Mei-Fang Cheng

National Taiwan University Hospital, T’ai-pei, Taipei, Taiwan

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Publications (31)111.58 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to examine the patterns of lymph node metastases from esophageal squamous cell carcinoma (ESCC) and compare the laterality of lymphatic metastasis in cervical, supraclavicular, and paratracheal areas using F-FDG PET/CT. The data of 75 patients who underwent F-FDG PET/CT for staging of ESCC between January 2011 and March 2012 were reviewed. Fourteen groups of lymph nodes from the neck to abdomen were defined. Lateralization of the upper thoracic lymph nodes was defined in reference to the midline of the trachea. Frequencies of positive lymph nodes were used to determine the pattern of lymphatic spread and compare the lateralization of metastases in the cervical and upper thoracic regions. The right paratracheal region was the most frequent site of metastasis among all patients. Left paratracheal and paragastric nodes were more frequent in upper and lower third ESCC, respectively. Upward and downward lymphatic spread was equal in mid third ESCC. In all patients, there was a trend toward more frequent lymph node metastasis on the right side than the left side for the supraclavicular and paratracheal regions. Further stratified analysis with tumor location found that right paratracheal node metastasis was significantly associated with mid third ESCC (P = 0.03). Remote nodal metastasis was found in 10.5% of patients with upper third ESCC and 13% of patients with lower third ESCC, respectively. Remote nodal metastasis was associated with higher SUV of the primary tumor (P = 0.02) and worse survival (P = 0.03). Receiver operating characteristic analysis showed a cutoff SUV of 14.8 for predicting remote lymph node metastases. PET/CT provides important information before radiotherapy planning. Mid and lower third ESCC tends to metastasize to the right paratracheal/supraclavicular lymph nodes. Remote nodal metastases on PET/CT correlated with higher primary tumor SUV and worse survival.
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    ABSTRACT: Background This study described a method for tracking and compensating respiratory motion in cadmium-zinc-telluride (CZT) cameras. We evaluated motion effects on myocardial perfusion imaging and assessed the usefulness of motion compensation in phantom and clinical studies. Methods SPECT studies were obtained from an oscillating heart phantom and 552 patients using CZT cameras with list-mode acquisition. Images were reformatted in 500-ms frames, and the activity centroid was calculated as respiratory signal. The myocardial perfusion, left ventricular (LV) wall thickness, and LV volume were assessed before and after the motion compensation technique. Results In phantom studies, we documented only minimal bias between simulated and measured shifts. Significantly reduced tracer activity, increased wall thickness and decreased volume in scans with 15 mm or more axial shifts were noted. In clinical studies, there was a higher prevalence of significant motion after treadmill exercise. The motion compensation technique could successfully compensate those motion artifacts. Conclusion The described method allows for tracking and compensating respiratory motion in CZT cameras. Significant respiratory motion is still not uncommon using CZT cameras, especially in patients who underwent treadmill tests. Motion blurring can be compensated using image processing techniques and image quality could be significantly improved.
    Journal of Nuclear Cardiology 08/2014; 22(2). DOI:10.1007/s12350-014-9963-8 · 2.65 Impact Factor
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    ABSTRACT: Instant oatmeal has been proposed as a good alternative to the standardized low-fat egg-white test meal for gastric emptying studies. We aim to establish normal values of oatmeal-based gastric emptying scintigraphy and test its correlation with gastroparesis symptoms in the Chinese population.
