核子醫學暨分子影像雜誌/Annals of Nuclear Medicine and Molecular Imaging
中華民國核醫學學會 & Ainosco Press,正常發行
選擇卷期
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泰國作為東南亞國家的領頭羊之一，醫療市場具有龐大潛力，本文整理泰國核醫發展歷史及現況，以期為願意開發此一潛在市場的國內人士提供有益的信息。內文分為四個部分：一為醫院、設備、學會專業人員人數及各造影人次之統計資料，二為核醫藥物主管機關介紹和各機構主責，三為目前臨床使用之核醫藥物和其供應者，最後則為討論與未來展望。望收集之核醫臨床應用及發展趨勢資訊可作為未來雙方學術、人員交流以及拓展東南亞巿場推動之參考。
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Background: Single photon emission tomography (SPECT) myocardial perfusion imaging (MPI) can provide valuable diagnostic and prognostic information in patients with known or suspected coronary artery disease (CAD). Recently, the development of cadmium-zinc-telluride (CZT) SPECT MPI provided satisfactory sensitivity but suboptimal specificity for detecting CAD. Coronary artery calcification (CAC) is a useful CAD indicator when assessed by dedicated calcium scoring computed tomography (CT) scan. Simultaneous CAC scoring with CZT SPECT MPI offered incremental diagnostic and prognostic information over CZT SPECT alone using Tc-99m sestamibi. The aim of this study is to assess diagnostic implications of CAC incorporated with Thallium (Tl)-201 CZT SPECT MPI. Methods: We retrospectively analyzed patients who underwent invasive coronary angiography (ICA) within 6 months of SPECT MPI. Patients who received diagnostic chest CT within 6 months prior to ICA were included (n = 126). The MPI and CT images were interpreted by experienced nuclear medicine physicians and radiologists without knowledge of clinical history. For assessing the location and severity of perfusion defects, 17 segmentation scores and a 5-point scale were used. The global summed stress score (SSS) was calculated by adding all scores in 17 segments on stress images. MPI results were considered abnormal when SSS ≥ 4. Identification of any calcified region (HU ＞ 130) within coronary artery territories on non-contrasted CT scan was defined as CAC positive. A coronary stenosis ≥ 50% on ICA was considered obstructive CAD. Results: The specificity of MPI plus CAC were higher than in MPI alone (86% vs 71%; p = 0.004). The sensitivity showed no significant difference between MPI plus CAC and MPI alone (75% vs 78%; p = 0.5). Positive predictive value (PPV) of MPI plus CAC is 86% but only 76% in MPI alone (p ＜ 0.001). Negative predictive value (NPV) showed no significant difference (75% vs 73%; p = 1.0). Both SSS and CAC were independent factors predicting obstructive CAD. Conclusions: CAC provides additional diagnostic values by improving the specificity of Tl-201 CZT SPECT MPI.
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Background: Few studies have explored the relationship between benign prostatic hyperplasia (BPH) and bone mineral density (BMD). This retrospective study aims to investigate the relationship between BPH and BMD. Methods: Male patients who underwent a general health examination from June 2014 to December 2017 at a regional hospital in southern Taiwan were eligible for this study. Those with a history of spinal surgery, total hip replacement, use of anti-osteoporosis or anti-BPH medications, and those without complete medical histories were excluded. In the final cohort of 1997 patients, BMD and prostate size were estimated by dual-energy X-ray absorptiometry and ultrasonography, respectively, and subjects were divided into normal and BPH groups based on prostate size. BMD and T-scores were compared between the normal and BPH groups. Results: The mean BMD and lumbar spine T-scores but not hip T-scores were significantly higher in patients with BPH than in those with normal prostate size. Conclusions: Our results suggest that for males with elevated lumbar spine BMD but normal hip BMD and hip T-scores, the possibility of an enlarged prostate should be considered. Further clinical evaluation of such individuals for asymptomatic prostate enlargement is recommended.
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Anti-synthetase syndrome (ASS) is a rare autoimmune disease. The diagnosis of ASS often requires multidisciplinary approaches. We presented a 63-year-old female patient with progressively multiple joints pain for 3 months. The diagnosis of ASS was established based on the presence of antibodies against aminoacyl transfer RNA (tRNA) synthetases and clinical features (e.g. interstitial lung disease [ILD], myositis, arthritis, and mechanic's hand). F18-labeled fluoro-2-deoxyglucose (F18-FDG) and positron emission tomography/computed tomography (F18-FDG PET/CT) showed no significant malignancy-associated FDG uptake, but there was diffuse increased uptake in the bilateral lungs, skeleton muscles, and multiple joints. We suggest that F-18 FDG PET/CT may aid in the evaluation of ASS by assessing the extent of inflammation throughout the body.
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A 45-year-old woman with rheumatic arthritis history suffered from fever and some airway symptoms. She was treated as airway infection and rheumatic arthritis flare up initially. Owing to recurrent fever, she was admitted. Chest computed tomography (CT) showed left lower lung minimal ground-glass opacities and splenomegaly. Pulmonary samples from video-assisted thoracoscopic surgery revealed diffuse large B-cell lymphoma. Because subsequent FDG-PET for staging showed a characteristic diffuse pulmonary FDG uptake pattern without corresponding CT abnormality, intravascular large B-cell lymphoma (IVLBCL) was suspected. Further pathologic review made the final diagnosis of IVLBCL, a subtype of diffuse large B-cell lymphoma.
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We present the case of an 81-year-old man with a newly diagnosed prostate cancer who showed different findings on two distinct positron emission tomography/ computed tomography (PET/CT) imaging modalities. Specifically, Ga-68 prostate-specific membrane antigen (PSMA)-11 PET/CT identified three foci of increased tracer uptake in the prostate, liver, and left upper lobe of lung, whereas an abnormal uptake in the prostate and left upper lobe of lung was evident on F18-FDG PET/CT. Subsequent lung lobectomy revealed the presence of a well-differentiated adenocarcinoma of pulmonary origin. Our case demonstrates that F-18 FDG PET/CT can provide complementary diagnostic information in a complex clinical scenario like double cancer.