The RECIST criteria compared to conventional response evaluation after peptide receptor radionuclide therapy in patients with neuroendocrine neoplasms

Annals of Nuclear Medicine - The Response Evaluation Criteria In Solid Tumors (RECIST) is the most used radiological method for evaluating response after peptide receptor radionuclide therapy...     

Clinical applications of radionuclide imaging in the evaluation and management of patients with congenital heart disease

Non-invasive testing of children with congenital heart disease (CHD) began in the 1950s with the introduction of radionuclide studies to assess shunt fractions, pulmonary blood flow, and ventricular contractile function. Echocardiography and cardiac magnetic resonance imaging have since replaced radionuclide imaging in many of these roles. Concurrently, percutaneous and surgical repairs of complex CHD evolved, creating new roles for radionuclide imaging. In this paper on applications of radionuclide imaging in CHD, we review the multiple mechanisms for myocardial ischemia in CHD. We critically compare optimal radionuclide imaging techniques to other imaging modalities for assessing ischemia in CHD. We present the current role of nuclear imaging for assessing viability and pulmonary blood flow. We highlight the value added by advances in dedicated cardiac SPECT scanners, novel reconstruction software, and cardiac PET in performing low-dose radionuclide imaging in CHD. Finally, we discuss the emerging clinical indications for radionuclide imaging in CHD including coronary flow reserve assessment and evaluation of cardiovascular prosthesis and device infections.     

核素显像用于输卵管功能受损程度分级及药物疗效评价

目的 观察核素显像示不同程度输卵管功能损伤患者经内科方法治疗后的妊娠情况,为不同损伤程度输卵管治疗方法的选择提供指导.方法 回顾性分析改良99TcmO-4输卵管显像示至少一侧输卵管通畅的不孕症患者602例,根据输卵管功能损伤情况进行分级(轻度、中度、重度受损,无功能,阻塞),并对不同损伤程度患者采用内科方法(中药腹部热敷+桂芝茯苓胶囊口服+康妇消炎栓直肠给药)治疗后的妊娠情况进行对比分析.采用SPSS 11.0软件对不同组间患者妊娠构成比的比较行x2检验,并计算患者的治愈(输卵管功能恢复正常)率和有效(输卵管功能改善)率.结果 患者经内科方法治疗1～6个疗程,87例(174条输卵管)有治疗前后显像,按条数计,其治愈率为29.5％(46/156),总有效率为71.8％(112/156),治疗前后均正常的输卵管未纳入统计.输卵管不同损伤程度组间妊娠构成比比较,其差异有统计学意义(x2=166.4,P＜0.05).输卵管功能一侧正常而另一侧不同程度受损(A)组,经内科方法治疗后自然妊娠率78.3％ (144/184),较双侧功能均受损者明显增高[一侧轻度受损+另一侧至少轻度受损(B)组、一侧中度受损+另一侧至少中度受损(C)组、一侧重度受损+至少一侧重度受损(D)组相应数据分别为52.6％(102/194)、42.6％(46/108)和13.8％(16/116);x2 =37.86、52.09和121.71,均P＜0.05];B组和C组经内科方法治疗后自然妊娠率差异无统计学意义(x2=3.29,P≥0.05);而B组、C组与D组比较,差异均有统计学意义(x2=67.29和42.82,均P＜0.05).D组经内科方法治疗后,自然不孕者占32.8％(38/116),选择行试管婴儿者占53.4％(62/116),其中成功妊娠者占51.6％(32/62).结论 核素显像示输卵管功能轻度受损者内科方法治疗后自然妊娠率较高,而双侧输卵管均重度受损者同样治疗后自然妊娠率低,宜首选行试管婴儿治疗不孕.放射性核素输卵管功能显像对不同损伤程度的输卵管治疗方法的选择具有指导作用.     

The diagnostic role of radionuclide imaging in evaluation of patients with nonhypersecreting adrenal masses.

