ORIGINAL_ARTICLE
Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy
Objective(s): Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the left hemi thorax is not low. It is reasonable to minimize the volume of the heart being in the field of radiation employing didactic radiation planning techniques. Also it is advisable to screen these patients with MPI-SPECT, even if they are clinically asymptomatic, as early diagnosis and treatment of silent ischemia may change the outcome.
https://aojnmb.mums.ac.ir/article_3132_18d05d04ab5e2216bd3fab9a72881940.pdf
2015-01-01
3
9
10.7508/aojnmb.2015.01.002
Myocardial perfusion
Breast Cancer
Radiotherapy
SPECT
Mohammad
Eftekhari
meftekhari@yahoo.com
1
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Robabeh Anbiaei
Anbiaei
dbeiki@yahoo.com
2
Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Hanie
Zamani
zamani@yahoo.com
3
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Babak
Fallahi
bfallahi@sina.tums.ac.ir
4
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Davood
Beiki
beikidav@sina.tums.ac.ir
5
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Ahmad
Ameri
ameri@yahoo.com
6
Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
Alireza
Emami-Ardekani
emami_a@sina.tums.ac.ir
7
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Armaghan
Fard-Esfahani
fardesfa@tums.ac.ir
8
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Ali
Gholamrezanezhad
gholamrezanezhad@yahoo.com
9
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Seid Kazem
Razavi Ratki
razavi@yahoo.com
10
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Alireza
Momen Roknabadi
memen@yahoo.com
11
Department of Radiation Oncology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
AUTHOR
1. Sioka C, Exarchopoulos T, Tasiou I, Tzima E, Fotou N, Capizzello A, et al. Myocardial perfusion imaging with (99 m)Tc-tetrofosmin SPECT in breast cancer patients that received postoperative radiotherapy: a case-control study. Radiat Oncol. 2011;6:151.
1
2. Chung E, Corbett JR, Moran JM, Griffith KA, Marsh RB, Feng M, et al. Is there a dose-response relationship for heart disease with low-dose radiation therapy? Int J Radiat Oncol Biol Phys. 2013; 85:959-64.
2
3. Seddon B, Cook A, Gothard L, Salmon E, Latus K, Underwood SR, et al. Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy. Radiother Oncol. 2002; 64:53-63.
3
4. Goethals I, Dierckx R, De Meerleer G, De Sutter J, De Winter O, De Neve W, et al. The role of nuclear medicine in the prediction and detection of radiation-associated normal pulmonary and cardiac damage. J Nucl Med. 2003;44:1531-9.
4
5. Yusuf SW, Sami S, Daher IN. Radiation-induced heart disease: a clinical update. Cardiol Res Pract. 2011;317659.
5
6. Konings AW, Hardonk MJ, Wieringa RA, Lamberts HB. Initial events in radiation-induced atheromatosis I. Activation of lysosomal enzymes. Strahlentherapie. 1975;150:444-8.
6
7. Paris F, Fuks Z, Kang A, Capodieci P, Juan G, Ehleiter D, et al. Endothelial apoptosis as the primary lesion initiating intestinal radiation damage in mice. Science. 2001; 293:293-7.
7
8. Beckman JA, Thakore A, Kalinowski BH, Harris JR, Creager MA. Radiation therapy impairs endothelium-dependent vasodilation in humans. J Am Coll Cardiol. 2001;37:761-5.
8
9. Stewart FA, Hoving S, Russell NS. Vascular damage as an underlying mechanism of cardiac and cerebral toxicity in irradiated cancer patients. Radiat Res. 2010;174:865-9.
9
10. Stewart FA. Mechanisms and dose-response relationships for radiation-induced cardiovascular disease. Ann ICRP. 2012;41:72-9.
10
11. Correa CR, Das IJ, Litt HI, Ferrari V, Hwang WT, Solin LJ, et al. Association between tangential beam treatment parameters and cardiac abnormalities after definitive radiation treatment for left-sided breast cancer. Int J Radiat Oncol Biol Phys. 2008; 72:508-16.
11
12. Gyenes G, Fornander T, Carlens P, Glas U, Rutqvist LE. Detection of radiation-induced myocardial damage by technetium-99m sestamibi scintigraphy. Eur J Nucl Med. 1997;24:286-92.
