Publications (18)38.42 Total impact
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Article: 18F-FDG PET/CT in inflammatory pseudotumor of the colon causing intussusception
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ABSTRACT: Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the colon that showed 18F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception. KeywordsPlasma cell granuloma–Colon–Intussusception–Positron-emission tomographyAnnals of Nuclear Medicine 04/2012; 25(6):447-450. · 1.50 Impact Factor -
Article: The clinical efficacy of 18F-FDG-PET/CT in benign and malignant musculoskeletal tumors
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ABSTRACT: ObjectiveMost of the current clinical data on the role of 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with 18F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. Methods 18F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of 18F-FDG uptake in soft tissue and bone tumors, and investigated the ability of 18F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUVmax) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUVmax and the final diagnosis. Unpaired t test was used for the statistical analysis. ResultsFinal diagnosis revealed 19 benign soft tissue tumors (mean SUVmax 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUVmax between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUVmax 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUVmax 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUVmax 3.7. Conclusions 18F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and falsenegative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of 18F-FDG-PET/CT.Annals of Nuclear Medicine 04/2012; 22(7):603-609. · 1.50 Impact Factor -
Article: 18F-FDG PET/CT with Contrast Enhancement for Evaluation of Axillary Lymph Node Involvement in T1 Breast Cancer
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ABSTRACT: Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography ((PET) safely predicts axillary status in patients with breast cancer, but is not sufficiently accurate in early breast cancer patients. This study analyzed the value of 18F-FDG PET/computed tomography (CT) with contrast enhancement in detecting axillary lymph node involvement in T1 breast cancer patients. MethodsContrast-enhanced 18F-FDG PET/CT was performed within 20days of surgery in 143 breast cancer patients with tumors ≤2cm in size. The patients underwent either axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB), and histopathology reports were used to provide the definitive diagnosis against which the contrast-enhanced 18F-FDG PET/CT study results were compared. ResultsThe sensitivity, specificity, and negative and positive predictive values of contrast-enhanced 18F-FDG PET/CT in detecting axillary involvement were 70.0%, 92.2%, 88.8%, and 77.8%, respectively, in the entire series of 143 patients, with eight false-positive and 12 false negative results. The false-negative results were associated with the number of metastatic lymph nodes and the rate of FDG uptake. ConclusionContrast-enhanced 18F-FDG PET/CT cannot replace histologic staging using SLNB in patients with breast cancer, but 18F-FDG PET/CT increases the sensitivity for predicting axillary node metastasis, and allows for a selective approach to either ALND or SLNB, even in patients with T1 breast cancer. KeywordsBreast cancer-Axillary lymph node-FDG-PET/CT04/2012; 44(3):170-176. -
Article: (18)F-FDG PET/CT in inflammatory pseudotumor of the colon causing intussusception.
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ABSTRACT: Inflammatory pseudotumor is a rare benign lesion mimicking malignancy both clinically and radiologically. An accurate diagnosis is still difficult and is based on the histological examination. Since inflammatory pseudotumor is exceptionally rare in the colon, this unexpected lesion can be mistaken for malignancy. We report the first case of inflammatory pseudotumor in the colon that showed (18)F-fluorodeoxyglucose (FDG) uptake and acted as the lead point causing colocolic intussusception.Annals of Nuclear Medicine 04/2011; 25(6):447-50. · 1.50 Impact Factor -
Article: Clinical usefulness of combinatorial protocol with stress only myocardial perfusion SPECT, CTA and SPECT/CTA 3-dimensional fusion image.
