Sung M. Kim

Thomas Jefferson University, Philadelphia, Pennsylvania, United States

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Publications (71)128.39 Total impact

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    ABSTRACT: PURPOSE Tc-99m sestamibi (MIBI) scintigraphy is commonly utilized for the preoperative location of parathyroid adenomas. A focal area of tracer retention that persists on delayed images is fairly specific for a parathyroid adenoma. Occassionally, there are 2 foci of MIBI retention on delayed imaging, which theorectically suggests a double parathyroid adenoma. Our aim was to determine just how often this finding was shown to represent a double adenoma. METHOD AND MATERIALS Over a 4-year interval, all parathyroid scans with the finding of 2 areas of MIBI concentration in initial images of the neck, that retained the tracer on 3-hour delayed images were collected and corresponding histopathological results were reviewed. RESULTS A total of 16 patients demonstrated the above finding. Of these, 14 underwent neck exploration; 12 were diagnosed as having asymmetric parathyroid gland hyperplasia, while only 2 were diagnosed with double parathyroid adenoma. CONCLUSION Of the group of 14 patients whose parathyroid scintigraphy showed 2 areas of MIBI retention on 3-hour delayed images of neck, 12 (85.7%) had asymmetric parathyroid hyperplasia, whereas only 2 patients with this finding had true double adenoma.. CLINICAL RELEVANCE/APPLICATION In parathyroid scintigraphy, 2 foci of tracer retention more than likely indicate parathyroid gland hyperplasia, as opposed to double parathyroid adenoma.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: As uveal melanoma originates in the neural crest, we aimed to explore whether somatostatin receptor (SSTR) expression is present and plays any role in these patients. Heavily pretreated metastatic uveal melanoma patients were tested with somatostatin receptor scintigraphy (SRS). Planar images of the whole body complemented by single-photon emission computed tomography on suspected sites were acquired between 4 and 24 h after an intravenous administration of 185-222 MBq (5-6 mCi) of indium-octeotride. SSTR expression in metastatic tissues was confirmed by immunohistochemistry. In seven patients, sandostatin LAR was used with therapeutic intention. Thirty white patients were tested. All had extensive metastatic disease and the median number of previous treatments was three. SRS was found to be positive in 14 (46%) of the patients, but was not related to sex, type of previous treatments, tumor site, or histological type. In 10 patients, sufficient tumor specimens were available to perform immunohistochemical staining for SSTR. All cases with positive SSTR-2A staining were also positive by SRS. Two of the seven patients who received sandostatin LAR died within a month after receiving the first dose, whereas another two (28.5%) had stable disease for more than 5 months. The median time to progression after starting sandostatin was 2.1 months (range: 0.2-5.5 months). Approximately 50% of the uveal melanoma patients with extensive metastatic disease were positive for SSR, which was consistent with immunohistochemical staining for SSTR-2A. Therapeutic approaches targeting SSTR might be beneficial in patients with metastatic uveal melanoma.
    Melanoma research 11/2012; · 2.06 Impact Factor
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    ABSTRACT: The thyroid gland was one of the first organs imaged in nuclear medicine, beginning in the 1940s. Thyroid scintigraphy is based on a specific phase or prelude to thyroid hormone synthesis, namely trapping of iodide or iodide analogues (ie, Tc99m pertechnetate), and in the case of radioactive iodine, eventual incorporation into thyroid hormone synthesis within the thyroid follicle. Moreover, thyroid scintigraphy is a reflection of the functional state of the gland, as well as the physiological state of any structure (ie, nodule) within the gland. Scintigraphy, therefore, provides information that anatomical imaging (ie, ultrasound, computed tomography [CT], magnetic resonance imaging) lacks. Thyroid scintigraphy plays an essential role in the management of patients with benign or malignant thyroid disease. In the former, the structure or architecture of the gland is best demonstrated by anatomical or cross-sectional imaging, such as ultrasound, CT, or even magnetic resonance imaging. The role of scintigraphy, however, is to display the functional state of the thyroid gland or that of a clinically palpable nodule within the gland. Such information is most useful in (1) patients with thyrotoxicosis, and (2) those patients whose thyroid nodules would not require tissue sampling if their nodules are hyperfunctioning. In neoplastic thyroid disease, thyroid scintigraphy is often standard of care for postthyroidectomy remnant evaluation and in subsequent thyroid cancer surveillance. Planar radioiodine imaging, in the form of the whole-body scan (WBS) and posttherapy scan (PTS), is a fundamental tool in differentiated thyroid cancer management. Continued controversy remains over the utility of WBS in a variety of patient risk groups and clinical scenarios. Proponents on both sides of the arguments compare WBS with PTS, thyroglobulin, and other imaging modalities with differing results. The paucity of large, randomized, prospective studies results in dependence on consensus expert opinion and retrospective analysis with inherent bias. With a growing trend not to ablate low-risk patients, so that a PTS cannot be performed, some thyroid carcinoma patients may never have radioiodine imaging. In routine clinical practice, however, imaging plays a critical role in patient management both before and after treatment. Moreover, as evidenced by the robust flow of publications concerning WBS and PTS, planar imaging of thyroid carcinoma remains a topic of great interest in this modern age of rapidly advancing cross sectional and hybrid imaging with single-photon emission computed tomography, single-photon emission computed tomography/CT, and positron emission tomography/CT.
