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Marissa Penna-Martinez,
Elizabeth Ramos-Lopez,
Julienne Stern,
Heinrich Kahles,
Nora Hinsch,
Martin-Leo Hansmann,
Ivan Selkinski, Frank Grünwald,
Christian Vorländer,
Wolf O Bechstein,
Stefan Zeuzem,
Katharina Holzer,
Klaus Badenhoop
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ABSTRACT: Common polymorphisms of the vitamin D receptor gene have been reported to affect the risk of breast, colon, prostate, and differentiated thyroid cancer (DTC), but polymorphisms within the genes of vitamin D metabolizing enzymes have not been studied in DTC. The aim of the present study was to investigate the genes for vitamin D enzymes in patients with DTC and healthy controls (HC) as well as the vitamin D (25-hydroxyvitamin D(3), and 1,25-hydroxyvitamin) status.
German patients (n=253) with DTC (papillary thyroid carcinoma [PTC] and follicular thyroid carcinoma [FTC]) and HC (n=302) were genotyped for polymorphisms within the vitamin D metabolizing enzymes such as 25-hydroxylase (CYP2R1[rs12794714, rs10741657]), 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1[rs10877012, rs4646536]), and 25-hydroxyvitamin D 24-hydrolase (CYP24A1[rs927650, rs2248137, rs2296241]). Furthermore, the 25-hydroxyvitamin D(3) [25(OH)D(3)] and 1,25-hydroxyvitamin [1,25(OH)(2)D(3)] plasma levels were measured by a radioimmunoassay.
There was no difference in the genotypes; however, the CYP24A1 haplotype analysis showed that rs2248137C/rs2296241A (13.1% vs. 19.1%; corrected p [pc]=0.04) was less frequent in the PTC, whereas the haplotypes rs2248137C/rs2296241G (56.0% vs. 41.9%; pc=0.03), rs927650C/rs2296241G (22.5% vs. 8.4%; pc=1.6×10(-3)), and rs927650C/rs2248137C/rs2296241G (21.1% vs. 7.3%; pc=1.5×10(-3)) were more frequent in the FTC compared with HC. Furthermore, if patients and controls were grouped according to four 25(OH)D(3) categories (severely deficient, deficient, insufficient, and sufficient), then the patients with both DTC subtypes had significantly lower levels of circulating 1,25(OH)(2)D(3), especially in the group with a deficient 25(OH)D(3) status compared with the controls. Although the polymorphisms showed no differences stratified for the four 25(OH)D(3) categories, the activation status by 1,25(OH)(2)D(3) differed significantly depending on the genotypes of the investigated CYP24A1 polymorphisms.
A higher risk for DTC is conferred by haplotypes within the CYP24A1 gene, low circulating 25(OH)D(3) levels (deficiency), and a reduced conversion to 1,25(OH)(2)D(3). These results confirm and extend previous observations and also support a role of the vitamin D system in the pathogenesis of DTC. How deficient 25(OH)D(3) levels in combination with certain CYP24A1 haplotypes affect vitamin D activation is the subject of future studies.
Thyroid: official journal of the American Thyroid Association 06/2012; 22(7):709-16. · 2.60 Impact Factor
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Marissa Penna-Martinez,
Elizabeth Ramos-Lopez,
Julienne Stern,
Heinrich Kahles,
Nora Hinsch,
Martin-Leo Hansmann,
Ivan Selkinski, Frank Grünwald,
Christian Vorlaender,
Wolf O Bechstein,
Stefan Zeuzem,
Katharina Holzer,
Klaus Badenhoop
[show abstract]
[hide abstract]
ABSTRACT: Background: Common polymorphisms of the vitamin D receptor gene have been reported to affect the risk of breast, colon, prostate and differentiated thyroid cancer (DTC) but polymorphisms within genes of vitamin D metabolizing enzymes have not been studied in DTC. The aim of the present study was to investigate genes for vitamin D enzymes in patients with DTC and healthy controls (HC) as well as the vitamin D (25- hydroxyvitamin D3, and 1,25-hydroxyvitamin) status. Methods: German patients (n = 253) with DTC [papillary (PTC) and follicular (FTC)] and HC (n = 302) were genotyped for polymorphisms within vitamin D metabolizing enzymes such as 25-hydroxylase (CYP2R1: rs12794714, rs10741657), 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1: rs10877012, rs4646536) and 25-hydroxyvitamin D 24-hydrolase (CYP24A1: rs927650, rs2248137, rs2296241). Furthermore, the 25-hydroxyvitamin D3 [25(OH)D3] and 1,25-hydroxyvitamin [1,25(OH)2D3] plasma levels were measured by radioimmunoassay. Results: There was no difference in the