    Journal of Gastroenterology and Hepatology 06/2014; DOI:10.1111/jgh.12640 · 3.63 Impact Factor
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    ABSTRACT: Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 5-13 % of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. This study aimed to evaluate the usefulness of semiquantification of (131)I-6β-iodomethyl-norcholesterol (NP-59) single photon emission computed tomography (SPECT)/CT in differentiating aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH) and in predicting clinical outcomes after adrenalectomy. We retrospectively reviewed 49 PA patients who had undergone adrenalectomy after NP-59 SPECT/CT within 1 year. A conventional visual scale (VS) and two semiquantitative parameters generated from SPECT/CT, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON), with cutoff values calculated by receiver-operating characteristic (ROC) analysis, were compared with pathology results and postsurgical outcomes to determine the accuracy. An ALR cutoff of 1.84 and a CON cutoff of 1.15 showed an ability to distinguish adenoma from hyperplasia similar to VS (p = 0.2592 and 0.1908, respectively). An ALR cutoff of 2.28 and a CON cutoff of 1.11 yielded the highest sensitivity and specificity to predict postsurgical outcomes, and an ALR of 2.28 had an ability superior to VS (p = 0.0215), while a CON of 1.11 did not (p = 0.1015). Patients with either ALR or CON greater than the cutoff had a high probability of positive postsurgical outcomes (n = 36/38), while patients with both ALR and CON less than the cutoff had a low probability of positive postsurgical outcomes (n = 2/11). Semiquantification of NP-59 scintigraphy has an ability similar to VS in differentiating APA from IAH, but an excellent ability to predict postsurgical outcomes of adrenalectomy. An ALR or CON greater than the cutoff strongly suggests benefits from adrenalectomy, and both ALR and CON less than the cutoff implies a reduced chance of improvement in postsurgical outcome.
    European Journal of Nuclear Medicine 02/2014; 41(7). DOI:10.1007/s00259-014-2692-z · 4.53 Impact Factor
  • International Journal of Cardiology 10/2013; 169(2):154. DOI:10.1016/j.ijcard.2012.12.040 · 6.18 Impact Factor
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    ABSTRACT: At present, there is no ideal imaging modality for the diagnosis of periampullary lesions. We prospectively evaluated the preoperative diagnostic usefulness of PET/CT for differentiating malignant from benign periampullary lesions. A total of 62 patients aged 27-86 years with periampullary lesions scheduled for surgical resection were consecutively recruited. Dual-phase F-FDG PET/CT was performed in all patients. An additional 3'-deoxy-3'-[F]fluorothymidine (FLT) scan was performed in 21 patients (33.9%). The relationship of visual interpretation, SUV, and lesion to background ratio (LBR) with surgical histopathology diagnosis was evaluated. There were 36 patients with malignancies, 15 with benign neoplasms, and 11 with benign non-neoplasms. Using visual analysis, FDG PET/CT had good sensitivity (86.1%; 31/36), lower specificity (57.7%; 15/26), and fair accuracy (74.2%; 46/62). Regional lymph node metastases were identified in 7 of 11 patients by FDG PET/CT and only in 1 patient by abdominal CT. On the other hand, hepatic metastasis was detected in 1 patient by FDG PET/CT. Dual-phase FDG (P < 0.001) and FLT (P < 0.05) SUVmax and LBR were significantly higher in malignant than in benign lesions, and in malignant neoplasms than in benign neoplasms. Although average FLT SUVmax was significantly lower than the average FDG SUVmax (P < 0.001), the specificity and accuracy of the former were significantly better. FDG PET/CT may help identify patients with periampullary malignancy. FDG SUVmax and LBR appear to aid in the differential diagnosis and add diagnostic confidence. In addition, higher specificity and diagnostic accuracy may be achieved by additional FLT PET/CT.
    Clinical nuclear medicine 06/2013; DOI:10.1097/RLU.0b013e31829b266a · 2.86 Impact Factor
  • International journal of cardiology 04/2013; 167(6). DOI:10.1016/j.ijcard.2013.04.063 · 6.18 Impact Factor
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    ABSTRACT: A 56-year-old woman, who had already suffered from systemic sclerosis and primary biliary cirrhosis, was presented with progressive pain at the right lower quadrant of abdomen, lower-grade fever, and leukocytosis for 4 days. Blood cultures did not yield pathogens. Abdominal ultrasonography revealed a right iliac artery aneurysm compressing the right kidney resulting in right hydronephrosis. Ga SPECT/CT demonstrated an intense hot area at the right common iliac artery, suggestive of an infected aneurysm. Contrast-enhanced CT showed concordant findings. This case illustrates the value of Ga SPECT/CT in discriminating pathologic uptake of the abdomen from physiologic activity of the bowels.