12
13. Dogan I, Sezen O, Sonmez B, Zengin AY, Yenilmez E, Yulug E, et al. Myocardial perfusion alterations observed months after radiotherapy are related to the cellular damage. Nuklearmedizin. 2010;49:209-15.
13
14. Cuzick J, Stewart H, Rutqvist L, Houghton J, Edwards R, Redmond C, et al. Cause-specific mortality in longterm survivors of breast cancer who participated in trials of radiotherapy. J Clin Oncol. 1994;12:447-53.
14
15. Stewart JR, Fajardo LF. Radiation-induced heart disease: an update. Prog Cardiovasc Dis. 1984;27:173-94.
15
16. Veinot JP, Edwards WD. Pathology of radiationinduced heart disease: a surgical and autopsy study of 27 cases. Hum Pathol. 1996;27:766-73.
16
17. Hardenbergh PH, Munley MT, Bentel GC, Kedem R, Borges-Neto S, Hollis D, et al. Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results. Int J Radiat Oncol Biol Phys. 2001;49:1023-8.
17
18. Tishler RB, Schiff PB, Geard CR, Hall EJ. Taxol: a novel radiation sensitizer. Int J Radiat Oncol Biol Phys. 1992;22:613-7.
18
19. Chakravarthy A, Abrams RA. Radiation therapy and 5-Fluorouracil in pancreatic cancer. Semin Radiat Oncol. 1997;7:291-299.
19
20. Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, et al. The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys. 2005;63:214-23.
20
21. Borges-Neto S, Coleman RE, Potts JM, Jones RH. Combined exercise radionuclide angiocardiography and single photon emission computed tomography perfusion studies for assessment of coronary artery disease. Semin Nucl Med. 1991;21:223-9.
21
22. Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. JAMA. 1993;270:1949-55
22
ORIGINAL_ARTICLE
FDG-avid portal vein tumor thrombosis from hepatocellular carcinoma in contrast-enhanced FDG PET/CT
Objective(s): In this study, we aimed to describe the characteristics of portal vein tumor thrombosis (PVTT), complicating hepatocellular carcinoma (HCC) in contrast-enhanced FDG PET/CT scan. Methods: In this retrospective study, 9 HCC patients with FDG-avid PVTT were diagnosed by contrast-enhanced fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT), which is a combination of dynamic liver CT scan, multiphase imaging, and whole-body PET scan. PET and CT DICOM images of patients were imported into the PET/CT imaging system for the re-analysis of contrast enhancement and FDG uptake in thrombus, the diameter of the involved portal vein, and characteristics of liver tumors and metastasis. Results: Two patients with previously untreated HCC and 7 cases with previously treated HCC had FDG-avid PVTT in contrast-enhanced FDG PET/CT scan. During the arterial phase of CT scan, portal vein thrombus showed contrast enhancement in 8 out of 9 patients (88.9%). PET scan showed an increased linear FDG uptake along the thrombosed portal vein in all patients. The mean greatest diameter of thrombosed portal veins was 1.8 ± 0.2 cm, which was significantly greater than that observed in normal portal veins (P<0.001). FDG uptake level in portal vein thrombus was significantly higher than that of blood pool in the reference normal portal vein (P=0.001). PVTT was caused by the direct extension of liver tumors. All patients had visible FDG-avid liver tumors in contrast-enhanced images. Five out of 9 patients (55.6%) had no extrahepatic metastasis, 3 cases (33.3%) had metastasis of regional lymph nodes, and 1 case (11.1%) presented with distant metastasis. The median estimated survival time of patients was 5 months. Conclusion: The intraluminal filling defect consistent with thrombous within the portal vein, expansion of the involved portal vein, contrast enhancement, and linear increased FDG uptake of the thrombus extended from liver tumor are findings of FDG-avid PVTT from HCC in contrast-enhanced FDG PET/CT.