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ABSTRACT: This study was designed to assess the value of a combinatorial protocol, namely, stress only myocardial perfusion SPECT (MPS), 64-slice coronary computed tomographic angiography (CTA), and SPECT/CTA 3-dimensional (3D) fusion imaging for the evaluation of coronary artery disease. A total of 142 patients were retrospectively reviewed. All underwent stress only MPS and 64-slice CTA before invasive coronary angiography (ICA). The SPECT/CTA 3D fusion images were generated. We compared the results of the combinatorial protocol with ICA. Seventy nine (76.0%) subjects were found to have ≥50% stenoses, by ICA. The sensitivity of the combinatorial examination was 100% and its specificity 80.8%. Its positive and negative predictive values were 94.0 and 100%, respectively. The number of lesion for abnormal MPS with matching significant stenoses on CTA is 94 [43 in left anterior descending (LAD); 19 in left circumflex (LCX); 32 in right coronary artery (RCA)], the number of lesion for equivocal perfusion defect with matching stenoses on CTA is 24 (14 in LAD; 7 in LCX; 3 in RCA). The number of coronary arterial stenoses without MPS abnormality is 10, 4 stenoses were detected in left main lesion and the other stenoses were comparatively mild lesion in multi-vessel disease. Stress only MPS/CTA 3D fusion imaging could provide the potential for improved diagnostic accuracy and additional information of hemodynamically relevant coronary arterial stenoses.Annals of Nuclear Medicine 03/2011; 25(6):387-95. · 1.50 Impact Factor -
Article: Incidental pituitary uptake on whole-body 18F-FDG PET/CT: a multicentre study.
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ABSTRACT: The purpose of this study was to determine the incidence of incidental pituitary uptake on whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and to investigate its clinical significance. The files of 40,967 patients who underwent whole-body FDG PET/CT were retrospectively reviewed. Quantification of pituitary metabolic activity was obtained by using the maximum standardized uptake value (SUVmax). Hormone assays and pituitary MRIs were performed to assess pituitary lesions. Focally increased pituitary FDG uptake on PET/CT was found in 30 of 40,967 patients, accounting for an incidence of 0.073%. The mean SUVmax of 30 patients was 8.9±6.6 (range: 3.2-32.6). Histological diagnosis was obtained in three patients and included two growth hormone-secreting adenomas and one non-functioning adenoma. Hormone assays were performed on serum samples from 11 patients, 2 of whom were shown to have hypersecretion of pituitary hormone. MRI was performed on 19 patients. Abnormal MRI findings suggesting a pituitary mass were found in 18 of 19 cases (94.7%). The mean SUV(max) calculated without correction for partial volume effect for macroadenomas was significantly higher than the SUVmax for microadenomas (11.5±8.4 vs 4.8±1.3; p<0.05). There were no cases diagnosed with metastasis to the pituitary gland during clinical follow-up. Incidental pituitary FDG uptake was a very rare finding. Cases with incidental pituitary FDG uptake were diagnosed primarily with clinically non-functioning adenomas, and there were also a few functioning adenomas. Further evaluations, including hormone assays and pituitary MRI, are warranted when pituitary uptake is found on FDG PET/CT.European Journal of Nuclear Medicine 12/2010; 37(12):2334-43. · 4.53 Impact Factor -
Article: The clinical efficacy of (18)F-FDG-PET/CT in benign and malignant musculoskeletal tumors.