    Seminars in nuclear medicine 01/2012; 42(1):49-61. · 3.96 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the accuracy of FDG-PET/CT in the initial staging and restaging of cholangiocarcinoma (CCA), as well as its utility in response to therapy. METHOD AND MATERIALS Over a 4-year interval, a total of 42 patients with CCA underwent FDG-PET/CT for either initial staging prior to surgery, for follow-up after therapy (chemotherapy, radiofrequency ablation, or targeted therapy), and for suspicion of recurrence (on clinical grounds or elevation of tumor markers). RESULTS In all 42 patients, FDG accumulated in the primary tumors, yielding a sensitivity of 100%. The maximum standardized uptake values (SUV Max) ranged from 3. to 19.8, and either did not change significantly or increased by less than 10% on 2-hour delayed imaging of the abdomen. Intrahepatic metastases were seen in 21patients, abdominal lymph node metastases were seen in 29 patients, and distant metastases in 27 patients. The latter group included lung, bone, splenic, adrenal, and peritoneal metastases. In 5 patients, hypermetabolic abdominal lymph nodes were not enlarged by CT or MRI criteria. The bone metastases in 4 patients were either not seen or outside the field of view on MRI or diagnostic CT, and the splenic metastases of one patient was not well-defined on CT. For restaging, (30 patients) follow-up PET/CT demonstrated either improvement or progression of disease, thereby impacting patient management. CONCLUSION FDG-PET/CT is a highly sensitive imaging modality for the detection of primary and metastatic CCA. CLINICAL RELEVANCE/APPLICATION FDG-PET/CT is useful in the staging and restaging of CCA, and impacts patient management.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE It is generally accepted that FDG-PET/CT is approximately 60% sensitive in detecting primary hepatocellular carcinoma (HCC). Our aim is to determine the sensitivity in detecting the metastases of HCC, regardless of whether the primary tumor is FDG-avid. METHOD AND MATERIALS Over a 3-year interval, the findings of PET/CT scans and cross-sectional imaging (diagnostic CT and/or MRI) of 17 patients with metastatic HCC were compared. The PET/CT scans and cross-sectional imaging used for comparison were either on the same day or within a few days of each other. The diagnosis of metastatic disease was confirmed either by biopsy or subsequent clinical course. RESULTS All 17 patients studied had FDG uptake in metastatic HCC, either abdominal lymph nodes (10), bone (3), adrenal (2), or spleen (2). Of these 17 patients, the metastases seen on PET/CT were concurrent in 13 (76.5%). In 1 paitent, diagnostic CT demonstrated more gastrohepatic lymph nodes then were seen on PET/CT. However, in the remaining 3 patients, the metastases identified on PET/CT were not seen on cross-sectional imaging; these included abdominal lymph nodes (2) and bone metastases (1). CONCLUSION In metastatic HCC, PET/CT is at least as sensitive in diagnosing metastases as diagnostic CT or MRI. Differences in biological behavior between the primary tumor and its metastases could account for the FDG avidity of the metastases. CLINICAL RELEVANCE/APPLICATION FDG-PET/CT is a reliable tool in the detection of metastatic disease from HCC and conceivably has a role in HCC staging and response to therapy.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE FDG-PET/CT is a well established modality for evaluating indeterminate solitary pulmonary nodules (SPN). Although the sensitvity for detecting malignancy is considered quite high, the specificity is lower. By adding delayed imaging (Dual-Point PET/CT), the specificity for malignancy improves, since malignant SPN increase glucose utilization over time, i.e. an increase by > 10% in the maximum standardized uptake value (SUV Max). By contrast, a decrease or no significant change in SUV max suggests benign etiology. We observed, however, that it was not uncommon for biopsy-proven malignant nodules to show either no significant change or a significant decease (> 10%) in SUV Max on delayed imaging. Our aim was to (1) determine the frequency of this pattern and (2) to