Is bone scintigraphy necessary in initial staging of prostate cancer patients?

Our aim was to determine whether serum prostate specific antigen (PSA) and total Gleason score (GS) on biopsy in newly diagnosed prostate cancer (PCa) can predict osseous metastases and eliminate the need for a bone scan as a routine procedure in initial staging. We studied retrospectively 155 patients with previously untreated PCa who underwent bone scintigraphy. Relationship between PSA, GS and bone metastases was examined. Sensitivity, specificity, likelihood ratio (LR) and odds ratio (OR) were calculated with corresponding 95% conidence interval. Results showed that thirty of all bone scans (19.35%) were positive for metastases. This proportion was significantly higher in patients with PSA>20ng/mL (31.66% , P=0.002) vs. PSA<10ng/mL (10.52%). For PSA<10ng/mL as well as 10ng/mL≤ PSA≤ 20ng/mL the test was not a predictor for bone metastases (OR=0.36; OR=0.55). For PSA>20 ng/mL (OR=3.53) the likelihood of bone metastases was increased by 13% . The proportion of positive scintigraphy findings was significantly lower in patients with GS≤ 7 (11.47% ) vs. GS≥ 8 (48.48% , P<0.0001). The GS≥ 8 was highly predictive for bone metastases (OR=7.260). The analysis showed that GS≥ 8 increases the risk of bone metastases by 29%. In conclusion, bone scintigraphy is not necessary in asymptomatic patients with localized disease, GS≤ 6 and PSA<10ng/mL, because of the negligible risk of bone metastases in that stage. Higher levels of GS and PSA may predict bone metastases.     

What can be identified by three-phase bone scintigraphy in patients with chronic osteomyelitis of the mandible?

Objective  

Three-phase bone scintigraphy has been used for the diagnosis of osteomyelitis in some regions of the body. However, its utility in patients with chronic osteomyelitis of the mandible (COM) has been reported only occasionally and the significance has not been fully examined. The aim of this study was to investigate what can be identified from each phase of the three-phase bone scintigraphy in patients with COM.     

Detection of bone metastases in thyroid cancer patients: bone scintigraphy or 18F-FDG PET?

BACKGROUND: Similar to the situation in other tumour types, it is currently unclear whether fluorodeoxyglucose (FDG) positron emission tomography (PET) is adequate in the detection of bone metastases of thyroid cancer. The purpose of this retrospective study was to evaluate the performance of bone scans in comparison with FDG PET in the detection of bone metastases in patients with differentiated thyroid cancer (DTC). MATERIALS AND METHODS: Twenty-four patients had undergone both FDG PET and bone scans within 6 months because of suspected bone metastases. All scans were re-evaluated using all available additional imaging and clinical data for verification. Scan findings were scored as positive, negative or doubtful. RESULTS: Bone metastases were present in eight of 24 (33%) patients. Only bone scintigraphy but not FDG PET suggested the presence of bone metastases in three patients, all confirmed with magnetic resonance imaging (MRI)/X-ray. Five patients were identified with bone metastases on both bone scan and FDG PET, which was confirmed by computed tomography (CT)/MRI/X-ray in four. Five patients had doubtful findings on bone scans whereas FDG PET scans were negative. MRI showed degenerative disorders in two of five and was normal in two. Eleven patients had both a negative bone scan and FDG PET scan. CONCLUSION: In three of eight (38%) thyroid cancer patients bone metastases were only identified on bone scans. Therefore, bone scans are still valuable in detecting bone metastases in patients with DTC and can not be replaced by FDG PET.     

A meta-analysis of ¹⁸FDG-PET-CT, ¹⁸FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer

Background and purpose

Lung cancer is the most common cause of cancer related death among both men and women worldwide. The skeleton is the most common site of cancer metastasis. Early detection is crucial for prognosis. To evaluate and compare the capability for bone metastasis assessment of [¹⁸F] fluoro-2-d-glucose positron emission tomography with computed tomography (¹⁸FDG-PET–CT), [¹⁸F] fluoro-2-d-glucose positron emission tomography (¹⁸FDG-PET), magnetic resonance imaging (MRI) and bone scintigraphy (BS) in lung cancer patients, a meta-analysis is preformed.

Methods

We searched MEDLINE, OVID, EMBASE and the Cochrane Library for studies evaluating diagnosis validity of ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS between January 1990 and August 2010. Meta-analysis methods were used to pool sensitivity, specificity, diagnostic odd ratios (DORs) and to construct a summary receiver-operating characteristic curve (SROC).