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ABSTRACT: Most of the current clinical data on the role of 2-[(18)F]fluoro-2-deoxy-D -glucose positron emission tomography ((18)F-FDG-PET) in musculoskeletal tumors come from patients studied with PET and less frequently with hardware fusion PET/computed tomography (CT). And the number of cases in each report is too small to clarify the exact clinical efficacy of PET or PET/CT. This prompted us to analyze our experience with (18)F-FDG-PET/CT in a relatively large group of patients with musculoskeletal tumors. (18)F-FDG-PET/CT was performed on 91 patients from May 2004 to June 2007. The final diagnosis was obtained from surgical biopsy in 83 patients (91%) and clinical follow-up in 8 (9%). We analyzed the characteristics and amount of (18)F-FDG uptake in soft tissue and bone tumors, and investigated the ability of (18)F-FDG-PET/CT to differentiate malignant from benign tumors. The cutoff maximum standardized uptake value (SUV(max)) was calculated using the receiver-operation characteristic curve method. Sensitivity, specificity, and diagnostic accuracy were calculated with cutoff SUV(max) and the final diagnosis. Unpaired t test was used for the statistical analysis. Final diagnosis revealed 19 benign soft tissue tumors (mean SUV(max) 4.7), 27 benign bone tumors (5.1), 25 malignant soft tissue tumors (8.8), and 20 malignant bone tumors (10.8). There was a significant difference in SUV(max) between benign and malignant musculoskeletal tumors in total (P < 0.002), soft tissue tumors (P < 0.05), and bone tumors (P < 0.02). Sensitivity, specificity, and diagnostic accuracy were 80%, 65.2%, and 73% in total with cutoff SUV(max) 3.8, 80%, 68.4%, and 75% in the soft tissue tumors with cutoff SUV(max) 3.8, and 80%, 63%, and 70% in the bone tumors with cutoff SUV(max) 3.7. (18)F-FDG-PET/CT reliably differentiated malignant soft tissue and bone tumors from benign ones, although there were many false-positive and false negative lesions. Further studies with all kinds of musculoskeletal tumors in large numbers are needed to improve the diagnostic accuracy of (18)F-FDG-PET/CT.Annals of Nuclear Medicine 09/2008; 22(7):603-9. · 1.50 Impact Factor -
Article: A case of silent giant cell arteritis involving the entire aorta, carotid artery and brachial artery screened by integrated PET/CT.
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ABSTRACT: We report a case of giant cell arteritis involving the aorta and several large arteries identified by integrated positron emission tomography (PET)/computed tomography (CT) obtained in a patient with a high erythrocyte sedimentation rate (ESR). A 63-year-old man with anemia and a high ESR noted on a regular medical examination was transferred to our department. The patient complained of only a low-grade general weakness for several months; there were no specific symptoms or signs. A PET was recommended. The image showed strong (18)F-fluorodeoxyglucose ((18)F-FDG) uptake at the ascending aorta, aortic arch, descending aorta, thoraco-lumbar aorta, brachial artery, and the carotid artery wall, bilaterally. Suspicious for large-vessel vasculitis, a temporal artery biopsy was performed, which confirmed giant cell arteritis. After treatment with prednisolone, the high ESR and anemia resolved, and (18)F-FDG uptake decreased on follow-up integrated PET/CT.Clinical Rheumatology 12/2007; 26(11):1959-62. · 2.00 Impact Factor -
Article: Evaluation of hepatic function with (99m)Tc-galactosylated serum albumin scintigraphy in patients with malaria: comparison with (99m)Tc-colloid scintigraphy and liver ultrasonography.
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ABSTRACT: Malarial parasites injected by the mosquito rapidly target hepatocytes, and hepatomegaly is commonly observed during the progress of the disease in malaria patients. To evaluate the degree of hepatic damage and functional status of hepatocytes in malaria patients, we performed liver scintigraphy using (99m)Tc-galactosylated serum albumin (GSA) prospectively and the findings were compared with those of (99m)Tc-colloid scintigraphy, ultrasonography and clinical results in the same subject. Eight malaria patients (all male, mean age 22 years) confirmed to be infected with Plasmodium vivax underwent (99m)Tc-GSA liver scintigraphy, followed by liver ultrasonography and (99m)Tc-colloid scintigraphy using phytate within 3 days. For hepatocyte scintigraphy, anterior images of cardiac blood-pool and liver were continuously acquired for 30 min after injection of 185 MBq (99m)Tc-GSA (3 mg). In addition to visual interpretation of the images, quantitative measurement of hepatic function was performed with several