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Carlo Carnaghi,
Maria Chiara Tronconi,
Lorenza Rimassa,
Luca Tondulli,
Monica Zuradelli,
Marcello Rodari,
Roberto Doci,
Fabio Luttmann,
Guido Torzilli,
Domenico Rubello, Adil Al-Nahhas,
Armando Santoro,
Arturo Chiti
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ABSTRACT: Neoadjuvant chemotherapy has been successfully used in the treatment of patients with colorectal liver metastases. The selection of patients for surgical resection after chemotherapy still poses a significant clinical challenge. (18)F-FDG PET is a useful tool in the assessment of liver metastases but the data regarding its sensitivity after chemotherapy is scarce. Our aim was to assess the value of this imaging modality in the selection of patients with colorectal liver metastasis for surgery following adjuvant chemotherapy.
We reviewed the diagnostic performances of (18)F-FDG PET and contrast-enhanced CT scan data from patients with colorectal liver metastases following treatment with chemotherapy. Nineteen patients (12 males, 7 females; median age 61 years; range 41-79) were evaluated. Chemotherapy regimens were: FOLFOX (14 patients), FOLFIRI (3 patients), 5-FU/FA (1 patient) and UFT-irinotecan-oxaliplatin (1 patient). Median time between end of chemotherapy and CT scan was 3.4 weeks, between end of chemotherapy and PET was 5.9 weeks and between end of chemotherapy and surgery was 9.9 weeks. All patients underwent surgery and had histopathological confirmation of liver lesions. Nine patients had segmentectomy, 2 patients had wedge resection, 5 patients had right hepatectomy and 3 patients had explorative laparotomy with liver biopsies.
Data from all 19 patients, comprising 65 liver lesions, were confirmed by histo-pathology. Results on a per-lesion basis showed a sensitivity of 62% for (18)F-FDG PET and 70% for CT scan. A complete agreement between (18)F-FDG PET or CT scan and histology was documented in 5 and 3 patients, respectively. The sensitivity of (18)F-FDG PET was shown to increase for lesions larger than 1 cm (74% vs. 18%).
These results suggest that (18)F-FDG PET and CT scan have sub-optimal sensitivity in the evaluation of colorectal liver lesions after neo-adjuvant chemotherapy, especially for lesions < 1 cm. The combined use of the two imaging techniques does not significantly increase the sensitivity of lesion detection.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 01/2007; 10(1):12-5.
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Nuclear Medicine Communications 10/2006; 27(9):685-8. · 1.40 Impact Factor
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ABSTRACT: A prerequisite for optimum minimally invasive radio-guided surgery (MIRS) for primary hyperparathyroidism (PHPT) is the demonstration of significant uptake of (99m)Tc-sestamibi in a parathyroid adenoma (PA). The aim of this study was to evaluate the clinical role or (99m)Tc-sestamibi SPECT in selecting patients for this procedure.
Fifty-four consecutive PHPT patients were evaluated by single-session (99m)Tc-pertechnetate/(99m)Tc-sestamibi planar subtraction scintigraphy, followed by (99m)Tc-sestamibi SPECT acquisition to localise hyperfunctioning PAs and assist in planning the surgical approach.
Scintigraphy showed the presence of a solitary PA in 47/54 patients (87%) and two or more PAs in four patients (7.4%); it was negative in the remaining three patients (5.6%). The overall sensitivity of (99m)Tc-sestamibi scintigraphy was 94.6%. In 7/54 patients, the PA was located deep in the para-oesophageal/paratracheal space. So far, 22 patients with scintigraphic evidence of a solitary PA (in four of whom the PA was located deep in the neck) have undergone successful MIRS using the low 37 MBq (1 mCi) (99m)Tc-sestamibi dose protocol. Intraoperative quick parathyroid hormone (QPTH) assay demonstrated a fall in all 22 patients, thus confirming successful removal of the hyperfunctioning PA. No major surgical complications were observed. After a period of follow-up ranging between 6 and 27 months (median 13 months), no case of persistent/recurrent PHPT was recorded. When comparing the parathyroid to background (P/B) ratio measured at planar and SPECT preoperative scintigraphy with that measured intraoperatively with the gamma probe, a good linear correlation was found between the SPECT and the intraoperative gamma probe measurements (r=0.89; p<0.01) but no correlation was found with planar scintigraphic data.