Results

A total of 17 articles (9 ¹⁸FDG-PET–CT studies, 9 ¹⁸FDG-PET studies, 6 MRI studies and 16 BS studies) that included 2940 patients who fulfilled all of the inclusion criteria were considered for inclusion in the analysis. The pooled sensitivity for the detection of bone metastasis in lung cancer using ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS were 0.92 (95% CI, 0.88–0.95), 0.87 (95% CI, 0.81–0.92), 0.77 (95% CI, 0.65–0.87) and 0.86 (95% CI, 0.82–0.89), respectively. The pooled specificity for the detection of bone metastasis from lung cancer using ¹⁸FDG-PET–CT, ¹⁸FDG-PET, MRI and BS were 0.98 (95% CI, 0.97–0.98), 0.94 (95% CI, 0.92–0.96), 0.92 (95% CI, 0.88–0.95), 0.88 (95% CI, 0.86–0.89), respectively. The pooled DORs estimates for ¹⁸FDG-PET–CT 449.17 were significantly higher than for ¹⁸FDG-PET (118.25, P < 0.001), MRI (38.27, P < 0.001) and BS (63.37, P < 0.001). The pooled sensitivity of BS was not correlated with the prevalence of bone metastasis.

Conclusion

The results showed that both ¹⁸FDG-PET–CT and ¹⁸FDG-PET were better imaging methods for diagnosing bone metastasis from lung cancer than MRI and BS. ¹⁸FDG-PET–CT has higher diagnostic value (sensitivity, specificity and DORs) for diagnosing bone metastasis from lung cancer than any other imaging methods.     

Diagnosis of bone metastasis with whole body MRI?

Ohne Zusammenfassung     

Diagnostic validity of dynamic salivary gland scintigraphy with ascorbic acid stimulation in patients with Sjögren's syndrome: comparation with unstimulated whole sialometry

BACKGROUND/AIM: Beside many actual groups of classification criteria, uniform classification criteria for Sj?gren's syndrome (SS) are still missing. The ophtalmic component of SS is well defined. Criteria for classifying its oral component remain controversial. The fifth item of the European Union and the United States of America (EU-US) revised diagnostic classification criteria in 2002, is an objective evidence of xerostomia, diagnosed by one of the tests: unstimulated whole sialometry (UWS), parotid sialography, and dynamic salivary gland scintigraphy (DSGS). The aim of this study was to evaluate senstitivity, specificity, positive and negative predictive value and accuracy of DSGS with ascorbic acid stimulation in detecting xerostomia in SS patients and to compare DSGS findings with UWS values. METHODS: Tests DSGS and UWS were done in 20 patients with SS and in 10 of the control subjects. The findings of DSGS were graded from 1 to 4 scintigraphie (SCT) grade 1--normal finding; SCT grade 2--moderate function damage; SCT grade 3--serious function damage, SCT grade 4--very serious function damage. UWS measured 1.5 hour after the breakfast lasted 15 minutes. UWS bellow 2.5 ml/15min min. considered pathological. RESULTS: All SS patients had pathological SCT findings. Comparing SCT grade between the patients and the control group, high statistical significance was found (p < 0.001). The estimated sensitivity of DSGS was 100%, specificity 80%, positive predictive value 91%, negative predictive value 100% and accuracy 93%. The calculated sensitivity of UWS was 75%. Salivary function damage detected by scintigraphy was in positive correlation with UWS findings. CONCLUSION: DSGS is a diagnostic test with high sensitivity, specificity, accuracy and positive and negative predictive values in detecting salivary function damage in SS patients. DSGS and UWS are very sensitive diagnostic tests for objective evidence of xerostomia, and have to be ones of the earliest investigations which shoud be performed in subjects suspected of SS. Test DSGS is more sensitive, and seems to better reflect symptoms of dry mouth than UWS.     

Is bone scintigraphy necessary in the initial surgical staging of chondrosarcoma of bone?

Objective  

To assess the value of whole-body bone scintigraphy in the initial surgical staging of chondrosarcoma of bone.     

Usefulness of rCBF analysis in diagnosing Parkinson’s disease: supplemental role with MIBG myocardial scintigraphy