functional parameters, such as hepatic uptake index (LHL15), blood clearance index (HH15) and modified receptor index (LHL/HH) calculated from the radioactivity of the liver and heart. (99m)Tc-colloid images were assessed and graded visually. Severity of hepatic dysfunction or reticuloendothelial system activation was classified as normal, mild, moderate and severe on GSA or colloid images. Hepatomegaly was observed in five and splenomegaly in seven of the eight patients. Serum levels of transaminase and alkaline phosphatase were mildly elevated in two. Visual assessment of GSA scintigraphy revealed normal findings in all subjects, except for mild increases in size. The mean values of LHL15, HH15 and LHL/HH were 0.928+/-0.014, 0.537+/-0.031 and 1.732+/-0.106, respectively. They were graded as normal in five, and near-normal to mild dysfunction in three subjects. In contrast, (99m)Tc-colloid scintigraphy revealed abnormal findings in all of the subjects, and graded as moderate in three or severe reticuloendothelial system activation in five subjects. Liver ultrasonographic findings were normal for all subjects except mild hepatomegaly. Malaria-induced injury of the hepatocyte is likely to be minimal whereas hepatomegaly is commonly seen during disease process. This suggests that hepatic damage in malarial infection is mainly due to involvement of the reticuloendothelial system. (99m)Tc-GSA scintigraphy can be used in differentiating hepatocellular damage from reticuloendothelial system involvement in patients with infectious disease showing hepatomegaly.Nuclear Medicine Communications 03/2007; 28(2):95-9. · 1.40 Impact Factor -
Article: Upregulation of PBR mRNA expression in human neuroblastoma cells by flavonoids.
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ABSTRACT: To investigate the putative mediation of peripheral benzodiazepine receptor (PBR) in the cytotoxicity of flavonoids, in this study, modulatory effects of several flavonoids on the lipid peroxide (LPO) production and PBR mRNA expression of human neuroblastoma cells were observed. Elevated levels of peroxidated products in cancer cells may activate pro-apoptotic and anti-proliferative signaling pathways. Treatment of 10(-6) M 4'-chlorodiazepam and PK 11195 ligands of the PBR for 6 days enhanced the generation of LPO of the human neuroblastoma cells. Several flavonoids, well-known cytotoxic substances, potentiated the enhancement of LPO production by PBR ligands. Treatment of 10(-6) M flavonoids for 6 days elevated the expression of PBR mRNA in cells. These findings indicate that the potential of flavonoids to induce apoptosis in cancer cells is strongly associated with their PBR-inducing properties, thereby providing a new mechanism by which polyphenolic compounds may exert their cancer-preventive and anti-neoplastic effects.Phytomedicine 03/2007; 14(2-3):232-5. · 3.27 Impact Factor -
Article: Evaluation of hepatic function with 99mTc-galactosylated serum albumin scintigraphy in patients with malaria: Comparison with 99mTc-colloid scintigraphy and liver ultrasonography
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ABSTRACT: Objective: Malarial parasites injected by the mosquito rapidly target hepatocytes, and hepatomegaly is commonly observed during the progress of the disease in malaria patients. To evaluate the degree of hepatic damage and functional status of hepatocytes in malaria patients, we performed liver scintigraphy using 99mTc-galactosylated serum albumin (GSA) prospectively and the findings were compared with those of 99mTc-colloid scintigraphy, ultrasonography and clinical results in the same subject. Methods: Eight malaria patients (all male, mean age 22 years) confirmed to be infected with Plasmodium vivax underwent 99mTc-GSA liver scintigraphy, followed by liver ultrasonography and 99mTc-colloid scintigraphy using phytate within 3 days. For hepatocyte scintigraphy, anterior images of cardiac blood-pool and liver were continuously acquired for 30 min after injection of 185 MBq 99mTc-GSA (3 mg). In addition to visual interpretation of the images, quantitative measurement of hepatic function was performed with several functional parameters, such as hepatic uptake index (LHL15), blood clearance index (HH15) and modified receptor index (LHL/HH) calculated from the radioactivity of the liver and heart. 