The aim of this study was to evaluate the role of radionuclide imaging in the characterization of nonhypersecreting adrenal masses. METHODS: A total of 54 patients (19 men, 35 women; mean age, 50 +/- 16 y) with nonhypersecreting unilateral adrenal tumors that had been originally detected on CT or MRI underwent adrenal scintigraphy using different radiotracers. None of the patients showed specific symptoms of adrenal hypersecretion. Screening tests for excess cortical and medullary products showed normal adrenal hormone levels. Radionuclide studies (n = 73) included (131)I-norcholesterol (n = 24), (131)I-metaiodobenzylguanidine (MIBG) (n = 23), and (18)F-FDG PET (n = 26) scans. RESULTS: Histology after surgery (n = 31) or adrenal biopsy (n = 23) was obtained. Adrenal lesions were represented by 19 adenomas, 4 cysts, 1 myelolipoma, 1 neurinoma, 2 ganglioneuromas, 5 pheochromocytomas, 4 pseudotumors, 6 carcinomas, 2 sarcomas, and 10 metastases (size range, 1.5- to 5-cm diameter; mean, 4.9 +/- 3.1 cm). For norcholesterol imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 71%, and 92%, respectively; the positive predictive value (PPV) of the norcholesterol scan to characterize an adrenal mass as an adenoma was 89%, whereas the corresponding negative predictive value (NPV) to rule out this type of tumor was 100%. For MIBG imaging, diagnostic sensitivity, specificity, and accuracy were 100%, 94%, and 96%, respectively; the PPV of the MIBG scan to characterize an adrenal mass as a medullary chromaffin tissue tumor was 83%, whereas the corresponding NPV to rule out this type of tumor was 100%. For FDG PET, diagnostic sensitivity, specificity, and accuracy were 100%, 100%, and 100%, respectively; the PPV of FDG PET to characterize an adrenal mass as a malignant tumor was 100%, whereas the corresponding NPV to rule it out was 100%. Furthermore, in 7 patients with malignant adrenal tumors, FDG whole-body scanning revealed extra-adrenal tumor sites (n = 29), allowing an accurate diagnosis of the disease's stage using a single-imaging technique. CONCLUSION: In patients with nonhypersecreting adrenal masses, radionuclide adrenal imaging, using specific radiopharmaceuticals such as norcholesterol, MIBG, and FDG, may provide significant functional information for tissue characterization. Norcholesterol and MIBG scans are able to detect benign tumors such as adenoma and pheochromocytoma, respectively. Conversely, FDG PET allows for recognition of malignant adrenal lesions. Therefore, adrenal scintigraphy is recommended for tumor diagnosis and, hence, for appropriate treatment planning, particularly when CT or MRI findings are inconclusive for lesion characterization.     

153Sm-citrate-HA滑膜切除术治疗类风湿关节炎患者57例近期疗效分析

目的观察^153 Sm-柠檬酸-羟基磷灰石（citrate—HA）滑膜切除术治疗类风湿关节炎（RA）所致膝关节滑膜增生的近期疗效。方法对57例RA患者103个有明显滑膜增生的膝关节行关节腔内注射^153 Sm—citrate．HA5×37MBq（0．5～1m1），比较治疗前后关节症状（疼痛、肿胀、积液、功能活动度、上下楼及蹲站受限）变化情况，按优效、良效、微效、无效4级标准评判疗效，并对不同X线分期患者的疗效进行分析。结果治疗后1周开始起效，在半年内疗效逐渐明显，患者关节症状逐渐减轻甚至消失；总有效率为98．1％，其中Ⅰ、Ⅱ期患者的优效率分别为100％和91．3％。结论^153 Sm-citrate—HA滑膜切除术对RA滑膜增生性变是一项简单、安全、有效的治疗方法。     

Improved left ventricular function after growth hormone replacement in patients with hypopituitarism: Assessment with radionuclide angiography