correlate with histopathology. METHOD AND MATERIALS Over a 4-year period, we collected all cases of FDG-PET/CT scans used for SPN evaluation in which the final diagnosis was lung malignancy, yet the SUV Max either did not significantly change, or decreased by 10% or more on delayed imaging. RESULTS A total of 42 patients met the above criteria, 26 men and 16 women. In 22 of the patients (Group A), the SUV Max decreased by > 10%, which was considered a significant decrease. Of these, 13 patients had adenocarcinoma, 2 had squamous cell, 4 had small cell, and 3 had bronchoalveolar (BAC). The remaining 20 patients (Group B) demonstrated either no significant change in SUV Max, or a decrease less than 10%; 12 had adenocarcinoma, 1 had small cell and 7 had BAC. CONCLUSION (1) Although a significant increase in SUV Max in dual-point FDG PET/CT imaging generally indicates SPN malignancy, a decrease or lack of change in SUV does not necessarily mean a benign etiology. (2) Adenocarcinoma is the most common cell type in which SUV Max decreases or does not significantly change, likely a reflection of tumor differentiation. CLINICAL RELEVANCE/APPLICATION A lack of change or a significant decrease in SUV Max over time of an SPN does not exclude malignancy and this pattern is unreliable in SPN evaluation.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: Subclinical hyperthyroidism is defined as normal serum free thyroxine and a free triiodothyronine level, with a thyroid-stimulating hormone level suppressed below the normal range and is usually undetectable. Although patients with this diagnosis have no or few signs and symptoms of overt thyrotoxicosis, there is sufficient evidence that it is associated with a relatively higher risk of supraventricular arrhythmias as well as the acceleration or the development of osteoporosis. Consequently, the approach to the patient with subclinical hyperthyroidism is controversial, that is, therapeutic intervention versus watchful waiting. Regardless, it is imperative for the referring physician to identify the causative thyroid disorder. This is optimally accomplished by a functional study, namely scintigraphy. Recognition of the scan findings of the various causes of subclinical hyperthyroidism enables the imaging specialist to help in diagnosing the underlying condition causing thyroid-stimulating hormone suppression thereby facilitating the workup and management of this thyroid disorder.
    Clinical nuclear medicine 09/2011; 36(9):e107-13. · 3.92 Impact Factor
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    ABSTRACT: PURPOSE Tc-99m MAA liver perfusion SPECT is performed before administration of Yttrium-90 Sir sphere (Y-90) in the patient presenting with hepatic malignancy to evaluate biodistribution of tumor perfusion, estimation of tumor-to-normal liver perfusion ratio and intra-tumor shunting. It is assumed that perfusion pattern observed from MAA liver SPECT is similar to that of Y-90. However there has been discrepancy in distribution of MAA and Y-90 perfusion. This study investigates the frequency of discordant perfusion pattern between the two tracers and its impact on subsequent treatment strategy. METHOD AND MATERIALS 28 Liver SPECT studies were obtained in the 21 patients with known metastatic liver malignancy. Tc-99m –MAA liver perfusion was obtained following 14.8 MBq of Tc-99m MAA. About 2 to 4 weeks later, liver SPECT was obtained following the infusion of Y-90 SIR spheres by Bremsstrahlung, peak around 70 Kev. Distribution pattern on each liver SPECT was scored qualitatively as mild, moderate and marked discordant on the each lobe of the liver. In case of discordant distribution pattern, tumor-to-normal liver perfusion ratio was estimated for each SPECT studies to see the magnitude of % discrepancy. RESULTS There were 7/28 (25%) studies showing a discordant perfusion pattern between the two liver SPECT studies. Most discordant segment occurs in the left lobe. Average degree of the discordant is mild. Tumor-to-liver ratio noted in the discordant MAA liver SPECT ranges from 3.2 to 5.3. Y-90 liver SPECT underestimates the tumor perfusion noted, compared to the MAA Liver SPECT; average 23% underestimation was noted. CONCLUSION Discordant perfusion pattern between the MAA and Y90 Liver SPECT occurs in 25% of the studies. Y-90 perfusion underestimates tumor-to-liver ratio which might compromise the tumor dosimetry for adequate treatment. CLINICAL RELEVANCE/APPLICATION Discrepancy of tumor perfusion beteen MAA and Y-90 liver SPECT has been observed.Awareness of discordant tumor perfusion between MAA and Y-90 liver SPECT should improve future treatment planning.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 12/2010