99mTc-colloid images were assessed and graded visually. Severity of hepatic dysfunction or reticuloendothelial system activation was classified as normal, mild, moderate and severe on GSA or colloid images. Results: Hepatomegaly was observed in five and splenomegaly in seven of the eight patients. Serum levels of transaminase and alkaline phosphatase were mildly elevated in two. Visual assessment of GSA scintigraphy revealed normal findings in all subjects, except for mild increases in size. The mean values of LHL15, HH15 and LHL/HH were 0.928±0.014, 0.537±0.031 and 1.732±0.106, respectively. They were graded as normal in five, and near-normal to mild dysfunction in three subjects. In contrast, 99mTc-colloid scintigraphy revealed abnormal findings in all of the subjects, and graded as moderate in three or severe reticuloendothelial system activation in five subjects. Liver ultrasonographic findings were normal for all subjects except mild hepatomegaly. Conclusions: Malaria-induced injury of the hepatocyte is likely to be minimal whereas hepatomegaly is commonly seen during disease process. This suggests that hepatic damage in malarial infection is mainly due to involvement of the reticuloendothelial system. 99mTc-GSA scintigraphy can be used in differentiating hepatocellular damage from reticuloendothelial system involvement in patients with infectious disease showing hepatomegaly.Nuclear Medicine Communications 01/2007; 28(2):95-99. · 1.40 Impact Factor -
Article: Direct comparison of adenosine and adenosine 5'-triphosphate as pharmacologic stress agents in conjunction with Tl-201 SPECT: Hemodynamic response, myocardial tracer uptake, and size of perfusion defects in the same subjects.
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ABSTRACT: Adenosine 5'-triphosphate (ATP), a potent and inexpensive coronary vasodilator, was introduced as a pharmacologic stress agent for thallium 201 single photon emission computed tomography (SPECT). However, there has been no direct comparison of ATP and adenosine as myocardial stressors in the same subjects. Thirty-six patients underwent consecutive Tl-201 SPECT imaging with adenosine and ATP in a randomly assigned order. There were no changes in clinical status and no invasive procedures were performed between the two tests. The hemodynamic response and side effects were monitored, and myocardial tracer uptake was assessed by use of a visual grading system and quantitative analysis via a CEqual map. The hemodynamic changes and adverse effects did not differ significantly between the two groups. There were no changes in the detection of any perfusion defect on a per-subject basis, except in one. The exact agreement rate for the visual grading of the myocardial tracer uptake was 84.8%. However, the average extent of the perfusion defect and the severity score were higher with adenosine. The hemodynamic changes and the degree of myocardial uptake were similar between the adenosine and ATP infusion. However, quantitative analysis by use of a CEqual map revealed smaller perfusion defects and lower severity scores in subjects undergoing Tl-201 SPECT with ATP.Journal of Nuclear Cardiology 10/2006; 13(5):621-8. · 2.67 Impact Factor -
Article: A protective role for heme oxygenase-1 in INS-1 cells and rat islets that are exposed to high glucose conditions.
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ABSTRACT: Heme oxygenase-1 (HO-1) has been described as an inducible protein that is capable of cytoprotection via radical scavenging and the prevention of apoptosis. Chronic exposure to hyperglycemia can lead to cellular dysfunction that may become irreversible over time, and this process has been termed glucose toxicity. Yet little is known about the relation between glucose toxicity and HO-1 in the islets. The purposes of the present study were to determine whether prolonged exposure of pancreatic islets to a supraphysiologic glucose concentration disrupts the intracellular balance between reactive oxygen species (ROS) and HO-1, and so this causes defective insulin secretion; we also wanted to evaluate a protective role for HO-1 in pancreatic islets against high glucose levels. The intracellular peroxide levels of the pancreatic islets (INS-1 cell, rat islet) were increased in the high glucose media (30 mM glucose or 50 mM ribose). The HO-1 expression was induced in the INS-1 cells by the high glucose levels. Both the HO-1 expression and glucose stimulated insulin secretion (GSIS) was decreased simultaneously in the islets by treatment of the HO-1 antisense. The HO-1 was upregulated in the INS-1 cells by hemin, an inducer of HO-1. And, HO-1 upregulation induced by hemin reversed the GSIS in the islets at a high glucose condition. These results suggest HO-1 seems to mediate the protective response of pancreatic islets against the oxidative stress that is due to high glucose conditions.Journal of Korean Medical Science 07/2006; 21(3):418-24. · 0.99 Impact Factor -
Article: Adenosine-induced long-standing postischemic left ventricular dysfunction evaluated with gated SPECT.