genotypes, however the CYP24A1 haplotype analysis showed that rs2248137C/rs2296241A (13.1% vs. 19.1% corrected p; pc = 0.04) was less frequent in the PTC whereas the haplotypes rs2248137C/rs2296241G (56.0% vs. 41.9%;pc = 0.03), rs927650C/rs2296241G (22.5% vs. 8.4%;pc = 1.6 x 10-3) and rs927650C/ rs2248137C/rs2296241G (21.1% vs 7.3%;pc = 1.5 x 10-3) were more frequent in the FTC compared to HC. Furthermore, if patients and controls were grouped according to four 25(OH)D3 categories (severely deficient, deficient, insufficient, sufficient), patients with both DTC subtypes had significantly lower levels of circulating 1,25(OH)2D3 especially in the group with a deficient 25(OH)D3 status compared to controls. Although the polymorphisms showed no differences stratified for the four 25(OH)D3 categories, the activation status by 1,25(OH)2D3 differed significantly depending on the genotypes of the investigated CYP24A1 polymorphisms. Conclusions: A higher risk for DTC is conferred by haplotypes within the CYP24A1 gene, low circulating 25(OH)D3 levels (deficiency) and a reduced conversion to 1,25(OH)2D3. These results confirm and extend previous observations and support a role of the vitamin D system in the pathogenesis of DTC. How deficient 25(OH)D3 levels in combination with certain CYP24A1 haplotypes affect vitamin D activation is subject of future studies.
Thyroid: official journal of the American Thyroid Association 05/2012; · 2.60 Impact Factor
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Birgit Assmus,
Masayoshi Iwasaki,
Volker Schächinger,
Tino Roexe,
Masamichi Koyanagi,
Kazuma Iekushi,
Quanfu Xu,
Torsten Tonn,
Erhard Seifried,
Stefan Liebner,
Wolfgang Tilman Kranert, Frank Grünwald,
Stefanie Dimmeler,
Andreas M Zeiher
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ABSTRACT: We aimed to characterize the influence of acute myocardial infarction (AMI) on the metabolic activity of the bone marrow (BM) and on the composition and functional activity of BM-derived mononuclear cells (BMC). Acute ischaemia or other stressors induce the mobilization of progenitor cells from the BM stem cell niche. The effect of AMI on the numbers and functional activity of cells within the BM is unknown.
In patients of the REPAIR-AMI trial as well as in mice, the number and functionality of BMC was compared with respect to the time interval from AMI. Activation of Wnt signalling was assessed after AMI induction in TOP-GAL transgenic reporter mice, carrying a β-galactosidase gene driven by an LEF/TCF/β-catenin responsive promoter. The metabolic activity of the BM, as determined by F-18-fluorodeoxyglucose-positron emission tomography, was significantly higher in patients with AMI compared with patients with chronic post-ischaemic heart failure. Moreover, the number of haematopoietic CD34(+) (P < 0.05) and CD133(+) (P < 0.05) cells in the BM aspirates was significantly increased in patients within 7 days after AMI. In order to confirm these clinical data, we induced AMI in mice, which time-dependently increased the number of c-kit + Sca-1 + lin- cells and colony-forming units in the BM. Activation of the BM by AMI induced a significant increase in Wnt signalling, which is known to induce proliferation of haematopoietic stem cells, and demonstrated increased levels of the Wnt target Axin-2 in BM-derived cells on Day 7 (P < 0.01 vs. control).
Acute myocardial infarction is associated with an increased metabolic activity and increased levels of progenitor cells within days after AMI. These findings document an activation of the stem cell niche within the BM following AMI, which may have important implications for the optimal timing of cell aspirations used for therapeutic application in patients with AMI.
European Heart Journal 12/2011; 33(15):1911-9. · 10.48 Impact Factor
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ABSTRACT: Real-time tissue elastography, a qualitative elastography method, has shown promising results in the diagnostic work up of thyroid nodules. However, to our knowledge no study has evaluated a quantitative elastography method in the thyroid gland. The present study is a feasibility study evaluating Acoustic Radiation Force Impulse-Imaging, a novel quantitative elastography method in the thyroid gland.