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    ABSTRACT: PURPOSE Both radiologists (RAD) and nonradiologists (NONRAD) perform therapeutic radioiodine (RAI) procedures for hyperthyroidism and thyroid cancer throughout the USA, a potential "turf" issue. RAD include primarily nuclear medicine physicians, while NONRAD include primarily endocrinologists. The latter group benefitted in 2000 when the Nuclear Regulatory Commission (NRC) issued new rulings, 10 CFR Parts 35.932 and 35.934, which reduced the number of training hours for therapeutic RAI procedures to 80, thereby easing MRC licensure requirements for endocrinologists. Our purpose was to determine the % of RAI procedures performed by both RAD and NONRAD on Medicare patients, using the most recent national Medicare database available (2007), and compare them to the % difference of RAI procedures performed at the time of the earliest available Medicare database (1996). METHOD AND MATERIALS All relevant CP-4 codes from the national Medicare Part B database for 1996 through 2007 were selected for hyperthyroidism, thyroid cancer ablation, and metastatic thyroid cancer ablation. From this data, the procedure volumes for RAD and NONRAD were tabulated. RESULTS In 1996, a total of 13,273 RAI procedures were performed on Medicare patients, of which RAD performed 9,715 (73%) and NONRAD performed 2,938 (22%). The remaining 5% were performed by physicians in multispecialty groups and independent daignostic facilities (MS/IDF) who are either RAD or NONRAD. In 2007, a total of 13,004 RAI procedures were performed on Medicare patients; 9,002 (69%) by RAD and 3,976 (30%) by NONRAD (less than 1% were done by MS/IDF). CONCLUSION (1) From 1996 to 2007, the volume of RAI treatments on Medicare patients slightly decreased by 2%. (2) In 1996, RAD performed 73% of all treatments; this decreased by 7.3% by 2007. (3) In 1996, NONRAD performed 22% of all treatments; this increased by 36.3% by 2007. CLINICAL RELEVANCE/APPLICATION Nonradiologists are gaining market share in RAI treatments of Medicare patients, arguably on account of NRC rulings.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    ABSTRACT: PURPOSE The National Oncologic Patient Registry (NOPR) was established to determine the impact of FDG-PET in the management of various malignancies. Through the NOPR program, FDG-PET/CT in patients with biliary duct and gallbladder cancers was fiscally allowable. Our goal was to evaluate the usefulness of FDG-PET in the staging and restaging of cholangiocarcinoma (CCA). METHOD AND MATERIALS Over a two-year interval, a total of 22 patients with CCA underwent FDG-PET/CT for staging (N=12) or restaging (N=10). Initial imaging was performed prior to resection or therapy for all patients, and follow-up PET/CT scans were performed in 10 patients for restaging after surgery, chemotherapy or radiofrequency ablation. RESULTS In all 22 patients, FDG accumulated in the primary tumors, yielding a sensitivity of 100%. The maximum standardized uptake values (SUV max) ranged from 4.3 to 19.8, and either did not change or increased by less than 10% on 2-hour delayed imaging of the abdomen. Intrahepatic metastases were identified in 5 patients; distant extrahepatic metastases were seen in 12 patients. In the latter group, bone metastases in 4 patients were either not seen or outside the field of view on MRI or diagnostic CT, and the splenic metastases of one patient was not well-defined on CT. For restaging, the follow-up PET/CT scan demonstrated either improvement or worsening of disease, thereby impacting patient management. CONCLUSION FDG-PET/CT is a highly sensitive imaging modality for the detection of primary and metastatic cholangiocarcinoma. CLINICAL RELEVANCE/APPLICATION FDG-PET/CT is highly usefuly in the staging and work-up of patients with cholangiocarcinoma, and has a definite impact on patient management.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 12/2009