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ABSTRACT: This study was performed to determine the after-effects of pharmacologic stress (adenosine) on left ventricular (LV) function-end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (LVEF)-with Tl-201 and Tc-99m MIBI SPECT. A total of 263 patients were grouped according to the time interval between isotope injection and imaging. Group A: within 1 hour (n = 99; men, n = 48; women, n = 51; mean age: 63.2 years), subgrouped as patients with no perfusion defect (NPD; n = 61), reversible defect (RD; n = 33), and fixed defect (FD; n = 5). Group B: 1 to 2 hours (n = 110; men, n = 66; woman, n = 44; mean age, 63 years), NPD (n = 64), RD (n = 26), and FD (n = 20). 3) Group C: 2 to 3 hours (n = 54; men, n = 30; women, n = 24; mean age, 62 years); NPD (n = 22), RD (n = 17), and FD (n = 15). All patients were in sinus rhythm during the study and had no prior history of myocardial infarction. In group A, in the patients with RD, poststress LVEF was significantly depressed after adenosine infusion (53.1 +/- 9.5% vs 58.3 +/- 10.2%, P < 0.001) and showed a wall motion abnormality, which was worse after stress than during rest. The mean difference in LVEF (DeltaLVEF) between rest and stress was 5.2%. The DeltaLVEF in those patients with RD was significantly higher than that in the NPD (0.9%, P < 0.01) or FD (2.1%, P < 0.05) subgroups. Twenty of the 33 patients (60.6%) with RD showed an increase in LVEF > or = 5% from poststress to rest, and the poststress ESV (43.3 +/- 19.0 mL) was significantly higher than the ESV (38.5 +/- 18.4 mL, P < 0.01) at rest, but there was no significant difference in the EDV (90.5 +/- 26.4 vs 89.7 +/- 26.2 mL). In group B, DeltaLVEF was 1.5%, 4.4%, and 1.2% in patients with NPD, RD, and FD respectively. In group C, DeltaLVEF was 2.5%, 3.2%, and 0.9% in patients with NPD, RD, and FD respectively, and there was no significant difference in DeltaLVEF among patients. In group C, 4 of 17 patients (23.5%) with RD showed an increase in LVEF > or = 5% from poststress to rest. These results showed that adenosine stress-induced postischemic LV dysfunction is well noted on early quantitative gated SPECT in patients with RD and can also be observed on delayed gated SPECT, even though the incidence of LV dysfunction is less than that in early gated SPECT.Clinical Nuclear Medicine 02/2005; 30(1):18-22. · 3.67 Impact Factor -
Article: Osteoblastoma as a cause of osteomalacia assessed by bone scan.
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ABSTRACT: A 27-year-old female patient was admitted to our hospital with a history of leg pain and mass. She had a benign osteoblastoma in right tibia. Resection of the tumor without treatment by vitamin D antagonist resulted in rapid cure of the osteomalacia. Bone scintigraphy with Tc-99m MDP revealed multiple hot uptakes in initial scan, and follow up scan showed a clear resolution of the lesions.Annals of Nuclear Medicine 08/2003; 17(5):411-4. · 1.50 Impact Factor -
Article: Bone marrow immunoscintigraphy using technetium-99m anti-granulocyte antibody in multiple myeloma.
