Yu-Chien Shiau

The diagnostic and prognostic effectiveness of F-18 sodium fluoride PET-CT in detecting bone metastases for hepatocellular carcinoma patients.

BackgroundThe aim of this prospective study is to evaluate the diagnostic and prognostic usefulness of F-18 sodium fluoride (NaF) positron emission tomography-computed tomography (PET-CT) relative to Tc-99m methylene diphosphonate (MDP) planar bone scintigraphy with no CT (BS) for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis. MethodsBoth Tc-99m MDP BS and F-18 NaF PET-CT were performed for 34 consecutive Taiwanese HCC patients (five female and 29 male; mean age, 61.0±12.0 years) within a time span of 1 month (mean: 11.3±10.4 days). The accuracies of BS and PET-CT were determined by comparing their results with the finalized clinical data in a lesion-by-lesion manner. ResultsAccording to the pathological and/or follow-up results, the accuracy for detecting metastatic bone lesions by Tc-99m MDP BS is 75.4% and that by F-18 NaF PET-CT is 95.7%, respectively. F-18 NaF PET-CT is significantly more accurate than Tc-99m MDP BS (P=0.0001). Furthermore, there is a significant correlation between the presence of F-18 NaF PET-CT-positive bone lesions and the survival time of HCC patients. On the other hand, the diagnostic results from BS are not correlated with the survival time of these HCC patients. ConclusionF-18 NaF using PET-CT system has significantly better sensitivity and specificity than conventional Tc-99m MDP BS in detecting metastatic HCC bone lesions that are predominantly osteolytic. The diagnostic result of PET-CT also serves as a more effective prognostic indictor for HCC patients.

The influences of blood glucose and duration of fasting on myocardial glucose uptake of [18F]fluoro-2-deoxy-D-glucose

During the study of chest using positron emission tomography (PET) with [18F]fluoro-2-deoxy-d-glucose (FDG), a significant myocardial FDG uptake can prevent detection of the lesion that is located either behind or closely attached to the heart border. Two well-known and possible factors of myocardial FDG uptake are blood glucose level and fasting duration before FDG PET scanning. This study investigates whether the two factors are related to myocardial FDG uptake. Our study also explores the possibility of eliminating myocardial FDG uptake by controlling patients blood glucose level and/or fasting duration. Whole-body FDG PET scans performed on 270 consecutive patients performed were reviewed. The study subjects were classified into four grades of myocardial FDG uptake according to the visual interpretation of the FDG PET image hard-copy films. For all study subjects, the blood sugar level and fasting duration before FDG injection were recorded. Then, the blood sugar levels and fasting duration were compared to the visual grade of myocardial FDG uptake for each study subject. About half of the study subjects showed graded 0 myocardial FDG uptake when the blood glucose levels were ⩽120 mg·dl−1 or when the fasting duration was between 5 and 12 h. One hundred and thirty-one of the 142 (92%) patients with graded 0 uptake were asked to fast for ⩾4 h and had blood glucose levels ⩽120 mg·dl−1. Based on our findings, we conclude that controlling the patients blood glucose levels to ⩽120 mg·dl−1 and at least 5 h fasting should be recommended to decrease myocardial FDG uptake.

Usefulness of technetium-99m hexamethylpropylene amine oxime lung scan to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative chest radiograph and pulmonary function test findings after a fire accident—a preliminary report

Objective: In this study, we employed technetium-99m hexamethylpropylene amine oxime (99mTc HMPAO) lung scan to detect inhalation lung injury of patients after a fire accident.Methods: Ten healthy men for controls and 10 male patients with pulmonary symptoms/signs from a fire accident were enrolled in this study for comparison.99mTc HMPAO lung scan was performed in each control and patient, as well as the degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratio). All of the controls and patients had no smoking histories. None of the controls and patients had positive findings of plain chest radiograph (CXR) and pulmonary function test (PFT).Results: The results showed that significantly higher L/L ratio in the 10 patients (0.53±0.07) than in the 10 controls (0.30±0.07) (the p value<0.05). Using a cut-off value of 0.40, all of the 10 patients had abnormally increased L/L ratios.Conclusions: We conclude that99mTc HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect inhalation lung injury of patients with pulmonary symptoms/signs but negative CXR and PFT findings after a fire accident.

The relation between serum level of amioterminal propeptide of type I procollagen and diastolic dysfunction in hypertensive patients without diabetes mellitus: a pilot study

The relation between serum level of amioterminal propeptide of type I procollagen and diastolic dysfunction in hypertensive patients without diabetes mellitus: a pilot study

Using thallium-201 SPECT to detect recurrent or residual nasopharyngeal carcinoma after radiotherapy in patients with indeterminate CT findings

The aim of this study is to evaluate the usefulness of thallium‐201 (Tl‐201) single‐photon emission CT (SPECT) to detect recurrent or residual nasopharyngeal carcinomas (NPC) when CT findings are indeterminate.

