• Journals

路易氏體病與MIBG心肌閃爍造影—織茂智之的三十年足跡

路易氏體病（Lewy body disease, LBD）包含巴金森病（Parkinson disease, PD）、路易氏體型失智症（dementia with Lewy bodies, DLB）及伴隨失智的PDD（PD with dementia），其核心病理為α-synuclein聚集。此一病理改變不僅影響中樞神經，也導致心臟交感神經去神經化。碘-123間碘苯基胍（metaiodobenzylguanidine, MIBG）心肌閃爍顯像可反映交感神經功能，近年被廣泛應用於LBD的診斷與鑑別。早期臨床觀察顯示，PD與DLB患者普遍呈現MIBG攝取下降，且在疾病初期即出現異常；相反地，多重系統退化症、進行性核上性麻痺、皮質基底核退化症及阿茲海默症患者則多維持正常攝取。定量分析顯示，PD與DLB的心臟／縱隔比（H/M ratio）明顯低於對照組，並與病程嚴重度呈相關。病理解剖研究進一步證實，MIBG攝取下降與心臟交感神經纖維中tyrosine hydroxylase與neurofilament陽性纖維顯著減少有關，且與α-synuclein沉積呈正相關。此發現指出，心臟交感神經變性可在PD臨床前期即發生，並解釋了臨床檢查中MIBG攝取下降的病理機轉。總結來說，MIBG心肌閃爍顯像不僅可協助鑑別LBD與其他巴金森症候群或阿茲海默症，更可作為反映疾病病理變化的重要生物標誌，並已納入PD與DLB的國際診斷準則之中。

• Journals

The Clinical Significance of Retropharyngeal/Parapharyngeal Lymph Node Metastasis in Papillary Thyroid Cancer: A Single-Center Observational Study

Background: Lymph node (LN) metastasis is common in papillary thyroid cancer (PTC) and accounts for 20%-50% of patients. However, the development of LN metastasis in retropharyngeal or parapharyngeal (RP/PP) space is rare. The objective of this study was to evaluate the clinical features and the prognosis of RP/PP LN metastasis in PTC. Methods: A total of 17 PTC cases with RP/PP LN metastasis were retrospectively reviewed from July 2008 to June 2022 in our institute. The clinicopathologic and demographic features, including age, gender, tumor size, extrathyroidal extension, TNM staging, American Thyroid Association (ATA) risk, thyroglobulin (Tg) level, radioiodine avidity, F-18 FDG uptake, and time to progression, were recorded according to medical chart review. RP/PP LN metastases were diagnosed based on imaging, with histopathological confirmation when available. The progression-free survival (PFS) analyses were estimated using the Kaplan- Meier method. Results: Among the 17 patients, 9 (53%) had RP/PP LN metastasis found at initial presentation, while 8 (47%) developed RP/PP LN metastasis during follow-up. The median age at RP/PP LN diagnosis was 57 years (range, 26-81 years). The median maximum diameter of a metastatic RP/PP LN was 0.9 cm (range, 0.6-3.1 cm, 2 unmeasurable). Regarding management, 3 underwent observation, 3 had locoregional treatment (2 with surgical resection and 1 with radiofrequency ablation plus external beam radiation), 9 received radioiodine therapy, and 7 received systemic therapy (6 patients received more than one treatment modality). At initial diagnosis, 15 patients (88%) had advanced T classification (T3 or T4); 10 patients (59%) had pathological N1b disease; 5 patients (29%) had distant metastasis (M1); 14 patients (82%) were classified as ATA high risk for recurrence. During the median follow-up of 32.1 months, 13 (72%) patients developed progressive disease, with a median PFS of 11.3 months (range, 5.1-117.5). High Tg level (> 20 ng/mL) at RP/PP LN metastasis diagnosis was an independent risk factor of worse PFS (p = 0.02). Conclusions: RP/PP LN metastasis is rare but often indicates aggressive disease. High Tg levels at RP/PP LN metastasis diagnosis imply poor outcomes, highlighting their prognostic significance.

• Journals

Reduction of Physiological Intestinal Activity Interference in PET Scan Using Low-Residue Diet

Background: Positron emission tomography/Computed tomography (PET/CT) has been proven sensitive in detecting many intestinal malignancies; however, its specificity is lower, posing certain diagnostic challenges in differentiating malignant from benign conditions. As the application of PET/CT in tumor staging and monitoring continues to expand, familiarity with these intestinal fluorodeoxyglucose (FDG) uptake patterns becomes crucial. This study investigates whether a low-residue diet can reduce intestinal activity in FDG PET/CT scanning. Methods: This study collected data from June 2022 to October 2022. The inclusion criteria required subjects to have undergone at least two PET scans at our hospital, with an interval not exceeding 2 years. Exclusion criteria included blood glucose levels above 180 mg/dL, use of glucose-lowering medications, colorectal cancer, pre-examination defecation, and subjects with the presence of obvious lymph nodes or tumors interfering with the intestinal tract. A total of 38 subjects met these criteria. Assessment involved tracing standardized uptake value along the subject's intestinal tract, using the liver's average standardized uptake value (SUVavg) as the threshold. Intestinal regions exceeding this threshold were delineated and their volumes calculated, then multiplied by the intestinal SUVavg of the region. The total lesion glycolysis (TLG) of the intestine was obtained by summing these values, and by comparing TLG values from two scans, we observed whether a low-residue diet could improve intestinal interference issues. Results: This study found that BMI (p = 0.377), laxative use (p = 0.480), age (p = 0.518), and cancer type (p = 0.514) showed no significant differences. However, gender (p < 0.05) and the implementation of a low-residue diet (p < 0.001) had significant effects, indicating that a low-residue diet can effectively suppress intestinal interference. Conclusion: Regarding intestinal visualization issues, many studies have proposed different perspectives. This study demonstrated that a low-residue diet can effectively reduce intestinal visualization problems in patients, though many issues still need to be addressed. In the future, standardized low-residue meal replacements will be used to quantify the overall impact on intestinal motility

• Journals

台灣核醫Theranostics發展歷程及未來展望

本文將引導了解台灣的Theranostics的發展歷程與所建構之技術基盤，並討論其未來展望，落實“核醫黃金三角”模式。面對先進核醫學新時代的到來，所帶給核醫學臨床意義將是：對癌症病患照護具有深遠的影響。

• Journals

Accurate Localization of Post-Biopsy Renal Hemorrhage in Lupus Nephritis Using Tc99m-Labeled Red Blood Cell SPECT/CT: A Case Report and Review of Diagnostic Value

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disorder that frequently affects the kidneys, manifesting as lupus nephritis (LN). Renal biopsy is the gold standard for diagnosing LN but is associated with complications such as hemorrhage. In cases where conventional imaging fails to localize the bleeding source, nuclear medicine techniques may offer a solution. Case presentation: We present a case of a 31-year-old female with a history of SLE who developed multiorgan dysfunction and active lupus nephritis following discontinuation of immunosuppressive therapy. A percutaneous renal biopsy led to persistent hemorrhage, yet CT angiography failed to identify the bleeding site. Tc99m-labeled red blood cell (RBC) scintigraphy, followed by SPECT/CT, successfully localized the active bleeding to the lower pole of the left kidney. Subsequent angiography confirmed a pseudoaneurysm and arteriovenous fistula, which were successfully embolized. Conclusion: Tc99m-labeled RBC SPECT/CT imaging is a valuable diagnostic adjunct in localizing active bleeding when conventional modalities fail. This case highlights its clinical utility in improving diagnostic accuracy and guiding successful interventional management in patients with post-biopsy renal hemorrhage.