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
- 期刊
Development of PET Radiopharmaceuticals at the Tokyo Metropolitan Institute of Gerontology 2010-2019
Approximately 150 medical cyclotrons are installed in Japan for the production of conventional positron emission tomography (PET) radionuclides for routine nuclear medicine practice. The PET Center of Tokyo Metropolitan Institute of Gerontology (TMIG) was the 19th PET Center to be established in Japan. It has provided continuous service since 1990, performing basic and clinical studies as well as clinical diagnosis, and underwent an upgrade in 2013. It is clear that the novel PET radiopharmaceuticals can provide new tools for research and exploration of the PET-based diagnosis of various diseases. From this standpoint, we have undertaken the development of novel PET radiopharmaceuticals specifically for the investigation of brain function. The status of the development of the novel PET radiopharmaceuticals for clinical use at TMIG 2010-2019 is reviewed here.
- 期刊
Prostate cancer (PCa) is a worldwide common malignancy in men with a progressive increase in trend. About 30-40% of cases turned out to be biochemical recurrence after the definitive treatment for localized PCa. In addition, for those with metastatic castration-resistant PCa, nuclear molecular theranostics using prostate-specific membrane antigen (PSMA), radio-ligands has played an increasing role. Ga-68 labeled PSMA 11 is the most common one in the clinical investigations, especially coupling with Lu-177 PSMA for PCa precision therapy. However, PSMA is also expressed in certain normal tissues, benign and non-PCa malignant tumors, causing potential pitfalls in clinical management. F-18 labeled PSMA serves as an alternative for PCa imaging with different biophysical characteristics from Ga-68 labeled PSMA. Its implications in practice, especially equipped with a new positron emission tomography/computed tomography or positron emission tomography/magnetic resonance imaging modalities are worth noting.
- 期刊
Background: Gallium-67 citrate (Ga-67) is a tumor and inflammation imaging agent with poor image resolution and variable physiologic uptake. A Ga-67 scan with planar images is sometimes insufficient to assess the location and extent of disease and to distinguish between pathologic uptake and physiologic distribution. The dual-modality imaging technique, single-photon emission computed tomography combined with computed tomography (SPECT/CT), exhibits improved diagnostic performance compared with the planar imaging alone. This retrospective study evaluated the added value of SPECT/CT in interpreting Ga-67 scans. Methods: Between February 2016 and April 2017, 379 Ga-67 inflammation or tumor scans were performed in our department. Sixty-one (16.1%) patients were selected by nuclear medicine physicians to undergo SPECT/CT. The selection criteria were inconclusive Ga-67 uptake on the planar images that included uncertain pathologic uptake or unusual physiologic distribution. Results: In the 61 patients, 86 sites with inconclusive Ga-67 uptake were observed on the planar images, comprising 52 sites with uncertain pathologic uptake and 34 with unusual physiologic distribution. Of the 52 uncertain pathologic uptake sites, 38 were confirmed to be pathologic uptake with the same interpretation, 12 had different interpretations of disease location or extent, and 2 changed from pathologic uptake to physiologic distribution according to SPECT/CT images. Of the 34 unusual physiologic distribution sites, 27 were confirmed to be physiologic distribution, and 7 changed to pathologic uptake from physiologic distribution according to SPECT/CT images. SPECT/CT increased diagnostic confidence in 65 (75.6%) sites and had an impact on diagnostic accuracy in 21 (24.4%) sites. Conclusions: A Ga-67 scan with SPECT/CT improves diagnostic confidence and accuracy compared with the planar imaging alone.