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ABSTRACT: Conventional skeletal radiography and bone scan have certain limitations in the initial evaluation of bone and bone marrow lesions in multiple myeloma (MM). In this study we investigated the value of bone marrow immunoscintigraphy (BMIS) using anti-granulocyte monoclonal antibody (AGA) for the diagnosis of bone involvement of MM, in comparison with bone scan and skeletal radiography. Whole-body BMIS using technetium-99m-labelled AGA was performed in 22 MM patients (15 male, 7 female) and the imaging findings compared with those of skeletal radiography and (99m)Tc-methylene diphosphonate bone scan. The findings of bone marrow aspiration and serum biochemical findings were also compared with BMIS findings. Abnormal findings of BMIS were defined as presence of a focal photon defect in the axial skeleton or expansion of peripheral bone marrow. A total of 124 focal lesions were detected in 19 subjects (86%) by skeletal radiography, bone scan or BMIS. BMIS detected 92 lesions (74%) in 19 subjects, whereas skeletal radiography detected 58 focal lesions (47%) in 14 and bone scan 40 lesions (32%) in 11. Fifty-one (41%) of the 124 lesions were only seen on BMIS. Spine and pelvic lesions were better visualised by BMIS, whereas skull lesions were better seen with skeletal radiography, and bone scan detected more lesions in the ribs. Marrow expansion was noted in 15 subjects (68%) on BMIS, and its grade correlated with marrow cellularity and myeloma cell percentage in bone marrow aspirates ( P=0.0055 and P=0.0541, respectively). BMIS revealed abnormal lesions in one of three stage II patients and 17 out of 19 stage III patients. The number of lesions of the thoracolumbar vertebrae on BMIS was correlated with cellularity ( P=0.0393), but not with myeloma cell percentage ( P=0.1262). These findings suggest that the results of BMIS with (99m)Tc-labelled AGA correlate with clinical stage, and thus reflect the functional status of bone marrow in MM patients. BMIS might be useful for the detection of bone involvement of MM when skeletal radiography or bone scan is inconclusive, especially for vertebral lesions.European journal of nuclear medicine and molecular imaging 06/2002; 29(5):591-6. · 4.99 Impact Factor -
Article: Comparison of Tc-99m Sestamibi and Tl-201 Uptake in Multiple Myeloma
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ABSTRACT: The authors report abnormal Tc-99m sestamibi (MIBI) and Tl-201 uptake in a 62-year-old patient with histologically and biochemically proved myeloma. Tl-201 imaging was undertaken for tumor evaluation, and 3 days later a Tc-99m MIBI study showed diffuse and focal marrow uptake with focal skull lesions, whereas Tl-201 did not show skull lesions. After treatment, follow-up Tc-99m MIBI whole-body imaging was performed and the marrow uptake was decreased.Clinical Nuclear Medicine 02/2001; 26(3):212-215. · 3.67 Impact Factor -
Article: High and low radioiodine doses to indicate a simple renal cyst.