https://aojnmb.mums.ac.ir/article_3296_a9f42714c7d89f81de206bc7fa5ca1cb.pdf
2015-01-01
10
17
10.7508/aojnmb.2015.01.003
PET/CT
FDG
portal vein tumor thrombosis (PVTT)
hepatocellular carcinoma (HCC)
Canh
Nguyen
nxcanh2000@yahoo.com
1
Unit of PET/CT and Cyclotron, Choray Hospital, Vietnam
LEAD_AUTHOR
Huy
Nguyen
songhuynd@yahoo.com
2
Department of Liver Tumor, Choray Hospital, Vietnam
AUTHOR
Tan
Ngo
v_tan84@yahoo.com
3
Unit of PET/CT and Cyclotron, Choray Hospital, Vietnam
AUTHOR
Simone
Maurea
maurea@unina.it
4
Dipartimento Di Scienze Biomediche Avanzate, Facoltá Di Medicina E Chirurgia, Università Degli Studi Di Napoli
Federico II, Italia
AUTHOR
1. Anh PT, Duc NB. The situation with cancer control in Vietnam. Jpn J Clin Oncol. 2002; 32 Suppl:S92-7.
1
2. Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, et al. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res. 2008; 122(3):299-306.
2
3. Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology. 1999; 29(1):62-7.
3
4. Jia L, Kiryu S, Watadani T, Akai H, Yamashita H, Akahane M, et al. Prognosis of hepatocellular carcinoma with portal vein tumor thrombus:assessment based on clinical and computer tomography characteristics. Acta Med Okayama. 2012; 66(2):131-41.
4
5. Takizawa D, Kakizaki S, Sohara N, Sato K, Takagi H, Arai H, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis. Dig Dis Sci. 2007; 52(11):3290-5.
5
6. Englesbe MJ, Kubus J, Muhammad W, Sonnenday CJ, Welling T, Punch JD, et al. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl. 2010; 16(1):83-90.
6
7. Lertpipopmetha K, Auewarakul CU. High incidence of hepatitis B infection-associated cirrhosis and hepatocellular carcinoma in the Southeast Asian patients with portal vein thrombosis. BMC Gastroenterol. 2011; 11(1):66.
7
8. Tarantino L, Francica G, Sordelli I, Esposito F, Giorgio A, Sorrentino P, et al. Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy. Abdom Imaging. 2006; 31(5):537-44.
8
9. Sorrentino P, D'Angelo S, Tarantino L, Ferbo U, Bracigliano A, Vecchione R. Contrast-enhanced sonography versus biopsy for the differential diagnosis of thrombosis in hepatocellular carcinoma patients. World J Gastroenterol. 2009; 15(18):2245-51.
9
10. Danila M, Sporea I, Popescu A, Sirli R, Sendroiu M. The value of contrast enhanced ultrasound in the evaluation of the nature of portal vein thrombosis. Med Ultrason. 2011; 13(2):102-7.
10
11. Rossi S, Ghittoni G, Ravetta V, Torello Viera F, Rosa L, Serassi M, et al. Contrast-enhanced ultrasonography and spiral computed tomography in the detection and characterization of portal vein thrombosis complicating hepatocellular carcinoma. Eur Radiol. 2008; 18(8):1749-56.
11
12. Tublin ME, Dodd GD, 3rd, Baron RL. Benign and malignant portal vein thrombosis: differentiation by CT characteristics. AJR Am J Roentgenol. 1997; 168(3):719-23.
12
13. Shah ZK, McKernan MG, Hahn PF, Sahani DV. Enhancing and expansile portal vein thrombosis: value in the diagnosis of hepatocellular carcinoma in patients with multiple hepatic lesions. Am J Roentgenol. 2007; 188(5):1320-3.
13
14. Nishie A, Yoshimitsu K, Asayama Y, Irie H, Tajima T, Hirakawa M, et al. Radiologic detectability of minute portal venous invasion in hepatocellular carcinoma. Am J Roentgenol. 2008;190(1):81-7.
14
15. Sandrasegaran K, Tahir B, Nutakki K, Akisik FM, Bodanapally U, Tann M, et al. Usefulness of conventional MRI sequences and diffusion-weighted imaging in differentiating malignant from benign portal vein thrombus in cirrhotic patients. Am J Roentgenol. 2013; 201(6):1211-9.
15
16. Ho CL, Yu SC, Yeung DW. 11C-acetate PET imaging in hepatocellular carcinoma and other liver masses. J Nucl Med. 2003; 44(2):213-21.
