% CI, 71.2–85.4), respectively, with an area under the curve of 0.858. Conclusion F18-FDG-PET is a useful method for detecting recurrent DTC in patients having undergone ablative therapy.

E-learning for medical imaging specialists: introducing blended learning in a nuclear medicine specialist course:

Background While e-learning has become an important tool in teaching medical students, the training of specialists in medical imaging is still dominated by lecture-based courses. Purpose To assess the potential of e-learning in specialist education in medical imaging. Material and Methods An existing lecture-based five-day course in Clinical Nuclear Medicine (NM) was enhanced by e-learning resources and activities, including practical exercises. An anonymized survey was conducted after participants had completed and passed the multiple choice electronic course examination. Results Twelve out of 15 course participants (80%) responded. Overall satisfaction with the new course format was high, but 25% of the respondents wanted more interactive elements such as discussions and practical exercises. The importance of lecture handouts and supplementary online material such as selected original articles and professional guidelines was affirmed by all the respondents (92% fully, 8% partially), while 75% fully and 25% partially agreed that the lectures had been interesting and relevant. Conclusion E-learning represents a hitherto unrealized potential in the education of medical specialists. It may expedite training of medical specialists while at the same time containing costs.