(123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is a useful tool for differentiating idiopathic Parkinson's disease (PD) from parkinsonism (PS) caused by other disorders. However, cardiac MIBG uptake is affected by various causes. Alternatively, hypoperfusion in the occipital lobe of PD is reported recently. OBJECTIVE: The objective is to clarify the correlation between regional cerebral blood flow (rCBF) alteration and cardiac MIBG uptake in PD. In addition, we examined whether additional brain perfusion analysis improved the differential diagnostic ability for PD from PS when compared with MIBG scintigraphy alone. METHODS: Forty-nine patients with PD (27 mild groups: Hoehn and Yahr stages I, II; 22 severe groups: Hoehn and Yahr stages III, IV) and 28 patients with PS participated. We compared absolute rCBF values between PD and PS. In addition, we determined correlation between MIBG parameters and each rCBF value. Finally, we compared the diagnostic ability for the differentiation of PD from PS between two diagnostic criteria, each MIBG index abnormality alone [heart-to-mediastinum ratio, H/M (E) < 1.9, H/E (D) < 1.7, washout rate > 40%] and each MIBG index abnormality or occipital lobe hypoperfusion (<36 ml/100 g per min). RESULTS: Absolute rCBF value of occipital lobe was significantly lower in severe PD as compared with PS or mild PD. In the correlation analysis, rCBF of occipital lobe correlated positively with MIBG parameters (H/M). Regarding the diagnostic ability, sensitivity improved by accounting for occipital hypoperfusion as compared with MIBG indices alone. In contrast, neither specificity nor accuracy improved by adding occipital lobe analysis. CONCLUSIONS: MIBG parameters (H/M) correlated positively with occipital hypoperfusion in PD. In the differential diagnosis between PD and PS, although its usefulness might be limited, analysis of rCBF in the occipital lobe added to (123)I-MIBG myocardial imaging can be recommended.     

Confirmation of alleged falanga torture by bone scintigraphy—Case report

Any objective persisting signs of previous torture would be very valuable in the late assessment of the individual claiming such abuse of human rights. We present the case of a 32-year-old man referred to our hospital for an opinion on alleged torture by the falanga method. Magnetic resonance imaging and bone scintigraphy were evaluated and compared as methods of confirming such torture.     

Do short-time SPECT images of bone scintigraphy improve the diagnostic value in the evaluation of solitary lesions in the thoracic spine in patients with extraskeletal malignancies?

OBJECTIVE: Single photon emission computed tomography (SPECT) images provide many details of the anatomical structure. Also about bone scintigraphy, there are many reports of the improvement of diagnosis by SPECT images. Although SPECT is useful, it requires much time. So to perform SPECT for all cases is difficult in the clinical situation. Recently, due to technical improvements in gamma cameras, we can get SPECT images in a short time. We examined diagnosis of solitary hot spots of thoracic spine in cancer patients using short-time SPECT. And we considered whether short-time SPECT contributes to the precise diagnosis of the lesion. MATERIAL AND METHODS: We performed bone scintigraphy image acquisition and both planar and short-time SPECT of the chest. Short-time SPECT was acquired in 6 minutes. We selected 36 cases with malignancy, whose bone scintigraphy demonstrated a solitary accumulation hot spot in the thoracic spine. Three experienced radiologists in nuclear medicine and 4 beginners diagnosed the images. They interpreted planar, short-time SPECT and maximum intensity projection (MIP) view of the chest of each case. The observers' response data were analyzed with receiver operating characteristic (ROC) curve analysis. RESULTS: Of the three types of images, the Az (the area under ROC curve) values of short-time SPECT were the highest in all the observers except for only one beginner. Compared with experienced observers, beginners scored lower Az values of short-time SPECT. MIP images were constructed using SPECT data, but the Az values of MIP images were not higher than those of planar images. As to diagnosis, beginners tended to interprete most of the accumulations as metastatic lesions. CONCLUSION: Short-time SPECT can be helpful to some degree, but to provide greater benefit, the observers require considerable exercise and experience.     

Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome

The purpose of the present study was to evaluate the validity of a scoring system based on excretion rate of salivary gland scintigraphy in patients with Sjögren’s syndrome (SjS). Total scintigraphic scores were compared with the results of the Saxon test. One hundred and twenty-four subjects who were clinically diagnosed with SjS and 11 normal ones underwent salivary gland scintigraphy and the Saxon test. In salivary gland scintigraphy, the difference between maximum and minimum counts after stimulation using vitamin C divided by maximum counts was defined as the excretion rate. We then defined a scoring system with 4 grades: severe dysfunction = 3 (excretion rate < 25%), moderate dysfunction = 2 (25% ≤ excretion rate < 40%), mild dysfunction = 1 (40% ≤ excretion rate < 50%) and normal function = 0 (50% ≤ excretion rate). The summation of the total scintigraphic score (0–12) of all 4 salivary glands was used as a semi-quantitative index indicating total salivary gland function, and total scintigraphic scores were compared with the results of the Saxon test. A significant inverse linear correlation (R² = 0.95) was observed between total scintigraphic scores and mean values of the Saxon test within a range of abnormal scintigraphic scores (≥ 4). The scoring system developed in the present study is a clinically available, objective, and reproducible method for evaluation of salivary gland function in patients with SjS.     