    Clinical nuclear medicine 04/2013; DOI:10.1097/RLU.0b013e318286c00c · 2.86 Impact Factor
  • Resuscitation 10/2012; 83:e101. DOI:10.1016/j.resuscitation.2012.08.262 · 3.96 Impact Factor
  • International journal of cardiology 04/2012; 161(2). DOI:10.1016/j.ijcard.2012.03.178 · 6.18 Impact Factor
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    ABSTRACT: Lymphoscintigraphy is a useful and safe tool for the diagnostic evaluation of a swollen extremity as well as sentinel lymph node biopsy in malignancies. Here, we report a 34-year-old woman who developed progressive abdominal distention and bilateral lower limb edema 3 months after simultaneous pancreas and renal transplantation. Color Doppler-duplex ultrasound revealed patent deep veins of bilateral lower extremities without evidence of thrombosis. Lymphoscintigraphy demonstrated a large area of tracer accumulation at left lower quadrant of abdomen, suggestive of a postoperative lymphocele. SPECT/CT successfully localized the lesion near the renal graft.
    Clinical nuclear medicine 04/2012; 37(4):374-6. DOI:10.1097/RLU.0b013e31823eac5e · 2.86 Impact Factor
  • Journal of Clinical Oncology 01/2012; 30(6):e83-5. DOI:10.1200/JCO.2011.39.1698 · 17.88 Impact Factor
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    ABSTRACT: We describe the case of a 4-month-old girl who was admitted for bilateral legs swelling for several weeks. Lymphoscintigraphy revealed the absence of the radiotracer proximal to the ilioinguinal nodes up to 6 hours postinjection. In light of the clinical and image findings, a diagnosis of congenital lymphedema was compatible. Systemic corticosteroid was given, and physical massage was applied at the lower extremities for 3 weeks. Repeat lymphoscintigraphy revealed faster lymphatic flow and liver visualization, demonstrating improvement in lymphatic function. This case illustrates the usefulness of lymphoscintigraphy in diagnosis and evaluating therapy response of lymphedema in children.
    Clinical nuclear medicine 04/2011; 36(4):e11-2. DOI:10.1097/RLU.0b013e31820aa35a · 2.86 Impact Factor
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    ABSTRACT: An 80-year-old woman, who had suffered from end-stage renal disease under peritoneal dialysis, was presented with intermittent fever, leukocytosis, and elevated C-reactive protein for 4 months. She did not have symptom of abdominal pain. Culture of ascites showed Klebsiella pneumoniae. Abdominal utrasonography was negative. Whole-body gallium-67 imaging showed a segmental uptake mimicking bowels in right abdomen. SPECT/CT revealed the uptake in a soft tissue density beneath the abdominal wall instead of bowels. Contrast-enhanced CT demonstrated a low-density mass with peripheral enhancement at the aforementioned area. Her clinical condition stabilized gradually after CT-guided percutaneous drainage of pus from the abscess.