Prolonged growth hormone deficiency (GHD) leads to marked cardiac dysfunction; however, whether reversal of this abnormality may be achieved after specific replacement therapy has not yet been completely clarified. Fourteen patients with childhood-onset GHD (nine men and five women, mean age 27±4 years) and 12 normal control subjects underwent equilibrium radionuclide angiography under control conditions at rest. Patients with GHD were also studied 6 months after recombinant human (rh) GH treatment (0.05 IU/kg per day). Normal control subjects and patients with GHD did not differ with respect to age, gender and heart rate. In contrast, left ventricular ejection fraction (53%±9% vs 66%±6%,P <0.001), stroke volume index (41±11 vs 51±8 ml/m²,P <0.01) and cardiac index (2.8±0.6 vs 3.±0.51/min/m²,P <0.001) were significantly lower in GHD patients than in normal control subjects. None of the GHD patients showed adverse or side-effects during rhGH therapy; thus none required a reduction in GH dose during the treatment period. Heart rate and arterial blood pressure were not significantly modified by rhGH treatment. After 6 months of rhGH therapy a significant improvement in left ventricular ejection fraction (from 53%±9% to 59%±9%,P <0.01), stroke volume index (from 41±11 to 47±13 ml/m²,P <0.05) and cardiac index (from 2.8±0.6 to 3.3±0.8 1/min/m²,P <0.01) was observed in GHD patients. In conclusion, prolonged lack of GH leads to impaired left ventricular function at rest. Reversal of this abnormality may be observed after 6 months of specific replacement therapy in patients with childhood-onset GHD.     

Delayed chromosomal instability in lymphocytes of cancer patients after radiotherapy

Purpose:?To assess possible delayed chromosomal instability (DCI) expressed as elevated chromatid breakage in cells containing previously formed chromosome type aberrations in cultured blood lymphocytes of cancer patients after radiotherapy (RT).

Materials and methods:?Twenty patients treated for uterine cancer with external Co⁶⁰ RT, without chemotherapy, were selected. Blood was taken before, 1–2 days after RT and one year later. Lymphocytes were cultured for 50 and 100?h. Metaphases were stained with fluorescence-plus-Giemsa and analysed for chromosome and chromatid aberrations in 1st (M1) and 3rd plus later (M3+) mitoses.

Results:?RT caused a significant increase of radiation-specific chromosome aberrations in patients' lymphocytes together with DCI, which was observed as an excessive yield of cells containing both chromosome and chromatid aberrations (defined as C_acs&act). This DCI passed successfully through mitoses in?vitro, and at the end of RT a mean yield of ‘extra’ C_acs&act was 3?×?10^?3?×?cell^?1 amongst either M1 or M3+ cells. At the end of RT and one year later DCI in M1 lymphocytes appeared at random amongst patients, but some inter-individual variation was found for DCI presence in M3+ cells at both post-irradiation samplings. As time passed, the mean yield of lymphocytes exhibiting DCI decreased in?vivo and one year after RT reached the pre-treatment level of 1?×?10^?3?×?cell^?1.

Conclusions:?DCI was demonstrated in descendants of human lymphocytes after therapeutic irradiation. The effect diminished one year later, suggesting that the progeny of patients' irradiated stem cells did not produce new daughter lymphocytes exhibiting DCI during the studied post-irradiation period.     

An evaluation of the diagnostic efficacy of phase analysis of data from radionuclide ventriculograms in patients with Wolff-Parkinson-White syndrome

It has been suggested that phase analysis of radionuclide ventriculograms may be of value for detecting and localising the abnormal sequence of ventricular contraction secondary to Wolff-Parkinson-White (WPW) syndrome. The present study was undertaken to test this hypothesis. The space-time sequences of right- and left-ventricular action obtained from radionuclide ventriculograms obtained during rest studies were evaluated in 8 patients with WPW syndrome (confirmed by 12-lead surface electrocardiography) and compared to those of 14 normal subjects. All of the latter showed a consistent ventricular activation pattern, i.e. the first site of ventricular activity in the upper septal region followed by a second site either at the base of the left ventricle or located apically. It was possible to diagnose 11 of the 14 normal subjects (specificity, 79%) and 7 of the 8 patients (sensitivity, 88%). The 4 patients who had been classified as having a left-sided accessory bundle by surface electrocardiography were likewise diagnosed by phase analysis, as were the 2 patients with a confirmed right-sided bypass tract. Two patients with septal posterior accessory pathways could not be identified by phase analysis. Furthermore, cases with an activation pattern which closely resembled that of the 2 patients with right-sided accessory bundles were found to be normal from their ECGs. It is now necessary to evaluate phase analysis against invasive electrophysiological methods in such patients.This work was made possible by an award by the Alexander von Humboldt Stiftung     