ARFI-imaging involves the mechanical excitation of tissue using short-duration acoustic pulses to generate localized displacements in tissue. The displacements induce a lateral shear-wave propagation which is tracked using multiple laterally positioned ultrasound "tracking" beams. Inclusion criteria were: thyroid nodules ≥1cm, non-functioning or hypo-functioning on radionuclide scanning, and cytological/histological assessment of thyroid nodule as reference method. All patients received conventional ultrasound, and examination of the thyroid gland including Power Doppler Ultrasound using a 9MHz linear transducer, in addition real-time elastography (RTE) was performed at 9MHz frequency and ARFI-imaging was performed at 4MHz using Siemens (ACUSON S2000) B-mode-ARFI combination transducer.
Sixty nodules in 55 patients were analyzed. Three nodules were papillary carcinoma. The stiffer the tissue the faster the shear wave propagates. The results obtained indicated that the shear wave velocity in thyroid lobes ranged between 0.5 and 4.9m/s. The median velocity of ARFI-imaging in the healthy nodule-free thyroid gland, as well as in benign and malignant thyroid nodules was 1.98m/s (range: 1.20-3.63m/s), 2.02m/s (range: 0.92-3.97m/s), and 4.30m/s (range: 2.40-4.50m/s), respectively. While no significant difference in median velocity was found between healthy thyroid tissue and benign thyroid nodules, a significant difference was found between malignant thyroid nodules on the one hand and healthy thyroid tissue (p=0.018) or benign thyroid nodules (p=0.014) on the other hand. Specificity of ARFI-imaging for the differentiation of benign and malignant thyroid nodules was comparable with RTE (91-95%).
ARFI can be performed in the thyroid tissue with reliable results.
Ultrasonics 07/2011; 52(1):69-74. · 1.84 Impact Factor
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ABSTRACT: The use of 18F-fluoroethylcholine (FEC) PET/ CT in staging and monitoring therapy response of advanced renal cell carcinoma (RCC) was prospectively analysed.
Preliminary results of two patients with metastatic RCC who underwent tumour nephrectomy as well as FEC PET/CT before and 10 weeks after two cycles of tyrosine kinase inhibitor therapy are presented.
All in all, 18 tumour lesions were detected by baseline PET/CT, of which 10 (56%) were positive in FEC PET and 17 (94%) visible on contrast-enhanced computed tomography (ceCT). Mainly, small lung metastases resulted in the lower detection rate of FEC PET compared with ceCT. In follow-up PET/CT of the first case, progressive disease (PD) occurred with increase in tumour diameters of all metastases but non-uniform metabolic response. In the second case, partial response (PR) was achieved with concordant results of PET and CT. These results were confirmed by further CT in the course of disease.
In this small sample more than half of the RCC metastases were evident in baseline FEC PET. Monitoring therapy, FEC PET showed heterogeneous results in the first case with PD and was consistent with ceCT in the second one displaying PR.
Annals of Nuclear Medicine 04/2010; 24(6):441-6. · 1.50 Impact Factor
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ABSTRACT: In the past decade, the management of differentiated thyroid carcinoma changed significantly and thus contributed to the improvement of the already favorable prognosis of this malignant disease. Surgical treatment techniques improved and the extent of initial surgery is more individualized. Radioiodine therapy is an essential part of therapeutic regimens in almost all cases, and the use of recombinant human thyroid-stimulating hormone has established for ablation of remnant tissue, treatment of iodine-positive cancer, and sensitive thyroglobulin measurement during follow-up. Risk stratification has become more important to plan treatment and follow-up individually, particularly to evaluate the need for thyroid-stimulating hormone suppression therapy. Especially for inoperable and radioiodine-negative thyroid carcinomas, novel treatment options such as tyrosine kinase inhibitor therapy have emerged. This article deals with the current options of optimal therapy regimens in differentiated thyroid carcinoma.