Detection of Recurrent or Residual Nasopharyngeal Carcinomas After Radiotherapy with Technetium-99m Tetrofosmin Single Photon Emission Computed Tomography and Comparison with Computed Tomography—A Preliminary Study

The effectiveness of technetium-99m tetrofosmin (Tc-TF) single photon emission computed tomography (SPECT) of the head and neck for detecting recurrence of nasopharyngeal carcinomas (NPC) was evaluated and compared with computed tomography (CT). Both Tc-TF SPECT and CT of the head and neck were performed in 36 NPC patients 4 months after radiotherapy. All 36 then underwent histopathological examinations of nasopharyngeal biopsies. Based on the histopathological results, the sensitivity, specificity, and accuracy of visually interpreted Tc-TF SPECT images, to differentiation of recurrent NPC from benign lesions, were 64%, 96%, and 86%, respectively. The sensitivity, specificity, and accuracy of CT for detecting recurrent NPC were 73%, 88%, and 83%, respectively. The Tc-TF SPECT has a better specificity but a lower sensitivity to differentiate benign lesions and recurrent/residual NPC when compared with CT. Combined Tc-TF SPECT and CT sensitivity and specificity were 100% and 88%, respectively. There are much better either test alone. However, further studies, including a larger NPC patient population, are warranted to determine the exact role and clinical usefulness of Tc-TF SPECT to differentiate benign lesions and recurrent/residual NPC.

F-18 FDG uptake in papillary carcinoma arising from thyroglossal duct cyst.

A 51-year-old man incidentally felt an anterior midline cervical mass since 2 months before presentation. Both neck echogram and contrast-enhanced CT exposed a cystic lesion with slightly calcified soft tissue in anterior neck and small nodules in both lobes of the thyroid gland. F-18 FDG PET/CT revealed an intense uptake over the soft-tissue component of the cystic lesion, which was located in front of the hyoid bone. The patient subsequently received Sistrunk procedure, selective neck lymph node dissection, and total thyroidectomy. Pathology revealed papillary carcinoma in thyroglossal duct cyst and microcarcinoma in both lobes of the thyroid gland.

Mechanical dyssynchrony and diastolic dysfunction are common in LVH: a pilot correlation study using Doppler echocardiography and CZT gated-SPECT MPI

Hypertrophic cardiomyopathy (HCM) is an often under-diagnosed cause of left ventricular hypertrophy (LVH). It affects 1/500 of the population, is the most commonly inherited cardiovascular disorder, and can present in apical, concentric, or septal forms. Although most patients are asymptomatic, sudden cardiac death can be the initial presentation of HCM. By retrospectively enrolling patients suspected of having three different types of HCM in the absence of epicardial coronary stenosis, we aimed to examine systolic and diastolic dysfunction and perfusion abnormalities using both Doppler echocardiography and state-of-the-art gated single-photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) with a cadmium-zinc-telluride camera and thallium-201. Both regional perfusion and gated SPECT parameters were collected in addition to diastolic parameters from Doppler echocardiography. The results showed that mild ischemia was common in patients suspected of having HCM, with a mean summed stress score of 4.7u2009±u20094.9 (score 0–4 in 17-segment model). The patients with HCM were associated with discernible left ventricular mechanical dyssynchrony, especially those with the apical form. In addition, diastolic dysfunction was prevalent and early to late ventricular filling velocity ratios were significantly different between groups. By combining gated-MPI and Doppler data, the trivial functional changes in HCM may be identified.

Association of amino-terminal propeptide of type III procollagen and acute myocardial rejection in male patients receiving heart transplantation.

Abstract Background: The amino-terminal propeptides of type I and III procollagens (PINP and PIIINP) are markers reflecting the status of collagen turnover. We hypothesized that measurement of these serum procollagen propeptides could be used to non-invasively assess acute rejection in heart transplant recipients. Methods: In heart transplant recipients, endomyocardial biopsy specimens taken at 6 and 12 months after surgery were used for study. PINP and PIIINP were measured postoperatively at 3, 6, and 12 months. Results: A total of 20 male heart transplant patients and seven male control subjects were enrolled. Five patients showed rejection 6 months after transplantation (group 1), while 15 patients showed no rejection (group 2). In group 2 patients, serum PINP and PIIINP levels decreased significantly 6 months after transplantation. In contrast, elevation of serum PINP and PIIINP levels persisted in group 1 patients 6 months after transplantation. At 6 months after transplantation, group 1 patients had significantly higher PIIINP levels than group 2 patients (p=0.025) and controls (p=0.003). After immunosuppressive therapy, all group 1 patients were free of rejection 12 months after transplantation and serial serum PIIINP levels decreased significantly in these patients. Conclusions: Serum PIIINP levels represent a non-invasive method to reflect the occurrence and resolution of acute rejection. Clin Chem Lab Med 2007;45:1004–8.

Clinical significance of quantitative assessment of glucose utilization in patients with ischemic cardiomyopathy

Background The aim of this study was to prospectively quantify the rate of myocardial glucose uptake (MRGlu) in myocardium with different perfusion-metabolism patterns and determine its prognostic value in patients with ischemic cardiomyopathy. Methods and Results 79 patients with ischemic cardiomyopathy were prospectively enrolled for dynamic cardiac FDG PET, and then followed for at least 6xa0months. Perfusion-metabolism patterns were determined based on visual score analysis of 201 Tl SPECT and FDG PET. MRGlu was analyzed using the Patlak kinetic model. The primary end-point was cardiovascular mortality. Significantly higher MRGlu was observed in viable compared with non-viable areas. Negative correlations were found between MRGlu in transmural match and a history of hyperlipidemia, statin usage, and triglyceride levels. Diabetic patients receiving dipeptidyl peptidase-4 inhibitors (DPP4i) had a significantly lower MRGlu in transmural match, mismatch, and reverse mismatch. Patients with MRGlu in transmural match ≥xa023.40 or reverse mismatch ≥xa036.90 had a worse outcome. Conclusions Myocardial glucose utilization was influenced by substrates and medications, including statins and DPP4i. MRGlu could discriminate between viable and non-viable myocardium, and MRGlu in transmural match and reverse mismatch may be prognostic predictors of cardiovascular death in patients with ischemic cardiomyopathy.