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    ABSTRACT: PURPOSE To determine the relationship, if any, between 18-FDG uptake and the hormone receptor status as well as HER-2 gene expression in invasive breast carcinoma (IBC). METHOD AND MATERIALS Over an 18-month interval, a total of 38 women with IBC 1 cm or larger underwent initial FDG-PET/CT imaging for staging purposes. Estrogen receptor (ER) and progesterone receptor (PR) status results were reviewed from histopathology reports. Results of the human epidermal growth receptor 2 (HER-2) gene expression testing were also recorded. Patient subgroups were subsequently formed: Group A (N=9) were ER positive/PR positive/HER-2 positive (i.e. "triple positive"), Group B (N=10) were ER negative/PR negative/PR negative/HER-2 negative (i.e. "triple negative"), and Group C (N=19) were any other combination, such as ER/PR positive/HER-2 negative, or ER/PR negative/HER-2 positive. TheSUV max of the breast tumors were tabulated. RESULTS The triple-negative tumors demonstrated the highest SUV max, ranging from 2.78-25, with a mean of 8.73. The triple-positive tumors had the lowest SUV max, ranging from 0-5.59, with a mean of 2.09. The mixed group had a range of 0-23, with a mean of 5.07. CONCLUSION The triple-negative breast cancers are known to be high-grade tumors that grow quickly and have a poor prognosis. Our results indicate that they demonstrate the highest SUV max than the others, a reflection of higher glucose utilization rates. By contrast, the triple-positive tumors are the least aggressive with the lowest glucose consumption. CLINICAL RELEVANCE/APPLICATION Patients with triple-negative invasive breast cancers have a significantly higher proportion of tumor glucose metabolism, as reflected by higher 18-FDG concentrations.
    Radiological Society of North America 2009 Scientific Assembly and Annual Meeting; 11/2009
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    ABSTRACT: Lymphoscintigraphy has become part of the standard of care for patients with a new or recurrent diagnosis of melanoma, in helping determine the status of regional lymph nodes. Correct identification of sentinel lymph nodes enables the surgeon to further delineate the extent of malignancy by allowing sampling of the appropriate nodal group. Performing the lymphoscintigraphy prior to the planned operation allows limited surgery with less extensive postoperative morbidity. For this reason, a thorough knowledge of the lymph node drainage patterns from the different primary tumor locations, as well as of proper lymphoscintigraphic techniques and radiopharmaceuticals, constitutes an important armamentarium in the hands of surgeons, radiologists, and nuclear medicine physicians.
    Radiographics 07/2009; 29(4):1125-35. · 2.73 Impact Factor
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    ABSTRACT: PURPOSE To evaluate the characteristics of F-18 FDG PET positive scan in detecting a recurrent metastatic thyroid cancer in relation to the serum TG level, post therapy iodine scan and other diagnostic scan such as ultrasound. METHOD AND MATERIALS We evaluated retrospectively 47 patients who had FDG PET scan with clinical suspicion of recurrent thyroid cancer. 