Seminars in nuclear medicine 03/2010; 40(2):145-52. · 3.96 Impact Factor
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ABSTRACT: Treatment with (131)I-metaiodobenzylguanidine (MIBG) has been introduced to the management of neuroendocrine tumors (NET) nearly 30 years ago. It provides efficient internal radiotherapy of chromaffin tumors (neuroblastoma, pheochromocytoma, and paraganglioma), but also of carcinoid and other less frequent tumors. Although for various NET types the role of this treatment form decreased by the emergence of peptide receptor radionuclide therapy, (131)I-MIBG still remains the primary radiopharmaceutical for targeting chromaffin tumors with outstanding efficiency. Results in neuroblastoma with overall response rates around 30% in refractory or recurrent diseases have been improved by combinations with chemotherapy, radiosensitizers, and autologous stem cell support. For adult chromaffin tumors, that is, pheochromocytoma and/or paraganglioma, (131)I-MIBG therapy is currently the most efficient nonsurgical therapeutic modality and applies for inoperable, disseminated disease. The antisecretory effect with powerful palliation of symptomatic disease (response rate: 75%-90%) should also be considered when judging treatment benefit. The results in carcinoid tumors are less pronounced, primarily achieving arrest of tumor growth, and most importantly effective functional control. With the presence of peptide receptor radionuclide therapy, (131)I-MIBG remains the alternative radionuclide in this tumor entity, for example, for patients with renal impairment. Another worthwhile mentioning indication-although less prevalent-are metastatic medullary thyroid carcinomas, especially if functioning. These patients are good candidates for this treatment form in the absence of reasonable surgical options and presence of diagnostic MIBG uptake. This article outlines the current status, results, and methodological improvements of (131)I-MIBG therapy.
Seminars in nuclear medicine 03/2010; 40(2):153-63. · 3.96 Impact Factor
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Marissa Penna-Martinez,
Elizabeth Ramos-Lopez,
Julienne Stern,
Nora Hinsch,
Martin-Leo Hansmann,
Ivan Selkinski, Frank Grünwald,
Christian Vorländer,
Robert A Wahl,
Wolf O Bechstein,
Stefan Zeuzem,
Katharina Holzer,
Klaus Badenhoop
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ABSTRACT: Vitamin D receptor (VDR) expression has been shown to be upregulated in several tumors and is supposed to represent an important endogenous response to tumor progression. To investigate the role of the VDR gene and its influence on 25(OH)D(3) and 1,25(OH)(2)D(3) plasma levels in thyroid carcinoma, we analyzed four VDR polymorphisms in patients and healthy controls (HC).
Patients with thyroid carcinoma (n = 172) (n = 132 for papillary and n = 40 for follicular) and HC (n = 321) were genotyped for the ApaI (rs7975232), TaqI (rs731236), BsmI (rs1544410), and FokI (rs10735810) polymorphisms within the VDR gene and correlated with 25(OH)D(3) and 1,25(OH)(2)D(3) plasma levels.
The genotypes AA of the ApaI (rs7975232) and FF of the FokI (rs10735810) polymorphisms were significantly less frequent (12.5% vs. 35.2% and 25% vs. 42.1%, respectively, both corrected p [p(c)] = 0.04) in patients with follicular thyroid cancer (FTC) than in HC. Additionally, the haplotypes, Ta (57.5% vs. 41.4%; p(c) = 0.0207), af (24.6% vs. 14.3%; p(c) = 0.0116), Tab (51.1% vs. 36.8%; p(c) = 0.0495), and Tabf (18.7% vs. 13.6%; p(c) = 0.0240) were more frequent, whereas the haplotypes AF (17.1% vs. 37.2%; p(c) = 0.0008), BF (11.4% vs. 31.9%; p(c) = 0.012), tF (7.9% vs. 25.5%; p(c) = 0.0016), and tABF (7.6% vs. 23%; p(c) = 0.0115) were less frequent in the FTC patients compared to HC. Neither genotype nor haplotype frequencies differed between patients with papillary thyroid cancer (PTC) and HC. Further, individuals with PTC and FTC had a significantly lower level of circulating 1,25(OH)(2)D(3) compared to controls. In contrast, no differences of the 25(OH)D(3) concentration between patients and HC were observed. VDR polymorphisms were not associated with 25(OH)D(3) and 1,25(OH)(2)D(3) plasma levels.
Lower circulating levels of 1,25(OH)(2)D(3) are observed in patients with differentiated thyroid carcinoma. Further, while the alleles AA and FF of the ApaI (rs7975232) and FokI (rs10735810) VDR polymorphisms and the haplotype tABF confer to protection from follicular carcinoma, the haplotype Tabf appeared to be associated with an increased FTC risk. Since this is the first report associating VDR polymorphisms with thyroid carcinoma, these findings need to be confirmed in studies with larger numbers of patients.