16
17. Talbot JN, Fartoux L, Balogova S, Nataf V, Kerrou K, Gutman F, et al. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med. 2010; 51(11):1699-706.
17
18. Chen YK, Hsieh DS, Liao CS, Bai CH, Su CT, Shen YY, et al. Utility of FDG-PET for investigating unexplained serum AFP elevation in patients with suspected hepatocellular carcinoma recurrence. Anticancer Res. 2005; 25(6C):4719-25.
18
19. Han AR, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, et al. The clinical value of 18F-FDG PET/CT for investigating unexplained serum AFP elevation following interventional therapy for hepatocellular carcinom. Hepatogastroenterology. 2009; 56(93):1111-6.
19
20. Agrawal A, Purandare N, Shah S, Puranik A, Rangarajan V. Extensive tumor thrombus of hepatocellular carcinoma in the entire portal venous system detected on fluorodeoxyglucose positron emission tomography computed tomography. Indian J Nucl Med. 2013; 28(1):54-6.
20
21. Sun L, Guan YS, Pan WM, Chen GB, Luo ZM, Wei JH, et al. Highly metabolic thrombus of the portal vein: 18F
21
fluorodeoxyglucose positron emission tomography/ computer tomography demonstration and clinical significance in hepatocellular carcinoma. World J Gastroenterol. 2008; 14(8):1212-7.
22
22. Sun L, Wu H, Pan WM, Guan YS. Positron emission tomography/computed tomography with (18) F-fluorodeoxyglucose identifies tumor growth or thrombosis in the portal vein with hepatocellular carcinoma. World J Gastroenterol. 2007; 13(33): 4529-32.
23
23. Sharma P, Kumar R, Jeph S, Karunanithi S, Naswa N, Gupta A, et al. 18F-FDG PET-CT in the diagnosis of tumor thrombus: can it be differentiated from benign thrombus? Nucl Med Commun. 2011; 32(9):782-8.
24
24. Hu S, Zhang J, Cheng C, Liu Q, Sun G, Zuo C. The role of F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis. Abdom Imaging. 2014; 39(6):1221-7.
25
25. Ter Voert EE, van Laarhoven HW, Kok PJ, Oyen WJ, Visser EP, de Geus-Oei LF. Comparison of liver SUV using unenhanced CT versus contrast-enhanced CT for attenuation correction in 18F-FDG PET/CT. Nucl Med Commun. 2014; 35(5):472-7.
26
ORIGINAL_ARTICLE
C-11 Choline and FDG PET/CT Imaging of Primary Cholangiocarcinoma – a Comparative Analysis
Objective(s): This study aimed to compare the diagnostic values of 11C-choline and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with cholangiocarcinoma (CCA). Methods: This prospective study was conducted on 10 patients (6 males and 4 females), aged 42-69 years, suspected of having CCA based on CT or magnetic resonance imaging (MRI) results. 11C-choline and 18F-FDG PET/CT studies were performed in all patients over 1 week. PET/CT results were visually analyzed by 2 independent nuclear medicine physicians and quantitatively by calculating the tumor-to-background ratio (T/B). Results: No 11C-choline PET/CT uptake was observed in primary extrahepatic or intrahepatic CCA cases. Intense 18F-FDG avidity was detected in the tumors of 8 patients (%80). Two patients, who were 18F-FDG negative, had primary extrahepatic CCA. Ki-67 measurements were positive in all patients (range; 14.2%-39.9%). The average T/B values of 11C-choline and 18F-FDG were 0.4±0.2 and 2.0±1.0 in all cases of primary CCA, respectively; these values were significantly lower for 11C-choline (P<0.005). Both FDG and 11C-choline PET/CT detected metastatic CCA foci in all 8 patients (two patients had no metastases). Conclusion: As the results suggested, primary CCA lesions showed a poor avidity for 11C-choline, whereas 18F-FDG PET/CT was of value for the detection of most primary CCA cases. In contrast to primary lesions, metastatic CCA lesions showed 11C-choline avidity.