    Clinical nuclear medicine 03/2011; 36(3):258-60. DOI:10.1097/RLU.0b013e3181f9e025 · 2.86 Impact Factor
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    ABSTRACT: Infiltrative hepatic lesions in conventional imaging modalities are a continuing diagnostic challenge in clinical practice, especially in an endemic area of viral hepatitis. The purpose of this study isto prospectively assess the role of F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT) in indeterminate infiltrative hepatic lesions seen in conventional CT or magnetic resonance imaging (MRI). Dual-phase FDG-PET/CT was performed on35consecutive patients with indeterminate infiltrative hepatic lesions in CT or MRI. The variables analyzed included visual score and maximum standardized uptakevalue. Final diagnosis was histopathology orclinicalfollow-up for at least 12 months. Malignancy was proven in 28 patients and there were benign strictures in seven patients. Sensitivity, specificity, and overall diagnostic accuracy of FDG-PET/CT using visual score were 85.7% (24/28), 71.4% (5/7), and 82.9% (29/35). Early and delayed maximum standardized uptake values were significantly higher in infiltrative hepatic malignancies than in benign lesions. Furthermore, PET/CT detected 13 unexpected distant metastatic foci notseen in other imaging studies. Thirteen patients (37.1%)had the plans of clinical treatment altered by FDG-PET/CT alone. FDG-PET/CT can help to clarify the diagnosis of indeterminate infiltrative hepatic lesions in CT or MRI. Inthis patient population, FDG-PET/CT may hold promisein the detection of unsuspected occult metastases, facilitating decision making and treatment planning.
    Nuclear Medicine Communications 02/2011; 32(4):252-9. DOI:10.1097/MNM.0b013e32834368bf · 1.37 Impact Factor
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    ABSTRACT: The left ventricular (LV) ejection fraction (EF) and end-diastolic and end-systolic volumes are strong predictors for prognosis of cardiac death. Quantitative-gated myocardial perfusion single-photon emission computed tomography (SPECT) is widely used to measure LV functional parameters. However, systematic differences may exist between referred populations. We sought to derive sex-specific normal values for LV functional parameters obtained using two quantitative methods. Among 1044 consecutive patients who underwent dipyridamole stress myocardial perfusion-gated 201Tl SPECT in 2008, a total of 140 (56 men) with normal perfusion imaging were selected. None had cardiac diseases or experienced cardiac events during 1-year follow-up. LV EF and end-diastolic and end-systolic volumes were calculated by quantitative-gated SPECT (QGS) and four-dimensional-myocardial single photon emission computed tomography (4D-MSPECT), respectively. There was excellent intrareader and interreader reproducibility for both QGS and 4D-MSPECT algorithms. The differences in LV volumes and EF between the software packages were small. High prevalence of small heart was noted in the study population, especially in women (>60%). Volumetric measures were significantly greater (P<0.001) in men than in women, even after adjustment for body surface area. Women had a higher LV EF than men when using QGS methods, but not when using the 4D-MSPECT method. Compared with 4D-MSPECT, sex remained significantly associated with EF determined by QGS methods, independent of age and body weight. LV functional parameters determined by means of gated 201Tl SPECT need to be corrected for sex and algorithms. Separate reference values of LV EF and volumes need to be applied in both women and men depending on the software package used.
    Nuclear Medicine Communications 02/2011; 32(2):113-20. DOI:10.1097/MNM.0b013e3283422838 · 1.37 Impact Factor
  • Mei-Fang Cheng, Yen-Wen Wu, Sung-Chun Tang
    Clinical nuclear medicine 06/2010; 35(6):456-8. DOI:10.1097/RLU.0b013e3181db4ba5 · 2.86 Impact Factor
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    ABSTRACT: The aim of this prospective study is to evaluate the diagnostic and prognostic usefulness of F-18 sodium fluoride (NaF) positron emission tomography-computed tomography (PET-CT) relative to Tc-99m methylene diphosphonate (MDP) planar bone scintigraphy with no CT (BS) for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis. Both Tc-99m MDP BS and F-18 NaF PET-CT were performed for 34 consecutive Taiwanese HCC patients (five female and 29 male; mean age, 61.0+/-12.0 years) within a time span of 1 month (mean: 11.3+/-10.4 days). The accuracies of BS and PET-CT were determined by comparing their results with the finalized clinical data in a lesion-by-lesion manner. According to the pathological and/or follow-up results, the accuracy for detecting metastatic bone lesions by Tc-99m MDP BS is 75.4% and that by F-18 NaF PET-CT is 95.7%, respectively. F-18 NaF PET-CT is significantly more accurate than Tc-99m MDP BS (P=0.0001). Furthermore, there is a significant correlation between the presence of F-18 NaF PET-CT-positive bone lesions and the survival time of HCC patients. On the other hand, the diagnostic results from BS are not correlated with the survival time of these HCC patients. F-18 NaF using PET-CT system has significantly better sensitivity and specificity than conventional Tc-99m MDP BS in detecting metastatic HCC bone lesions that are predominantly osteolytic. The diagnostic result of PET-CT also serves as a more effective prognostic indictor for HCC patients.