- 期刊
Background: Low-carbohydrate high-fat diet (LCHFD) has been reported to suppress myocardial ^(18)F-fluorodeoxyglucose (FDG) uptake and decrease the uptake of ^(18)F-FDG in hypermetabolic brown adipose tissue, and might decrease false-positive findings on oncologic ^(18)F-FDG positron emission tomography (PET) scans. This study was proposed in order to compare fasting with LCHFD for the distribution of FDG in the human body and cancers of the same individuals and evaluate the availability of LCHFD to be an alternative method of fasting in the ^(18)F-FDG PET/ computed tomography (CT) study. Methods: We recruited asymptomatic volunteers and patients with diabetes and primary cancer to perform fasting and LCHFD PET/CT. Both PET/CT scans were performed 24 hours apart. The LCHFD and fasting protocols were standardized. Blood tests before FDG injection were recorded. The maximal standardized uptake value (SUVmax) of the organs on PET/CT was measured including the brain, the myocardium, the mediastinum, the liver, the lungs, the muscles, and the tumors. Means and the standard deviation was determined, and a site-to-site comparison using the paired Student's t-test was performed to assess p values. Results: Eighteen asymptomatic volunteers, 9 diabetics and 11 patients with cancers were included. In all of the 38 subjects, the blood tests showed no significant difference in blood glucose and fatty acid on LCHFD and fasting protocols. The SUVmax of the organs on LCHFD showed decreased in the brain, the myocardium, the liver, the mediastinum, and the lungs, but increased in muscles as compared to those on fasting protocol. The difference was significant only in the mediastinum (p = 0.04), especially diabetics (p = 0.039). In the 11 patients with cancers, there was no significant difference in the SUVmax of the tumors between PET/CTs of fasting and LCHFD protocols either using patient or lesion-based statistics. Conclusions: LCHFD could suppress mediastinal ^(18)F-FDG uptake, and provided better image quality. Since it does not influence the FDG uptake in cancers, LCHFD might be an alternative method of fasting in the ^(18)F-FDG PET/CT study.
- 期刊
Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD) characterized by fibrotic encapsulation of the bowel and its diagnosis is often delayed. We illustrated a case whose Gallium-67 (Ga-67) single-photon emission computed tomography/computed tomography (SPECT/CT) facilitated the early diagnosis of EPS confirmed by contrast-enhanced CT. A 54-year-old female with end-stage renal disease undergoing peritoneal dialysis since 2009 was reported abdominal fullness, poor appetite, and malnutrition 9 years later; then one month later, epigastric pain; then five months later, general weakness, dizziness, and malaise. The ascites routine showed clear, red blood cell 0-2/high-power field (HPF), white blood cell (WBC) 0/HPF; the culture showed no bacteria, Mycobacterium, or fungus. Hemoglobin dropped from 11.1 g/dL (2018/11/27) to 7.2 g/dL (2019/02/01), indicating chronic occult infection. Blood WBC was 12.16 × 10^3/μL, c-reaction protein 2.19 mg/dL. Ga-67 scan with SPECT/CT (2019/02/13) showed some mild uptake in the mesentery region, probably mild inflammation. Nuclear medicine physician suggested checking up the possibility of EPS. CT (2019/03/14) showed long segmental mural swelling/thickening of the small and large bowel, bowel tethering and peritoneal calcification, suggesting EPS. Tamoxifen was prescribed, then EPS response to Tamoxifen initially. However, mild abdominal pain recurred and extra-hemodialysis once a week added. Now, the patient is preparing shift to hemodialysis under the suggestion of nephology.
- 期刊
A 59 years old female had a history of Non-Hodgkin's lymphoma with involvement in the left maxillary and ethmoid sinus, left maxilla, adjacent soft tissue, and intracranial invasion, status post chemotherapy during December 2018 to March 2019. Nine months later, the neurolymphomatosis (NL) was detected by F-18 fluorodeoxyglucose (FDG) positron emission tomography/ computed tomography (PET/CT) study. NL is a rare form of extranodal malignant lymphoma defined as the infiltration of malignant lymphocytes in the peripheral nerves, nerve roots, plexuses, or cranial nerves. It is extremely important for clinicians to recognize NL, as this may be the initial presentation of lymphoma or may be a manifestation of relapse or spread of a known malignancy. In both scenarios, early detection has implications on the treatment. NL is a rare complication of non-Hodgkin's lymphoma and leukemia; thus, its incidence is poorly defined. To date, there are only few cases of NL described in the literature. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary. The conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.
- 期刊
A 69-year-old male patient, who had hypertension, dyslipidemia, and smoking, was referred to perform a treadmill myocardial perfusion imaging (MPI) after an episode of chest tightness. The stress and rest images revealed fixed perfusion defects in the inferoseptal, inferior, and basal anterior walls. However, respiratory motion was considered due to blurred mid to basal anterior and inferior walls, and distorted left ventricular chamber shapes. Motion correction by motion compensation technique was performed. The corrected images showed only mildly reversible perfusion defect in the inferior wall and apex. Respiratory motion is not uncommon for MPI using cadmium-zinc-telluride camera. Careful identification and correction help avoid misinterpretation of the images.