https://aojnmb.mums.ac.ir/article_3144_7d6ae24bc07532fc79f93395bc91ec49.pdf
2015-01-01
18
25
10.7508/aojnmb.2015.01.004
Cholangiocarcinoma
FDG
Choline
PET/CT
Radiotracer
Chanisa
Chotipanich
chanisa.ja@gmail.com
1
National Cyclotron and PET Centre, Chulabhorn Hospital, Thailand
LEAD_AUTHOR
Chetsadaporn
Promteangtrong
jadesadaporn018@gmail.com
2
National Cyclotron and PET Centre, Chulabhorn Hospital, Thailand
AUTHOR
Anchisa
Kunawudhi
anchisa@gmail.com
3
National Cyclotron and PET Centre, Chulabhorn Hospital, Thailand
AUTHOR
Rawisak
Chanwat
mpub49@yahoo.com
4
Surgery Department, Chulabhorn Hospital, Thailand
AUTHOR
Thaniya
Sricharunrat
tsricharunrat@yahoo.com
5
Pathology Department, Chulabhorn Hospital, Thailand
AUTHOR
Savitree
Suratako
mu_savit1@hotmail.com
6
National Cyclotron and PET Centre, Chulabhorn Hospital, Thailand
AUTHOR
Paramest
Wongsa
w_paramest@hotmail.com
7
National Cyclotron and PET Centre, Chulabhorn Hospital, Thailand
AUTHOR
1. Shin HR, Oh JK, Masuyer E, Curado MP, Bouvard V, Fang YY, et al. Epidemiology of cholangiocarcinoma: an update focusing on risk factors. Cancer Sci.2010;101(3):579-85.
1
2. Attasara P BR. Hospital-based cancer registry 2009. Bangkok: Ramthai Press;2010.
2
3. Vatanasapt V PD, Sriamporn S. Epidemiology of liver cancer in Thailand. Khon Kaen (Thailand): Sriphan Press; 2000.
3
4. Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer in Five Continents 2002. IARC: Lyon; Vol VIII
4
5. Malhi H, Gores GJ. Cholangiocarcinoma: modern advances in understanding a deadly old disease. J Hepatol. 2006; 45(6):856-67.
5
6. Zech CJ, Schoenberg SO, Reiser M, Helmberger T. Cross-sectional imaging of biliary tumors: current clinical status and future developments. Eur Radiol. 2004; 14(7):1174-87.
6
7. Sainani NI, Catalano OA, Holalkere NS, Zhu AX, Hahn PF, Sahani DV. Cholangiocarcinoma: current and novel imaging techniques. Radiographics. 2008; 28(5):1263-87.
7
8. Khan SA, Davidson BR, Goldin R, Pereira SP, Rosenberg WM, Taylor-Robinson SD, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut. 2002; 51 Suppl 6:Vi1-9.
8
9. Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D. Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg. 2004; 8(1):90-7.
9
10. Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, et al. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 2008; 206(1):57 65.
10
11. Breitenstein S, Apestegui C, Clavien PA. Positron emission tomography (PET) for cholangiocarcinoma. HPB (Oxford). 2008; 10(2):120-1.
11
12. Lee SW, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. Clinical usefulness of 18F-FDG PET-CT for patients with gallbladder cancer and cholangiocarcinoma. J Gastroenterol. 2010; 45(5):560-6.
12
13. Petrowsky H, Wildbrett P, Husarik DB, Hany TF, Tam S, Jochum W, et al. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol. 2006; 45(1):43-50.
13
14. Talbot JN, Fartoux L, Balogova S, Nataf V, Kerrou K, Gutman F, et al. Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med. 2010; 51(11):1699-706.
14
15. Picchio M, Briganti A, Fanti S, Heidenreich A, Krause BJ, Messa C, et al. The role of choline positron emission tomography/computed tomography in the management of patients with prostatespecific antigen progression after radical treatment of prostate cancer. Eur Urol. 2011; 59(1):51-60.
15
16. Skoura E, Datseris IE. The use of 18F-fluorothymidine and 18F-fluorocholine in imaging with positron emission tomography. Hell J Nucl Med. 2010; 13(1):88-90.
16
17. Treglia G, Giovannini E, Di Franco D, Calcagni ML, Rufini V, Picchio M, et al. The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review. Ann Nucl Med. 2012;26(6):451-61.