    Nuclear Medicine Communications 04/2010; 31(7):637-45. DOI:10.1097/MNM.0b013e3283399120 · 1.37 Impact Factor
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    ABSTRACT: A 42-year-old woman presented with chest pain and ECG changes suggestive of acute myocardial infarction. However, a coronary angiogram showed no significant epicardial coronary stenosis. Nonetheless, abnormal Tc-99m pyrophosphate activity accumulated within the inferolateral wall, consistent with acute necrosis. Cardiac magnetic resonance revealed near transmural extent of late gadolinium-enhancement with mild hypokinesis in the mid to basal inferolateral segments. Dipyridamole Tl-201 single photon emission computed tomography 6 months later demonstrated stress-induced ischemia in the corresponding area, with subendocardial scar in the mid level. Nuclear perfusion scintigraphy is needed for accurate assessment of infarct size and coronary flow after the acute stage of a myocardial infarction has passed.
    Clinical nuclear medicine 10/2009; 34(10):734-6. DOI:10.1097/RLU.0b013e3181b539b9 · 2.86 Impact Factor
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    ABSTRACT: The 2 main causes of primary aldosteronism (PA) are aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). Dexamethasone-suppression (131)I-6beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy can assess the functioning of the adrenal cortex. This study evaluated the diagnostic usefulness of NP-59 SPECT/CT in differentiating APA from IAH and in predicting postadrenalectomy clinical outcome for PA patients who had inconclusive adrenal venous sampling (AVS) and CT results. We retrospectively reviewed the 31 adrenal lesions of 27 patients (age range, 33-71 y; mean age +/- SD, 50.4 +/- 10.9 y) who had been clinically confirmed (by saline infusion and captopril tests) to have PA, had inconclusive CT and AVS test results, and had undergone NP-59 imaging before adrenalectomy. The accuracy of NP-59 imaging was determined by comparison with histopathologic findings. NP-59 SPECT/CT gave us 18 true-positive, 3 false-positive, 6 true-negative, and 4 false-negative results. Compared with planar imaging, SPECT/CT significantly improved diagnostic accuracy and prognostic predicting ability (P = 0.0390 and P = 0.0141, respectively). The NP-59 results were negative for 7 of the 23 patients with unilateral adrenal lesions, and none of these 7 patients had shown postsurgical clinical improvement. NP-59 SPECT/CT is an effective imaging tool for differentiating APA from IAH in PA patients whose CT and AVS results are inconclusive. Our results suggest that patients with presurgically negative NP-59 results should be treated medically and that noninvasive NP-59 SPECT/CT may be suited for use as the first lateralization modality after CT in patients with clinically confirmed PA.
    Journal of Nuclear Medicine 09/2009; 50(10):1631-7. DOI:10.2967/jnumed.109.064873 · 5.56 Impact Factor

Publication Stats

125 Citations
111.58 Total Impact Points

Institutions

  • 2011–2014
    • National Taiwan University Hospital
      • • Department of Nuclear Medicine
      • • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
    • Far Eastern Memorial Hospital
      T’ai-pei, Taipei, Taiwan
    • Mackay Memorial Hospital
      • Department of Pediatrics
      Taipei, Taipei, Taiwan
  • 2013
    • National Yang Ming University
      T’ai-pei, Taipei, Taiwan
  • 2008–2012
    • National Taiwan University
      T’ai-pei, Taipei, Taiwan
  • 2007–2011
    • Taipei Medical University
      • Department of Nuclear Medicine
      T’ai-pei, Taipei, Taiwan