Our preliminary data suggest that measurement of the P/B ratio by means of (99m)Tc-sestamibi SPECT is more accurate in predicting the intraoperative measurements with the gamma probe. In this respect, a preoperative (99m)Tc-sestamibi SPECT acquisition should be recommended for better selection of PHPT patients in whom a MIRS approach can be offered.
European journal of nuclear medicine and molecular imaging 10/2006; 33(9):1091-4. · 4.99 Impact Factor
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ABSTRACT: This paper reports the results of minimally invasive radio-guided surgery (MIRS) performed in a large group of 280 consecutive patients affected by primary hyperparathyroidism (PHPT) and with a high probability of being affected by a solitary parathyroid adenoma before surgery.
The probability of a solitary parathyroid adenoma was established by evaluating the patients with a single-day imaging protocol based on parathyroid double-tracer scintigraphy and high resolution neck ultrasonography. MIRS was performed successfully in 269 (96.1%) patients. MIRS consisted of a very low dose (37 MBq (1 mCi)) of Tc-sestamibi, given by intravenous injection, in the operating theatre a few minutes before surgery, thus allowing the radiation exposure dose to the patient and operating theatre personnel to be minimized (< 1.5 muSv.h to the surgeon).
No major intraoperative complication was recorded in our series. Transient hypocalcaemia was observed in 8% of patients. MIRS required a mean duration time of 33 min and a mean hospital stay of 1.2 days. Local anaesthesia was successfully performed in 71 patients, 63 of whom were elderly and with concomitant invalidating diseases contraindicating general anaesthesia. No case of disease relapse was observed during the subsequent follow-up.
MIRS using the 'low sestamibi protocol' is a safe and effective treatment in PHPT patients with a high likelihood of a solitary parathyroid adenoma at preoperative imaging.
Nuclear Medicine Communications 10/2006; 27(9):709-13. · 1.40 Impact Factor
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Nuclear Medicine Communications 08/2006; 27(7):547-9. · 1.40 Impact Factor
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ABSTRACT: Vertebral osteomyelitis may be difficult to diagnose by conventional imaging methods. F-18 FDG PET is capable of detecting a lesion in the very early stages, long before there are any visible structural changes. We present a case of salmonella vertebral osteomyelitis in which F-18 FDG PET scanning provides the diagnosis by detecting increased metabolic activity before definitive changes are seen on plain radiography and magnetic resonance imaging (MRI). The imaging findings and SUV on serial follow up F-18 FDG PET studies improved and normalized in correlation with the clinical and biochemical indices, whereas the MRI abnormalities persisted. This assisted in the decision to stop long-term antimicrobial therapy.
Clinical Nuclear Medicine 08/2006; 31(7):437-40. · 3.67 Impact Factor
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Nuclear Medicine Communications 07/2006; 27(6):477-80. · 1.40 Impact Factor
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ABSTRACT: We describe a case of relapsed paratyphoid fever in which the isolate had reduced susceptibility to ciprofloxacin due to a rare mutation within the gyrA gene. 18fluorodeoxyglucose positron emission tomography scanning identified deep-seated infection including unsuspected aortitis and highlights the utility of novel imaging techniques to improve our understanding and treatment of this disease.