Quantitative evaluation of the phase image in radionuclide ventriculography

A functional image is a representation that enhances a particular characteristic of organ behaviour (feature enhancement) with a concomitant reduction or elimination of other informations. The functional image of phase (PI), obtained by Fourier analysis, may be interpreted to represent the onset of counts reduction or contraction in each region of the heart. Phase Spreading (PS), is a parameter derived from PI and represents ventricular temporal behaviour including some spatial information. Phase analysis and PS are very sensitive tools in the diagnosis and characterization of cardiac pathology. PS is a specific indicator of CAD, allows the introduction of normal ranges and is an example of quantitative evaluation of functional images.     

Chest radionuclide angiography in the evaluation of pulmonary masses

A retrospective analysis of 104 chest radionuclide angiography (CRNA) studies establishes the utility of this procedure in the evaluation of pulmonary malignancies and benign masses. Remarkable abnormalities in the perfusion of the lungs were identified in 36 (58%) of 62 cases that were not predictably normal or predictably abnormal form the clinical setting. While 60 of these 62 cases involved malignancy being evaluated for metastases, only 21 (34%) had metastases identified by radionuclide bone or liver-spleen scintigraphy. In addition to diagnosis of superior vena cava obstruction, the CRNA may have a more frequent application as an adjunct to routine scintigraphic studies directed to the identification of metastatic disease.     

Influence of nifedipine on left ventricular perfusion and function in patients with unstable angina: evaluation with radionuclide techniques

In 1981, a large, double-blind, randomized trial was started in The Netherlands to evaluate the therapeutic effects of nifedipine and/or metoprolol in patients with unstable angina. This study has been called the Holland Interuniversity Nifedipine/metoprolol Trial (HINT) and required several hundred patients to establish potential therapeutic effects. From December 1982 to January 1984 the effects of nifedipine on left ventricular (LV) performance in a subgroup of 52 HINT patients were studied using radionuclide techniques. All patients (23 on nifedipine, 29 controls) underwent thallium-201 scintigraphy or radionuclide angiography just before and 48 h after the start of experimental medication. The radionuclide angiographic studies were also performed at 1 and 4 h after treatment. Nifedipine did not influence the incidence or disappearance of perfusion defects on the 48-h thallium images. No significant differences in overall LV ejection fraction (EF) were seen at any time between nifedipine-treated patients and controls. However, paired observations in 37 patients showed improvement of LVEF after 48 h in 8 patients on nifedipine and in only 1 control patient. Scintigraphic measurements on admission were not related to clinical outcome after 48 h. Concomitant administration of metoprolol did not influence LVEF in either group. It is concluded that nifedipine improves LVEF after 48 h in a subset of patients with unstable angina without affecting myocardial perfusion. This finding indicates that nifedipine has a predominant effect on afterload reduction in patients with unstable angina. However, early scintigraphic measurements had no significant predictive value for subsequent cardiac events.     

核素显像在原发性醛固酮增多症患者中的应用

原发性醛固酮增多症（PA）是指体内无法抑制的醛固酮高分泌,导致肾素-血管紧张素系统被激活从而引起机体一系列病理生理改变的临床综合征。PA分为单侧和双侧肾上腺醛固酮分泌过多,两者的治疗方式存在本质差异,前者多采用手术治疗,而后者多采用药物治疗,如何早期分型对下一步的治疗具有重要的临床意义。核素显像包括正电子发射断层显像术（PET）与单光子发射断层显像术（SPECT）,它们以分子探针、功能显像及无创性等为特征,在PA患者的分型诊断中发挥着越来越重要的作用。笔者就核素显像在PA中的研究进展进行综述。