17
18. Li J, Kuehl H, Grabellus F, Muller SP, Radunz S, Antoch G, et al. Preoperative assessment of hilar cholangiocarcinoma by dual-modality PET/CT. J Surg Oncol. 2008; 98(6):438-43.
18
19. Kim JY, Kim MH, Lee TY, Hwang CY, Kim JS, Yun SC, et al. Clinical role of 18F-FDG PET-CT in suspected and potentially operable cholangiocarcinoma: a prospective study compared with conventional imaging. Am J Gastroenterol. 2008; 103(5):1145-51.
19
20. Jadvar H, Henderson RW, Conti PS. [F-18] fluorodeoxyglucose positron emission tomography and positron emission tomography: computed tomography in recurrent and metastatic cholangiocarcinoma. J Comput Assist Tomogr. 2007; 31(2):223-8.
20
21. Annunziata S, Caldarella C, Pizzuto DA, Galiandro F, Sadeghi R, Giovanella L, et al. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in the evaluation of the primary tumor in patients with cholangiocarcinoma: a meta-analysis. Biomed Res Int. 2014; 2014:247693.
21
22. Fritscher-Ravens A, Bohuslavizki KH, Broering DC, Jenicke L, Schafer H, Buchert R, et al. FDG PET in the diagnosis of hilar cholangiocarcinoma. Nucl Med Commun. 2001; 22(12):1277-85.
22
23. Nejjari M, Kryza D, Poncet G, Roche C, Perek N, Chayvialle JA, et al. In vitro and in vivo studies with [(18)F]fluorocholine on digestive tumoral cell lines and in an animal model of metastasized endocrine tumor. Nucl Med Biol. 2008; 35(1):123-30.
23
24. Qayyum A. MR spectroscopy of the liver: principles and clinical applications. Radiographics. 2009; 29(6):1653-64.
24
25. Langsteger W, Heinisch M, Fogelman I. The role of fluorodeoxyglucose, 18F-dihydroxyphenylalanine, 18F-choline, and 18F-fluoride in bone imaging with emphasis on prostate and breast. Semin Nucl Med. 2006; 36(1):73-92.
25
26. Schillaci O, Calabria F, Tavolozza M, Ciccio C, Carlani M, Caracciolo CR, et al. 18F-choline PET/CT physiological distribution and pitfalls in image interpretation: experience in 80 patients with prostate cancer. Nucl Med Commun. 2010; 31(1):39-45.
26
27. Rietbergen DD, van der Hiel B, Vogel W, Stokkel MP. Mediastinal lymph node uptake in patients with prostate carcinoma on F18-choline PET/CT. Nucl Med Commun. 2011;32(12):1143-7.
27
28. Lazaridis KN, Gores GJ. Cholangiocarcinoma. Gastroenterology. 2005; 128(6):1655-67.
28
29. Petrowsky H, Sturm I, Graubitz O, Kooby DA, Staib-Sebler E, Gog C, et al. Relevance of Ki-67 antigen expression and K-ras mutation in colorectal liver metastases. Eur J Surg Oncol. 2001; 27(1):80-7.
29
30. Yu CC, Filipe MI. Update on proliferation-associated antibodies applicable to formalin-fixed paraffinembedded tissue and their clinical applications. Histochem J. 1993; 25(12):843-53.