Clinical Infectious Diseases 07/2006; 42(11):e92-4. · 9.15 Impact Factor
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European journal of nuclear medicine and molecular imaging 05/2006; 33(4):506. · 4.99 Impact Factor
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Clinical Nuclear Medicine 03/2006; 31(2):99-100. · 3.67 Impact Factor
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ABSTRACT: Aim of the present study was to investigate the feasibility and long-term results of focused radioguided parathyroidectomy using a "low" 37 MBq (1 mCi) 99mTc-sestamibi dose protocol compared to conventional "high 740 MBq (20 mCi) 99mTc-sestamibi dose protocol" in patients with primary hyperparathyroidism (PHPT). The data of focused radioguided surgery obtained in a group of 320 consecutive PHPT patients with high probability of the presence of a solitary parathyroid adenoma (PA) were studied. All patients underwent preoperative imaging work-up of double-tracer 99mTc-pertechnetate/99mTc-sestamibi subtraction parathyroid scintigraphy (Sestamibi scintigraphy) and high resolution neck ultrasound (US). In 301/320 patients (96.6%) focused minimally invasive radioguided surgery was successfully performed by administering a "low" 37 MBq (1 mCi) 99mTc-sestamibi dose in the operating room 10 minutes before operation. No major intraoperative complications were recorded. Focused radioguided surgery required a mean time of 32 min and a mean hospital stay of 1.2 days. Local anesthesia was applied in 75 patients, 66 of whom (88%) were patients older than 65 years with comorbidities contraindicating general anesthesia. No case of persistent or recurrent PHPT was observed during post-surgical follow-up (range = 18-70 months; mean +/- SD = 15.3 +/- 9.1 months). Radiation exposure dose to the operating surgeon was 1.2 microSi/hour with the "low 37 MBq (1 mCi) 99mTc-sestamibi dose", and less than 1.0 microSi/hour for the other operating-room personnel. Focused low dose radioguided parathyroidectomy is a safe and effective means to localize parathyroid adenomas in patients affected by solitary PA thus reducing by 20 fold the radiation exposure dose to the patients and operating room personnel.
International Seminars in Surgical Oncology 02/2006; 3:30.
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Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2006; 9(1):1-5.
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Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2006; 9(2):105-7.
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ABSTRACT: The aim of the study was to evaluate the usefulness of 18F-FDG-PET in patients with gastric lymphoma, in particular those affected by mucosa-associated lymphoid tissue (MALT) type and aggressive gastric non-Hodgkin's lymphoma (NHL).
The study group consists of 15 patients with a previous diagnosis of gastric NHL referred to our PET centres in Bologna Hospital and Rovigo Hospital, Italy, in the period 2003-2004. In 9/15 patients the subsequent histological evaluation was consistent with a gastric MALT lymphoma, while aggressive gastric NHL was diagnosed in the other 6/15. PET scan was carried out in patients with known active disease in order to stage or re-stage disease prior to treatment or in patients in complete clinical remission to monitor disease during follow up. Patients were considered in complete clinical remission if free from disease for at least 8 months after chemotherapy or surgery.18F-FDG PET was performed following standard procedures.
Overall 18F-FDG-PET was true positive in all cases of gastric MALT and non-MALT aggressive NHL with known active disease, while no pathological 18F-FDG uptake was evident in the subjects who were in complete clinical remission. The degree of 18F-FDG uptake (mean SUVmax values) in MALT lymphoma was much less intense in comparison to aggressive gastric NHL, suggesting a prognostic role of SUV calculation in gastric lymphomas.
Our data demonstrate the significant accuracy of 18F-FDG-PET in detecting active disease in gastric lymphoma of both MALT and non-MALT NHL type. A higher SUV value appears to be related to a more aggressive disease.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2006; 9(1):37-40.
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Stefano Fanti,
Cristina Nanni,
Mohsen Farsad,
Paolo Castellucci,
Maurizio Dondi,
Arcangelo De Fabritiis,
Riccardo Galassi,
Antonio Palermo,
Domenico Rubello,
Lucia Rampin,
Neda Tehranipour, Adil Al-Nahhas,
Nino Monetti,
Roberto Franchi
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ABSTRACT: Exercise-induced alteration in renal function has been described in patients with essential hypertension. The aim of our study was to assess the significance of adopting a supine posture and the degree of workload required to induce these changes in patients with essential hypertension. The second aim was to assess whether the severity of hypertension had any influence on the development of exercise related renal dysfunction.