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ABSTRACT: High doses of iodine-131 ((131)I) are commonly used in patients with differentiated thyroid cancer (DTC) after total or subtotal thyroidectomy, in order to ablate the remaining cancer or normal thyroid tissue. Whole body scan performed after about 5 days can visualize possible metastatic lesions and may also show the stomach, salivary glands, the breasts expressing sodium iodide symporter (NIS), the liver due to metabolism of radioiodinated thyroglobulin and the urinary tract due to urinary excretion of the administered (131)I. A 65 years old female underwent a near total thyroidectomy for a 0.9cm DTC of the papillary type on the right lobe. Histopathology revealed extrathyroid extension of the cancer with multifocal metastases in both lobes, and in one pretracheal lymph node. After surgery, the patient underwent (131)I ablation with 5.55GBq of (131)I and whole body scan was obtained after 5 days. The scan demonstrated usual (131)I accumulation in the thyroid remnant, the salivary glands and the liver. Increased (131)I uptake at the area of the right kidney was also noted. The patient had a 5 years history of an asymptomatic large simple cyst in the right kidney. Computed tomography (CT) scan of the abdomen showed only the known cyst (7x6cm) involving the middle portion of the right kidney. Serum laboratory tests performed at the time of ablation revealed of thyrotropin: >81μIU/mL (reference range: 0.3-4.0μIU/mL), 3.2ng/mL thyroglobulin (reference range: 0-50.0μIU/mL), and 115.5U/mL antithyroglobulin antibody (reference range 0-35.0U/mL). The patient was followed-up with thyroid hormone replacement and serum thyroglobulin measurements every year. The thyroglobulin levels for the follow-up period remained undetectable (detection limit 0.2ng/mL). Three years after ablation, the patient underwent diagnostic whole body scan using 185MBq of (123)I. Thyroid function tests 4 weeks after thyroid hormone withdrawal were: thyrotropin >81μIU/mL, thyroglobulin was undetectable, antithyroglobulin antibody was 74.0U/mL, and the scan demonstrated no tracer uptake in the thyroid bed. No tracer uptake was apparent at the right kidney area where the cyst had been previously seen. The origin of simple renal cysts is not clear, but enlargement of a renal tubule and the eventual loss of its connection to the parent tubule has been suggested. The epithelium of the renal cyst may still be excreting as the renal tubular epithelium and might express NIS. Thus, activity of NIS of renal tissue of the renal cyst might be the mechanism for the radioiodine uptake of the renal cyst on the post-ablation (131)I whole body scan. Renal pelvis and ureter are not usually visualized due to the rapid transit time of the radioiodine through the kidneys. Uncomplicated renal cysts do not usually accumulate radioiodine, although several cases have been identified with this tracer indicating either communication between the cyst and the renal collecting system or diffusion of radioiodine from renal sinus lymphatics, and/or NIS activity of the renal cyst tissue. Renal metastases of DTC in the renal cyst, although very rare, have been reported and may also show radioiodine uptake. In the current case, the possibility of renal cyst metastases from the DTC was clinically ruled out by the typical finding of a well-defined cystic lesion in the right kidney on the CT scan and by the low serum thyroglobulin levels tested before both whole body scans. A possible reason for non-visualization of the renal cyst on the follow-up diagnostic (123)I whole body scan might be the ablation by the high (131)I dose, of the cystic epithelial cells having NIS expression and excreting radioiodine into the cyst. Both (131)I and (123)I, which emit gamma rays, can be used to detect hidden thyroid cancer lesions in thyroid cancer patients. In the present case, (123)I was used for the diagnostic whole body scan to reduce radiation burden to the patient. With the same administered activity, (123)I is known to deliver an absorbed radiation dose that is approximately one-fifth of that of (131)I to NIS-expressing tissues. The diagnostic (123)I whole body scan uses about 30 times a lower dose than the post-ablation (131)I scan, and offers a shorter time interval between its administration and image acquisition (1 day versus 5 days). These differences may eliminate image quality give lower target-to-background ratio and poorer spatial resolution, if the diagnostic (123)I whole body scan is applied. In conclusion, a renal cyst after a high dose whole body (131)I scan may be well identified as a false positive finding and may not reappear on a low dose diagnostic (123)I whole body scan performed after 3 years, possibly due to either ablation of NIS expressing cells or to the low dose of (123)I in the diagnostic scan.Hellenic journal of nuclear medicine 15(3):258-9. · 0.81 Impact Factor
Top co-authors
Top Journals
Institutions
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2003–2012
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Yeungnam University
- • Department Nuclear Medicine
- • Department of Orthopedic Surgery
Asan, South Chungcheong, South Korea
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2002–2010
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Kyungpook National University Hospital
Seoul, Seoul, South Korea
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2006
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Kyungpook National University
- Department of Nuclear Medicine
Sangju, North Gyeongsang, South Korea
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