30
ORIGINAL_ARTICLE
Extremity Radioactive Iodine Uptake on Post-therapeutic Whole Body Scan in Patients with Differentiated Thyroid Cancer
Objective(s): We investigated a frequency of lower extremity uptake on the radioactive iodine (RAI) whole body scan (WBS) after RAI treatment in patients with differentiated thyroid cancer, in order to retrospectively examine whether or not the frequency was pathological. Methods: This retrospective study included 170 patients with thyroid cancer, undergoing RAI treatment. Overall, 99r (58%) and 71 (42%)patients received single and multiple RAI treatments, respectively. Post-therapeutic WBS was acquired after 3 days of RAI administration. For patients with multiple RAI treatments, the WBS of their last RAI treatment was evaluated. Lower extremity uptake on post-therapeutic WBS was classified into 3 categories: bilateral femoral uptake (type A), bilateral femoral and tibia uptake (type B), and uptake in bilateral upper and lower extremities (type C). Then, the patients with RAI uptake in the lower extremities on WBS were analyzed with clinical parameters. Results: Overall, 99 patients (58%) had the extremity uptake on their posttherapeutic RAI WBS. As the results indicated, 42 ,53, and 4 patients had type A, type B, and type C uptakes, respectively. Lower extremity uptake was significantly associated with younger age, not only in subjects with multiple RAI treatments but also in all the patients (P<0.05). Accumulation in patients with multiple RAI treatments was more frequent than patients with single RAI treatment (P<0.05). Lower extremity uptake was not associated with counts of the white blood cell count, hemoglobin level, platelet count, estimated glomerular filtration rate, effective half-time of RAI, serum TSH level, and anti-Tg concentration. Conclusion: About half of the patients had lower extremity uptake on the posttherapeutic RAI WBS, especially younger patients and those with multiple courses of RAI treatment. Bilateral lower extremity’s RAI uptake on the posttherapeutic WBS should be considered as physiological RAI distribution in bone marrow.
https://aojnmb.mums.ac.ir/article_3428_038d68f70b75f1fa66368d0ec06ea53d.pdf
2015-01-01
26
34
10.7508/aojnmb.2015.01.005
Thyroid cancer
131I
whole body scan
lower extremity
physiological uptake
Hiroshi
Wakabayashi
wakabayashi@nmd.m.kanazawa-u.ac.jp
1
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
LEAD_AUTHOR
Junichi
Taki
taki@med.kanazawa-u.ac.jp
2
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
AUTHOR
Anri
Inaki
henri@nmd.m.kanazawa-u.ac.jp
3
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
AUTHOR
Ayane
Toratani
ayane@nmd.m.kanazawa-u.ac.jp
4
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
AUTHOR
Daiki
Kayano
kayano@staff.kanazawa-u.ac.jp
5
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
AUTHOR
Seigo
Kinuya
kinuya@med.kanazawa-u.ac.jp
6
Department of Nuclear Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
AUTHOR
1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167 214.
1
2. Kao PF, Chang HY, Tsai MF, Lin KJ, Tzen KY, Chang CN. Breast uptake of iodine-131 mimicking lung metastases in a thyroid cancer patient with a pituitary tumour. Br J Radiol. 2001;74(880):378-81.
2
3. Hsiao E, Huynh T, Mansberg R, Bautovich G, Roach P. Diagnostic I-123 scintigraphy to assess potential breast uptake of I-131 before radioiodine therapy in a postpartum woman with thyroid cancer. Clin Nucl Med. 2004; 29(28):498-501.
3
4. Basu S, Moghe SH. Unusual unilateral breast 131I uptake related to breastfeeding practice. Clin Radiol. 2009;64(7):743-4.
4
5. Brucker-Davis F, Reynolds JC, Skarulis MC, Fraker DL, Alexander HR, Weintraub BD, et al. False-positive iodine-131 whole-body scans due to cholecystitis and sebaceous cyst. J Nucl Med. 1996;37(10):1690-3.
5
6. Bohnen NI, Charron M. Isolated lower extremity I-131 bone marrow uptake in a runner. Clin Nucl Med. 2001;26(2):163-4.
6
7. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982-92.
7
8. Anner RM, Drewinko B. Frequency and significance of bone marrow involvement by metastatic solid tumors. Cancer. 1977; 39(3):1337-44.
8
9. Rufini V, Salvatori M, Saletnich I, Luzi S, Fadda G, Shapiro B, et al. Disseminated bone marrow metastases of insular thyroid carcinoma detected by radioiodine whole-body scintigraphy. J Nucl Med. 1996;37(4):633-6.
9
10. Moore SG, Dawson KL. Red and yellow marrow in the femur: age-related changes in appearance at MR imaging. Radiology. 1990;175(1):219-23.
10
11. Vande Berg BC, Lecouvet FE, Moysan P, Maldague B, Jamart J, Malghem J. MR assessment of red marrow distribution and composition in the proximal femur: correlation with clinical and laboratory parameters. Skeletal Radiol. 1997;26(10):589-96.