The effect of renal artery stenting on hypertension and renal function in patients with atherosclerotic renovascular disease

IntroductionAtheroscleroticrenal arterystenosisisassociatedwithhypertension ,progressivelossofrenalfunctionandrecurrentpulmonaryedema [1 3].Althoughsurgicalrevascularizationhasbeenshowntoimprovebloodpressurecontrol,preserveorstabilizerenalfunction [4 ],andreverseend stagerenalfailure[5 ],itsmorbidityandmortalityrateshavebeenhigherthanthoseofstentrevascularization [6 ].Stentrevascularizationhasbeenshowntobesuperiorto“balloononly”angioplastyandsurgicalrevascularization [7].Thisstudyevaluatesth…     

Validation of cardiac 123I-MIBG scintigraphy in patients with Parkinson’s disease who were diagnosed with dopamine PET

Purpose  

The aim of this study was to evaluate the diagnostic potential of cardiac ¹²³I-labelled metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy in idiopathic Parkinson’s disease (PD). The diagnosis was confirmed by positron emission tomography (PET) imaging with ¹¹C-labelled 2β-carbomethoxy-3β-(4-fluorophenyl)-tropane (¹¹C-CFT) and ¹¹C-raclopride (together designated as dopamine PET).     

Usefulness of albumin–globulin ratio as a clinical prognostic factor in patients with thyroid cancer treated with radioiodine

Annals of Nuclear Medicine - Albumin–globulin ratio (AGR), which is calculated by dividing serum albumin by serum globulin, is considered as a cancer-related inflammation biomarker. Although...     

What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?

AIM: To analyse the role played by bone scintigraphy in the diagnosis of infected joint prostheses. METHODS: The study included 77 patients, aged 32-77 years, in whom infection of a joint prosthesis (48 hip, 29 knee) was suspected. In all patients the following examinations were performed consecutively: a two-phase Tc methylene diphosphonate (Tc-MDP) bone scan, a Tc hexamethylproplyene amine oxime (Tc-HMPAO) labelled white blood cell (WBC) scan, and a Tc microcolloid bone marrow (BM) scan. The minimum interval between examinations was 48 h. The diagnoses were based on data obtained from bacteriological cultures. RESULTS: The bone scan was positive in all patients and 28 of them had an infection (sensitivity 100%, specificity 0%). The WBC scan was positive in 61 patients but only 27 had an infection. The WBC scan was negative in 16 patients, and the possibility of infection was discarded in 15 of these cases (sensitivity 96%, specificity 30%). The results of the bone marrow scan were not compatible with those of the WBC scan (suggestive of infection) in 27 patients: 26 of them had prosthesis infection. The results of both examinations were compatible in the other 34 patients and the possibility of infection was discarded in 33 of these patients (sensitivity 92.8%, specificity 98%). The addition of a BM scan to a WBC scan decreased the sensitivity from 96% to 92.8% but increased specificity from 30% to 98%. The addition of a bone scan to this dual combination did not alter the results. CONCLUSIONS: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan. This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.     

Usefulness of <Superscript>123</Superscript>I-metaiodobenzylguanidine myocardial scintigraphy for predicting the effectiveness of β-blockers in patients with dilated cardiomyopathy from the standpoint of long-term prognosis

Purpose The usefulness of ¹²³I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in predicting the effectiveness of -blocker therapy in dilated cardiomyopathy (DCM) was investigated from the standpoint of long-term prognosis.Methods The subjects were 53 DCM patients in whom -blockers had been successfully introduced and used for 6 months or longer. When symptoms were stable before the introduction of -blockers and for up to 1 year thereafter, MIBG myocardial single-photon emission computed tomography was performed and the images analysed to obtain the extent score (EXT), severity score (SEV) and washout rate (WR). At the same time, echocardiography was performed to measure left ventricular ejection fraction (LVEF). Thereafter, patients were placed under observation for an average of 1,314±986 days, with the occurrence of cardiac events as the endpoint.Results The degree of improvement in WR after introduction of -blockers was a significant predictor of cardiac events. In fact, none of the patients whose improvement in WR was valued at 10 or higher had cardiac events. Accordingly, using improvement in WR of 10 as the cut-off value, the patients were divided into two groups, improved and unimproved. There were significant differences between the groups in respect of early EXT, early SEV and WR before the introduction of -blockers . As regards predictors of WR improvement, multivariate logistic regression analysis demonstrated that early EXT, WR and LVEF were significant predictors.Conclusion This study shows that, from the standpoint of long-term prognosis, DCM patients who would benefit the most from -blocker therapy are those with low early EXT and early SEV and high WR before -blocker introduction regardless of LVEF values.