Thyroid: official journal of the American Thyroid Association 07/2009; 19(6):623-8. · 2.60 Impact Factor
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ABSTRACT: The early diagnosis of medullary thyroid carcinoma (MTC) is crucial for effective therapy. Elevated plasma calcitonin concentrations (pCT-Cs) are generally a specific and sensitive indicator for C-cell hyperplasia or MTC. The presence of thyroid nodules raises the possibility of MTC. Hence, in endemic goiter regions, there is a need for information regarding the pCT-C values that are indicative of C-cell hyperplasia or MTC. The aim of this study, therefore, was to determine an upper pCT-C to distinguish patients with and without MTC in a collective with nodular thyroid disease, and to give an estimation of the prevalence of MTC in an endemic goiter area.
Basal pCT-C was measured in 21,928 patients with thyroid nodules living in central Germany, an area with endemic goiter due to previous iodine deficiency. In 218 subjects with pCT-Cs exceeding 10 ng/L, stimulated pCT-C was additionally determined, as suggested by the German consensus recommendation. A nominal normal range for basal pCT-C was calculated with data from 21,900 subjects without known MTC. The predicted upper limit was then validated using the known diagnoses of 376 patients with pCT-Cs exceeding 10 ng/L, 28 of whom presented with MTC.
For basal pCT-C, calculation of the three-sigma borders after logarithmic transformation revealed upper limits of the nominal normal range of 14.6 ng/L in females and 32.8 ng/L in males, respectively. However, three male patients with small MTCs had basal pCT-Cs between 15 and 33 ng/L. None of the patients with MTC had a basal pCT-C below 15 ng/L or an increase in pCT-C after pentagastrin stimulation that was less than 80 ng/L. In the basal pCT-C range between 15 and 50 ng/L (n = 192; eight with MTC), the positive predictive value for the detection of MTC was 4% in our group. Applying an upper limit for basal pCT-C of 15 ng/L in both sexes, 329 of the total of 21,928 patients exceeded this range. Among these, the final outcome is known in 231 subjects, including all 28 MTCs.
An upper limit of 15 ng/L instead of 10 ng/L for basal pCT-C is able to detect all MTC and reduce false-positive cases. The prevalence of MTC in nodular thyroid disease in our group was approximately 1.8 per thousand.
Thyroid: official journal of the American Thyroid Association 05/2009; 19(4):327-32. · 2.60 Impact Factor
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ABSTRACT: To evaluate prognostic value of sentinel node biopsy (SNB) in oral/oropharyngeal squamous cell cancer (OOSCC) concerning overall/disease-free survival.
One hundred three consecutive patients with T1-2N0 OOSCC were consecutively recruited for SNB as single invasive staging method for the neck. Two hundred seventy-three sentinel nodes (SNs) were removed (mean, 2.65 per patient). Nine patients had 10 positive SNs (upstaging rate, 8.7%) found in levels I to III, leading to a therapeutic neck dissection.
Mean observation time of all patients was 6.7 years; mean survival time of patients with negative or positive SNs was 6.9 and 3.7 years, respectively. There has been no false-negative result of SNB to date becoming manifest in ipsilateral node metastasis during follow-up. Five-year overall/disease-free survival of all patients was 82%/72%, respectively. The same parameters for the patients with negative SNs were 85%/74%, for those with positive SNs 38%/47%, respectively (statistically significant). There has been a higher statistical risk for locoregional recurrence for patients with positive SNs. Rates of metachronous second primary tumors developing during follow-up were 10.6% (negative SNs) and 44.4% (positive SNs).
SNB was a valuable diagnostic method in patients with T1-2N0 OOSCC avoiding elective neck dissections. Patients with positive SNs had statistically significantly higher rates of locoregional recurrences, second primary tumors, tumor-related deaths, and a worse overall/disease-free survival. To date, no therapeutic consequences in case of a positive SN beyond execution of modified radical neck dissection (to remove other positive nodes) and closer attention during follow-up can be concluded from this study.
Annals of Surgical Oncology 10/2008; 16(2):233-9. · 4.17 Impact Factor
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02/2008; 105(4):69-70. · 2.92 Impact Factor
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Thyroid 06/2006; 16(5):517-9. · 4.79 Impact Factor
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ABSTRACT: The diagnostic potential of F-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and technetium-99m hexamethylpropylene amine oxime single-photon emission tomography (SPET) in early detection and differential diagnosis of early dementia was evaluated including a comparison of metabolic and perfusion indices (PI).
Twenty-four patients with initial clinical suspicion of beginning dementia were examined, 12 of them with mild cognitive impairment. All patients underwent SPET and PET within 2 weeks. Data were compared with the final clinical diagnosis at follow-up - 9 with Alzheimer's disease (AD), 1 with frontotemporal dementia, 1 with vascular dementia (VD), 7 with mixed type of dementia (MIX) and 6 without any type of dementia. Metabolic indices (MI) and PI were compared with each other. The regional cerebral blood flow difference (rCBFdiff) calculated as local uptake difference between the right and left hemisphere was measured for patients with VD and MIX.