33 of the patients had a negative radioactive whole body iodine scan with an elevated thyroglobulin level. The patients were divided into two groups: Group A (n = 17) with PET positive and group B (n = 30) with PET negative for recurrent thyroid cancer. Outcome of PET scan was correlated with serum thyroglobulin (TG) level at the time of imaging, outcome of post-iodine therapy whole body scan, thyroid staging and other diagnostic test, namely neck US if the patient had any of these study. RESULTS Median TG level of group A is 740 ng/ml (95%CI: 3-2300) and median TG level of group B is 182 ng/ml (95% CI: 2.3 to 1209). Diagnostic US is positive in 7/10 in the group A than in 11/25 in the group A. Post therapy iodine scan is positive in 8/15 in the group A than in group the B. PET positive finding is in the more advance staging than in negative group (stage 1 and II vs. stage III and IV.) CONCLUSION FDG PET positive group has a tendency of having higher thyroglobulin level, higher posive scan rate in post therapy iodine scan and high resolution US. CLINICAL RELEVANCE/APPLICATION Higher the serum TG level and higher the cancer staging, higher incidence of the FDG PET positive for recurrent thyroid cancer is noted.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: PURPOSE Subclinical hyperthyroidism (SBH) is defined as suppression of thyroid stimulating hormone (TSH) levels with normal serum hormone (T3 and T4) levels. SBH often progresses to overt hyperthyroidism. Our aim is to (1) classify the thyroid scan findings of SBH according to the etiology of the underlying thyroid disorder, and (2) determine the frequency with which patients with SBH become thyrotoxic. METHOD AND MATERIALS Over a 7-year period, a total of 86 patients with SBH underwent thyroid scintigraphy. Follow-up was obtained by contacting the referring physician or by review of medical records, or in some cases there were follow-up thyroid scans. RESULTS (1) 51 of the 86 patients (58.3%) with SBH had a autonomously functioning thyroid nodule(AFTN), 29 of whom developed toxic autonomous nodules (TAN), 10 remained euthyroid, and 12 were lost to follow-up. (2) 24 patients (27.9%) had a multinodular goiter (MNG), 9 of whom progressed to a toxic MNG, while 7 remainded euthyroid, and 8 were lost to follow-up. (3) 7 patients (8.1%) demonstrated diffuse gland enlargement and were termed "evolving Graves' disease". 6 of these patients developed overt Graves' disease, and 1 was lost to follow-up. (4) 4 patients (4.7%) had very low radioiodine uptake with decreased tracer activity, presumably from resolving silent thyroiditis. CONCLUSION (1) AFTN was the most common etiology of SBH, and most progressed to a toxic adenoma. (2) All paients with evolving Graves' disease became thyrotoxic. CLINICAL RELEVANCE/APPLICATION Autonomous thyroid nodule is the etiology of most cases of subclinical hyperthyroidism, and often become toxic.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: PURPOSE It has been a trend for the emergency room physicians (ERMD) at our academic institution to request lung V/Q scans on patients with sickle cell anemia presenting with the so-called acute chest syndrome, which is one of the acute manifestations of sickle cell anemia. Their rationale in ordering the lung scan is to "be sure that this isn't PE (pulmonary embolism)". Our goal was to determine the actual incidence of PE in this clinical setting. METHOD AND MATERIALS Over a 12-month interval, a total of 27 patients with sickle cell anemia who presented to the ER with the acute chest syndrome were sent by ERMDs for V/Q imaging, in order to exclude PE. The scan results were compared with clinical outcomes of the patients. The scans were interpreted using PIOPED II criteria. RESULTS Of the 27 patients, 21 had normal scans, and 6 had very low probability for PE scans. None of the patients underwent further work-up for PE back in the emergency room, and all were given a final presumptive diagnosis of the acute chest syndrome of sickle cell anemia. CONCLUSION When a patient with sickle cell anemia presents with the acute chest syndrome in the emergency room, characterized by chest pain, fever, abnormal chest x-ray, etc., the odds of the etiology being PE rather than the acute chest syndrome itself are so remote that a lung V/Q scan is not indicated. Performance of a V/Q scan in this clinical setting therefore results in wasted resources, particularly when the scans are ordered by the ERMD during non-working hours, thereby escalating the cost of healthcare (personnel, radiopharmacuetical expense, etc.). CLINICAL RELEVANCE/APPLICATION The emergency room physician is not justified in obtaining V/Q scans on patients with sickle cell anemia presenting with the acute chest syndrome.