Fifteen patients were studied (nine patients with mild and untreated hypertension and six patients with drug resistant hypertension). Exercise renography was carried out using a cycloergometer with the patient lying in supine posture and a target exercise rate of 20 bpm over baseline rate. Each patient was injected with 100 MBq of 99mTc-MAG3 and renography was carried out for 20 minutes. Renography was repeated in rest condition only when an abnormality was observed in exercise scans.
Exercise renography was normal in 12 patients, while in 3 patients minor abnormalities were observed during exercise related to a minimal degree of pelvic dilatation. These changes remained substantially unmodified at rest. In none of the 15 patients did we find positive studies (i.e. reversible exercise induced prolongation of tracer transit caused by cortical retention). There was no difference in the results between patients with mild or severe hypertension.
Our results are different from previous reports on exercise renography since different groups have demonstrated exercise-induced renal dysfunction in the majority of patients with essential hypertension. The main differences between our protocol and that adopted in the literature relate to posture during exercise (upright vs. supine) and degree of workload (minor in supine exercise with less workload). These differences may have contributed to our results but further and larger studies are required to address the pathophysiological basis of exercise-induced alteration in renal function in association with essential hypertension.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2006; 9(1):41-5.
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ABSTRACT: BACKGROUND/MATERIAL AND METHODS: The aim of this study was to assess the reliability of radioiodine ((131)I) and a gamma probe for radio-guided surgery (RGS) to detect and radically dissect lymph node recurrence (LNR) in 15 patients with differentiated thyroid cancer (DTC). The major inclusion criterion was the presence of a radioiodine-positive LNR after previous total thyroidectomy and at least two ineffective (131)I treatments. The protocol was designed as follows: Day 0--all patients were hospitalized and received 3.7 GBq of (131) I while clinically hypothyroid. Day 3--pre-surgery whole-body scan with a therapeutic (131)I dose (TxWBS) was acquired. Day 5--neck surgery using a gamma probe (Navigator GPS, AutoSuture, Italy), recording the absolute counts and the lesion/background (L/B) counts ratio was performed. Day 7--post-surgery TxWBS was performed using the remaining radioactivity. RESULTS AND CONCLUSIONS: This protocol permitted us to identify neoplastic foci with high sensitivity and specificity, enabling us to remove lymph node metastases resistant to radioiodine therapy in a single session. The protocol also allowed detection of some additional tumoural foci in sclerotic areas or behind vascular structures that were not seen at the pre-surgery TxWBS evaluation.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2006; 9(2):119-24.
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ABSTRACT: There is an unmet need to develop imaging methods for the early and objective assessment of breast tumors to therapy. 3'-Deoxy-3'-[18F]fluorothymidine ([18F]FLT)-positron emission tomography represents a new approach to imaging thymidine kinase activity, and hence, cellular proliferation. We compared graphical, spectral, and semiquantitative analytic methodologies for quantifying [18F]FLT kinetics in tumor and normal tissue of patients with locally advanced and metastatic breast cancer. The resultant kinetic parameters were correlated with the Ki-67 labeling index from tumor biopsies. [18F]FLT accumulation was detected in primary tumor, nodal disease, and lung metastasis. In large tumors, there was substantial heterogeneity in regional radiotracer uptake, reflecting heterogeneity in cellular proliferation; radiotracer uptake in primary tumors also differed from that of metastases. [18F]FLT was metabolized in patients to a single metabolite [18F]FLT-glucuronide. Unmetabolized [18F]FLT accounted for 71.54 +/- 1.50% of plasma radioactivity by 90 minutes. The rate constant for the metabolite-corrected net irreversible uptake of [18F]FLT (Ki) ranged from 0.6 to 10.4 x 10(-4) and from 0 to 0.6 x 10(-4) mL plasma cleared/s/mL tissue in tumor (29 regions, 15 patients) and normal tissues, respectively. Tumor Ki and fractional retention of radiotracer determined by spectral analysis correlated with Ki-67 labeling index (r = 0.92, P < 0.0001 and r = 0.92, P < 0.0001, respectively). These correlations were superior to those determined by semiquantitative methods. We conclude that [18F]FLT-positron emission tomography is a promising clinical tool for imaging cellular proliferation in breast cancer, and is most predictive when analyzed by graphical and spectral methods.