PET showed higher sensitivity and specificity in identifying the different types of early dementia (44--91 and 78--89%, respectively) than SPET (11--64 and 79--89%, respectively), especially in detecting AD (sensitivity 44%, specificity 83%) and MIX (sensitivity 71%, specificity 78%). Especially in patients with mild cognitive impairment, PET was the superior imaging modality for predicting dementia. Using PET, dementia could be excluded in all patients who did not develop dementia during the follow-up. In all patients, a weak correlation between PI and MI was observed (rho=0.64, p<0.002). The rCBFdiff in patients with VD and MIX ranged from 7 to 37%.
In this study on patients with initial suspicion of beginning dementia who underwent both imaging modalities, PET and SPET, PET was the superior imaging method, especially in the detection of early AD or MIX.
Dementia and Geriatric Cognitive Disorders 01/2005; 20(2-3):63-70. · 2.14 Impact Factor
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ABSTRACT: The follow-up of epithelial ovarian cancer (OCA) consists of clinical investigation, sonography, and tumor markers (TMs), especially CA 125. If tumor recurrence is suspected, other imaging modalities including positron emission tomography (PET) with (18)F-deoxyglucose (FDG) are often used. While there is still no consensus about the method of choice and the timing of its application, this study aims to find a TM threshold at which a PET would be appropriate.
A total of 90 PET studies and the associated CA 125 values (normal value < 35 U/ml) were available in 71 patients during the follow-up after primary therapy for OCA. In 48 studies a CEA value (normal value < 3 ng/ml) was also available. The results of PET imaging were related to the level of TM increase.
In 23/90 studies the PET scan was normal. These patients had a median CA 125 of 13.3 U/ml (range 4.2-168 U/ml). In 67/90 studies the PET indicated a potential recurrence of OCA and the median CA 125 was 166.7 U/ml (range 13.3-4,060 U/ml). The TM levels were significantly different (p < 0.001, U-test). With one exception, there were no normal PET scans above CA 125 levels of 30 U/ml; between 20 and 30 U/ml PET was positive in 4/7 studies.
In suspected recurrence of OCA, if imaging modalities are to be used, an FDG PET may be considered. Since the costs of this investigation are high, it should be restricted to clinical situations where it is likely to be most effective. In this study a PET indication is worthwhile at CA 125 levels of approximately 30 U/ml.
Strahlentherapie und Onkologie 09/2004; 180(8):497-501. · 3.56 Impact Factor
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ABSTRACT: Twenty patients suffering from malignancy received furosemide, twenty patients were examined by FDG-PET without diuretics. Urine volume and radioactivity were measured before and after acquisition. Bladder activity was evaluated qualitatively and quantitatively.
Radioactivity in the bladder was lower and the image quality higher in the furosemide group. SUV values showed a median of 3.0 in the furosemide and 6.0 in the control group. With furosemide, a larger excreted volume was seen compared to the control group. The furosemide group showed a significantly higher ratio of excreted/ injected radioactivity early after injection. However, the totally excreted radioactivity was not significantly different (p = 0.93).
Diuretics cause a higher urine volume with a diluted FDG concentration leading to an improved image quality. Furosemide accelerates early renal FDG elimination, reducing radiation exposure.
Acta Medica Austriaca 09/2004; 31(3):76-8.