    Radiological Society of North America 2008 Scientific Assembly and Annual Meeting; 12/2008
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    ABSTRACT: PURPOSE Scintigraphic imaging using Tc-99m sestamibi is a routine diagnostic procedure for the localization of parathyroid adenomas (PTA). while a PTA appears as an area of focal tracer retention throughout the examination, parathyroid gland hyperplasia (PGH) classically presents as a negative study (i.e. no discrete area of tracer retention). However, upon follow-up of scan results, we found instances where our interpretation as parathyroid adenoma or double adenoma was diagnosed histologically as asymmetric PGH. Our goal was to determine the various scan findings on all patients who underwent parathyroid scintigraphy, who had histologically-proven PGH. METHOD AND MATERIALS Over a 2-year period, we gathered the available pathology reports of all patients who underwent parathyroid scintigraphy. We then tabulated a list of patients whose pathology reports indicated PGH for the final diagnosis, and compared them to the scan results. RESULTS A total of 33 patients were ultimately diagnosed as having PGH. Of these, 8 patients had normal scans. 10 patients demonstrated 2 areas of tracer retention so their parathyroid scan reports were interpreted as "double parathyroid adenoma". 15 patients demonstrates one area of tracer retention on the parathyroid scan and were interpreted as parathyroid adenoma. The pathology reports of the 10 patients reported as having double adenoma and the 15 patients reported as having a single adenoma, all had the final histologic diagnosis of "asymmetric parathyroid gland hyperplasia". CONCLUSION On sestamibi parathyroid scintigraphy, parathyroid gland hyperplasia can appear as a normal scan, or as 1 or 2 areas of focal tracer retention depending on the degree of parathyroid cellularity of the gland observed by the pathologist. In our series of 33 patients with PGH, 24.2% had normal scans, 30.3% had 2 areas of tracer retention, and nearly half (45.5%) had one focus of retention, mimicking a parathyroid adenoma. CLINICAL RELEVANCE/APPLICATION Parathyroid gland hyperplasia has several sestamibi scan appearances.
    Radiological Society of North America 2007 Scientific Assembly and Annual Meeting; 11/2007
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    ABSTRACT: PURPOSE The use of epidermal growth factor (EGF) inhibitor, a monoclonal antibody, has been increasingly utilized in metastatic colon cancer unresponsive to conventional chemotherapy. At our institution FDG-PET is one of the means employed for the assessment of tumor response. The goal of this study was to determine if FDG uptake within the tumor preceded the decline in the level of serum tumor markers in those patients responsive to the antibody therapy. METHOD AND MATERIALS A total of 10 patients with metastatic colorectal cancer unresponsive to chemotherapy underwent treatment with the EGF inhibitor. FDG-PET imaging as well as measurements of serum tumor markers such as CEA and CA 19-9 were all obtained one week to one month after therapy. The efficacy of the immunotherapy was eventually assessed 6 to 8 weeks later by follow-up FDG-PET as well as other imaging, repeat tumor marker measurements, and clinical assessment. RESULTS In 8 patients, the FDG-PET scans demonstrated either normalization or a significant decrease in tumor uptake compared to the baseline pre-immunotherapy scans, while the corresponding markers either remained elevated or decreased slightly. At 6 to 8 week follow-up, all 8 patients had either minimal or no FDG uptake and were in clinical remission. Two paients did not respond to immunotherapy and their FDG-PET scans and tumor markers indicated tumor progression. CONCLUSION Assessment of tumor response to immunotherapy with EGF inhibitor antibody is earlier on FDG-PET compared to measurements of serum tumor marker levels in metastatic colorectal cancer. CLINICAL RELEVANCE/APPLICATION FDG-PET is a more reliable indicator of treatment response early after EGF inhibitor immunotherapy than serum tumor marker levels.
    Radiological Society of North America 2007 Scientific Assembly and Annual Meeting; 11/2007
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    ABSTRACT: Radionuclide imaging is often used in the diagnosis and work-up of a wide range of neoplasms, on the basis of the biologic behavior of the tumor. Neuroendocrine tumors are a subgroup of neoplasms that are generally small and slow growing, and consequently their identification with conventional anatomic imaging can be difficult. Depending on the physiologic properties of the tumor, functional images obtained with radionuclides are often complementary to anatomic images, not only in the localization of the tumor and its metastases, but also in the assessment of prognosis and response to therapy. Familiarity with the choice of the appropriate radiopharmaceutical, proper imaging protocols, and the wide range of imaging patterns will enable the radiologist to guide the clinician in case management.