Cancer Research 11/2005; 65(21):10104-12. · 7.86 Impact Factor
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ABSTRACT: The authors present a case of a 26-year-old man, under investigation for Cushing syndrome, who presented acutely with a dry cough and fever. The blood tests were unremarkable apart from a moderate to severe leukopenia. Imaging tests were suggestive of an atypical pneumonia, which was proven to be Pneumocystis carinii pneumonia (PCP) on cytology examination of a bronchoalveolar lavage (BAL). The acute lung changes were demonstrated on a whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) study. After treatment, a follow-up study showed complete resolution of these changes. The authors suggest that FDG PET may have a role to play in the diagnosis and, in particular, the monitoring of PCP in immunocompromised patients.
Clinical Nuclear Medicine 11/2005; 30(10):690-1. · 3.67 Impact Factor
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ABSTRACT: A 53-year-old man with In-111 octreotide-positive metastatic hepatic carcinoid was referred for Y-90 lanreotide therapy. A diagnostic In-111 lanreotide scan, performed to assess suitability for therapy, showed less uptake in lesions compared with In-111 octreotide. After 3 therapy doses of Y-90 lanreotide, a repeat In-111 lanreotide scan showed intense uptake in old lesions, appearance of new lesions, and uptake in the spleen. This was associated with improvement in flushing and regression of liver size. Computed tomography scan showed stable disease. Increased expression of somatostatin receptors has been observed with In-111 octreotide but not with In-111 lanreotide. If this is a flare response, then pretreatment with "cold" lanreotide may be beneficial before Y-90 lanreotide therapy.
Clinical Nuclear Medicine 05/2005; 30(4):238-40. · 3.67 Impact Factor
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Valentina Ambrosini,
Domenico Rubello,
Cristina Nanni,
Mohsen Farsad,
Paolo Castellucci,
Roberto Franchi,
Mario Fabbri,
Lucia Rampin,
Giorgio Crepaldi, Adil Al-Nahhas,
Stefano Fanti
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ABSTRACT: Despite being a relatively rare disease, the incidence of malignant pleural mesothelioma (MPM) is expected to increase over the next two decades due to the long time interval elapsing between exposure to causative factors, mainly asbestos, and disease onset. Early disease stages have been reported to benefit from radical surgery. In more advanced disease stages, a multimodality treatment, including various combinations of chemotherapy, external radiotherapy and surgery, may provide some favourable results though the prognosis remains poor. In this regard, an accurate pre-treatment staging plays an important role in offering patients a more appropriate therapeutic planning. In some preliminary studies, (18)F-FDG PET has proven to be able to provide useful information for staging purpose, especially for the detection of metastatic spread to lymph nodes and distant sites.
In the present study, we investigated 15 consecutive patients with histologically proven MPM by means of conventional 2-mm thickness whole-body CT scan with and without contrast medium in comparison with wholebody (18)F-FDG PET/CT fusion imaging.
(18)F-FDG PET/CT did not provide additional information about the primary tumour (T) compared to CT scan, but identified a higher number of metastatic mediastinal lymph nodes (N) in 6 patients (40% of cases) and unknown metastatic disease to distant sites (M) in 3 patients (20% of cases). On the basis of PET/CT findings, treatment planning was changed in 5 patients (33.3% of cases).
Our data show that (18)F-FDG PET/CT fusion imaging can play a relevant role in the staging and treatment planning of MPM patients.
Nuclear medicine review. Central & Eastern Europe: journal of Bulgarian, Czech, Macedonian, Polish, Romanian, Russian, Slovak, Yugoslav societies of nuclear medicine and Ukrainian Society of Radiology 02/2005; 8(2):111-5.