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Natascha Döbert,
Martina Britten,
Birgit Assmus,
Uwe Berner,
Christian Menzel,
Ralf Lehmann,
Nadja Hamscho,
Volker Schächinger,
Stefanie Dimmeler,
Andreas M Zeiher, Frank Grünwald
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ABSTRACT: Clinical outcome after myocardial infarction depends on the extent of irreversibly damaged myocardium. Implantation of bone marrow-/circulating blood-derived progenitor cells has been shown to improve contractile cardiac function after myocardial infarction in both experimental and initial clinical studies. In the present study, first observations of the effect of local intracoronary progenitor cell infusion on the regeneration of infarcted cardiac tissue after acute myocardial infarction was evaluated by means of 18F-fluorodeoxyglucose positron emission tomography (PET) and 201Tl single-photon emission computed tomography (SPECT). Twenty-six patients underwent intracoronary infusion of bone marrow-derived (BMCs) (15 patients) or circulating blood-derived endothelial progenitor cells (EPCs) (11 patients) 4+/-2 days after acute myocardial infarction. Based on a left ventricular segmentation model (17 segments), mean signal intensities as a parameter of viability and perfusion in the infarct zone and non-infarct areas were calculated quantitatively by PET and SPECT at baseline and at 4 months of follow-up. Transplantation of progenitor cells was associated with a significant increase in the mean signal intensity (MSI) in the infarct zone from 54.5% (25th and 75th percentiles: 47.7%, 60.0%) to 58.0% (52.7%, 66.7%) on PET (P=0.013) and from 58.0% (49.5%, 63.0%) to 61.5% (52.5%, 70.2%) on SPECT (P=0.005). Global left ventricular ejection fraction (LVEF) increased from 53.5% (42.6%, 60.0%) to 58.0% (53.0%, 65.8%) (P<0.001). In the five patients without an increase in MSI on PET, LVEF changed from 60.0% (50.0%, 64.0%) to 72.0% (64.0%, 75.5%) at follow-up. PET and SPECT did not show any significant changes in MSI in the non-infarct areas [from 73% (68.5%, 76.2%) to 73% (69.7%, 78.0%) for PET and from 72.0% (66.5%, 77.6%) to 73.0% (67.5%, 78.2%) for SPECT]. There were no significant differences in myocardial viability and perfusion between BMC and EPC infusion. These preliminary results show that coronary stenting and transplantation of progenitor cells result in a significant increase in myocardial viability and perfusion. Therapeutic effects can be reliably measured by PET and SPECT.
European journal of nuclear medicine and molecular imaging 08/2004; 31(8):1146-51. · 4.99 Impact Factor
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ABSTRACT: Background and Purpose:
The follow-up of epithelial ovarian cancer (OCA) consists of clinical investigation, sonography, and tumor markers (TMs), especially CA 125. If tumor recurrence is suspected, other imaging modalities including positron emission tomography (PET) with 18F-deoxyglucose (FDG) are often used. While there is still no consensus about the method of choice and the timing of its application, this study aims to find a TM threshold at which a PET would be appropriate.
Material and Methods:
A total of 90 PET studies and the associated CA 125 values (normal value < 35 U/ml) were available in 71 patients during the follow-up after primary therapy for OCA. In 48 studies a CEA value (normal value < 3 ng/ml) was also available. The results of PET imaging were related to the level of TM increase.
Results:
In 23/90 studies the PET scan was normal. These patients had a median CA 125 of 13.3 U/ml (range 4.2–168 U/ml). In 67/90 studies the PET indicated a potential recurrence of OCA and the median CA 125 was 166.7 U/ml (range 13.3–4,060 U/ml). The TM levels were significantly different (p < 0.001, U-test). With one exception, there were no normal PET scans above CA 125 levels of 30 U/ml; between 20 and 30 U/ml PET was positive in 4/7 studies.
Conclusion:
In suspected recurrence of OCA, if imaging modalities are to be used, an FDG PET may be considered. Since the costs of this investigation are high, it should be restricted to clinical situations where it is likely to be most effective. In this study a PET indication is worthwhile at CA 125 levels of approximately 30 U/ml.
Hintergrund und Ziel:
Patientinnen mit epithelialen Ovarialkarzinomen (OCA) werden durch regelmige Bestimmungen der Tumormarker CA 125 und CEA verlaufskontrolliert. Bei Rezidivverdacht hat sich hier die 18F-Desoxyglucose-Positronenemissionstomographie (FDG-PET) als eine sensitive und auch spezifische Methode etabliert. In dieser Studie soll untersucht werden, ob sich der Einsatz der PET in Abhngigkeit von der Hhe des CA-125-Spiegels an einem Schwellenwert orientieren kann.
Material und Methodik:
Es wurden insgesamt 90 PET-Studien von 71 Patientinnen in die Untersuchung eingeschlossen, bei denen der aktuelle CA-125-Wert (Normalwert < 35 U/ml) vorlag. Bei 48 Studien stand zustzlich der CEA-Wert (Normalwert < 3 ng/ml) zur Verfgung.