    Radiographics 09/2007; 27(5):1355-69. · 2.73 Impact Factor
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    ABSTRACT: PURPOSE Interval development of Pulmonary nodules or parenchymal opacity in the patients being treated with radiation and/or chemotherapy present a diagnostic challenge to clinician during the management of cancer. To determine a likelihood of malignancy by using dual-time point FDG PET imaging in the patient with pulmonary nodules/opacity during the restaging a lung cancer patients treated with radiation or chemotherapy METHOD AND MATERIALS A total of 62 patients presenting with pulmonary abnormality were evaluated by using dual-time point PET imaging. FDG PET scan was obtained at 60 min and 120 min after the injection of 10-15 mCI of FDG. SUV values on the initial uptake (IU) and delayed uptake (DU) and % change in SUV between two-time point were calculated. Clinical outcome was obtained by biopsy, or follow-up. RESULTS Thirty seven lesions were ultimately found to be a malignant. The mean SUV value at IU was 5.4 (95% CI: 4.3 to 6.6) and mean DU was 6.5 (95% CI: 4.9-7.9). Benign inflammatory changes were noted in 25 lesions: the mean IU was 2.8(95% CI: 1.8-3.8) and DU was 3.1 (95% CI:1.9-4.2). Benign lesions tends to decrease an average of 4% (95% CI: -3.2% to +11%) whereas a malignant lesion increases SUV value an average 19% (95% CI: 14-25%). Applying a conventional SUV of 2.5 for malignancy on IU yielded sensitivity, specificity, positive predictive value (PPV), negative predicitive value(NPV) of 84%, 64%, 78%, 73% respectively. Criterion of 2.5 on DU yielded sensitivity, specificity, PPV, NPV of 87%, 60%. 76%, and 75%. There is no statistical significance between the initial and delayed PET imaging in the sensitivity, specificity, PPV, and NPV. Most of false-positives (11/25) are noted in the patient with radiation changes and inflammation. CONCLUSION Delayed PET imaging does not improve sensitivity, specificity, predicitve values in differentiating radiation induced inflammatory changes from malignant lesions in restaging of the patients with pulmonary nodules/opacity. CLINICAL RELEVANCE/APPLICATION Delayed PET imaging obtained 120 min post injection does not add more differentiating power than the inital PET scan at 60 min post injection in patients with radiation pneumonitis.
    Radiological Society of North America 2006 Scientific Assembly and Annual Meeting; 12/2006
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    ABSTRACT: The lungs are among the most common sites for metastases from a multitude of cancers. The majority of pulmonary metastases appear nodular on radiologic images. Interstitial spread of tumor through pulmonary lymphatics, also known as pulmonary lymphangitic carcinomatosis (PLC), is not uncommon and constitutes approximately 7% of pulmonary metastases. PLC is most often seen with adenocarcinoma of a variety of histologies such as thyroid carcinoma, and melanoma. It is usually noted in late stages of malignancy and therefore is indicative of a poor prognosis. Diagnosis of PLC is usually based on a combination of clinical and radiologic findings. However, the diagnosis is difficult when patients have limited clinical findings or have a history of or the possibility of other interstitial lung diseases. High-resolution computed tomography (HRCT) has been the modality of choice in the radiologic diagnosis of PLC. Imaging features of PLC on HRCT include thickening of interlobular septa, fissures, and bronchovascular bundles. Distribution of PLC may be focal or diffuse, unilateral or bilateral, and symmetric or asymmetric. Although FDG-PET has been extensively used in primary or secondary lung malignancies, its role and appearance in PLC have not been well determined in the literature. In this communication, we describe a spectrum of FDG-PET and CT findings in 5 cases with PLC. Similar to CT, the distribution of PLC can be extensive or limited on the FDG-PET. Diffuse, lobar, or segmental FDG uptake in the lungs is seen in extensive PLC. In limited PLC, a linear or a hazy area of FDG uptake extending from the tumor can be seen. Recognition of various patterns related to PLC on FDG-PET may allow accurate diagnosis of disease and could potentially influence the management of these patients.
    Clinical Nuclear Medicine 12/2006; 31(11):673-8. · 2.86 Impact Factor

Publication Stats

328 Citations
128.39 Total Impact Points

Institutions

  • 1989–2012
    • Thomas Jefferson University
      • • Division of Nuclear Medicine
      • • Department of Radiology
      Philadelphia, Pennsylvania, United States
  • 1995
    • Thomas Jefferson University Hospitals
      • Division of Cardiology
      Philadelphia, PA, United States