Ergebnisse:
In 23/90 Untersuchungen lag in der PET ein unaufflliger Befund vor. Diese Patientinnen wiesen einen medianen CA- 125-Spiegel von 13,3 U/ml auf (Spannweite 4,2–168 U/ml). In 67/90 Studien konnte in der PET ein tumorsuspekter Befund dargestellt werden. Der mediane CA-125-Spiegel lag hier bei 166,7 U/ml (Spannweite 13,3–4 060 U/ml). Beide Gruppen unterschieden sich hinsichtlich der Tumormarkerspiegel signifikant (p < 0,001, U-Test). Mit einer Ausnahme wurden dabei oberhalb eines CA-125-Spiegels von 30 U/ml keine normalen PET-Befunde mehr erhoben. Im Bereich zwischen 20 und 30 U/ml lieferte die PET in vier von sieben Fllen den Nachweis einer rezidivsuspekten Lokalisation.
Schlussfolgerung:
Im Fall eines Tumormarkeranstiegs in der Verlaufskontrolle des OCA sollten die Mglichkeiten der FDG-PET frhzeitig bercksichtigt werden. Die PET liefert dabei offenbar in Abhngigkeit von der Hhe des CA-125-Spiegels auf die Tumorlokalisation hinweisende Befunde, wobei die PET berwiegend bereits bei Werten zwischen 20 und 30 U/ml positive Befunde erbringt und ab einem Schwellenwert von 30 U/l nahezu bei jeder Patientin einen Rezidivhinweis darstellen kann.
Strahlentherapie und Onkologie 07/2004; 180(8):497-501. · 3.56 Impact Factor
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ABSTRACT: Most patients with hepatocellular carcinoma are not eligible for surgery at the time of primary diagnosis. Portal vein thrombosis is frequent and represents a contraindication for transarterial chemoembolisation. Transarterial therapy with iodine-131-Lipiodol is superior to systemic therapy in tumours up to diameters of 5 cm and may be performed even in cases with portal vein thrombosis. Compared to other intraarterial therapy procedures, iodine-131-Lipiodol shows the same efficacy but less side effects.
Romanian journal of gastroenterology 07/2004; 13(2):119-24.
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ABSTRACT: To compare the new, 6th edition, UICC TNM staging system with the former edition, we updated TNM staging in patients with differentiated thyroid carcinoma.
The new and old TNM classification systems for differentiated thyroid carcinoma were applied in a retrospective analysis of 169 patients who underwent therapy with radioiodine (131I) from 1975 through 2002 at the Department of Nuclear Medicine, Frankfurt.
According to the new staging system, 83 patients (49%) were classified as T1 compared to 54 patients (32%) based on the former edition; 32 patients (19%) as T2 compared to 61 (36%) patients formerly. In 44 patients with minimal extrathyroid extension, formerly classified T4, the new TNM staging changed to T3, and no patient was classified T4. The one year relapse-free survival fraction under the former edition staging was 100% for T1 and 92.2% for T2, compared to 96.8% for new edition T1 and 93.3% for T2.
The new TNM classification causes a significant change in staging. New T1 classified tumors had a slightly worse relapse-free survival fraction compared with the old T1 carcinomas. For patients treated at our department, the altered criteria for classifying extrathyroid extensions have had only a minor impact on disease management.
Thyroid 02/2004; 14(1):65-70. · 4.79 Impact Factor
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ABSTRACT: We report the case of a woman who developed an early relapse of a squamous cell carcinoma (SCC) and was thus restaged twice within a year using [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET). While there was no evidence of metastatic tumor outspread, focally increased FDG uptake was visible in numerous nodes but showed no change during the period between the two PET scans. These nodes, predominantly located at the proximal extremities, ranged in size from about 1 cm to over 6 cm. They were located subcutaneously, showed a red/bluish livid color and were of stout consistency. These nodes occurred first after radiochemotherapy for a non-Hodgkin's lymphoma (NHL) about 6 years earlier and slowly increased in size and number. One node of the right forearm was resected and ex-vivo beta-imaging, directly measuring the positron emission of the intranodal FDG distribution, was done and showed an overall increased glucose utilization with distinct spots of high metabolism. Histopathological work-up of the tumor showed widespread granulomatous tissue with lymphocyte follicles. Immunostaining showed the tumor to be positive for S100, CD68 and vimentin. Rosai-Dorfman disease (RDD) was diagnosed and no evidence of a potential relapse of the previous NHL was detected. RDD is a rare disease that is associated with the multifocal growth of benign tumors. The lesions are metabolically highly active. The correlation of the beta-imaging and histopathological results showed a high metabolism within granulomatous tissue with more intense metabolism within lymphocyte follicles.
Archives for Dermatological Research 01/2004; 295(7):280-3. · 2.28 Impact Factor