11
12. Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW Jr, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology. 1990;177(1):83-8.
12
13. Kim SC, Krynyckyl BR, Machac J, Kim CK. Patterns of red marrow in the adult femur. Clin Nucl Med. 2006;31(12):739-41.
13
14. Hung BT, Huang SH, Huang YE, Wang PW. Appropriate time for post-therapeutic I-131 whole body scan. Clin Nucl Med. 2009;34(6):339-42.
14
ORIGINAL_ARTICLE
Production, biodistribution assessment and dosimetric evaluation of 177Lu-TTHMP as a bone pain palliation agent
Objective(s): Recently, bone-avid radiopharmaceuticals have been shown to have potential benefits for the treatment of widespread bone metastases. Although 177Lutriethylene tetramine hexa methylene phosphonic acid (abbreviated as 177Lu- TTHMP), as an agent for bone pain palliation, has been evaluated in previous studies, there are large discrepancies between the obtained results. In this study, production, quality control, biodistribution, and dose evaluation of 177Lu-TTHMP have been investigated and compared with the previously reported data. Methods: TTHMP was synthesized and characterized, using spectroscopic methods. Radiochemical purity of the 177Lu-TTHMP complex was determined using instant thin-layer chromatography (ITLC) and high performance liquid chromatography (HPLC) methods. The complex was injected to wild-type rats and biodistribution was studied for 7 days. Preliminary dose evaluation was investigated based on biodistribution data in rats. Results: 177Lu was prepared with 2.6-3 GBq/mg specific activity and radionuclide purity of 99.98%. 177Lu-TTHMP was successfully prepared with high radiochemical purity (>99%). The complex showed rapid bone uptake, while accumulation in other organs was insignificant. Dosimetric results showed that all tissues received almost insignificant absorbed doses in comparison with bone tissues. Conclusion: Based on the obtained results, this radiopharmaceutical can be a good candidate for bone pain palliation therapy in skeletal metastases.
https://aojnmb.mums.ac.ir/article_2840_6edada16b7d9f6096d15ece428960ac3.pdf
2015-01-01
35
42
10.7508/aojnmb.2015.01.006
Bone pain palliation
Lu-177
TTHMP
Dosimetry
samaneh
zolghadri
szolghadri@aeoi.org.ir
1
Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
AUTHOR
hassan
yousefnia
hasan_usefnia@yahoo.com
2
Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
LEAD_AUTHOR
amir reza
jalilian
ajalili@aeoi.org.ir
3
Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
AUTHOR
mohammad
ghannadi-maragheh
mghannadi@aeoi.org.ir
4
Nuclear Science and Technology Research Institute (NSTRI), Tehran, Iran
AUTHOR
1. Serafini AN. Therapy of metastatic bone pain. J Nucl Med. 2001;42:895-906.
1
2. Pandit-Taskar N, Batraki M, Divgi CR. Radiopharmaceutical Therapy for Palliation of Bone Pain from Osseous Metastases. J Nucl Med. 2004; 45:1358–65.
2
3. Criteria for Palliation of Bone Metastases –Clinical Applications, IAEA-TECDOC-1549. Austria, Vienna: IAEA; 2007.
3
4. Lipton A. Pathophysiology of Bone Metastases: How This Knowledge May Lead to Therapeutic Intervention. J Support Oncol. 2004; 2:205-13.
4
5. Liberman B, Gianfelice D, Inbar Y, Beck A, Rabin T, Shabshin N, et al. Pain Palliation in Patients with Bone Metastases Using MR-Guided Focused Ultrasound Surgery: A Multicenter Study. Ann Surg Oncol. 2009; 16:140-6.
5
6. Rajendran JG, Eary JF, Bensinger W, Durack LD, Vernon C, Fritzberg A. High-Dose 166Ho-DOTMP in Myeloablative Treatment of Multiple Myeloma: Pharmacokinetics, Biodistribution, and Absorbed Dose Estimation. J Nucl Med. 2002; 43:1383-90.
6
7. Farhanghi M, Holmes RA, Volkert WA, Logan KW, Singh A. Samarium- 153-EDTMP: Pharmacokinetic, Toxicity and Pain Response Using an Escalating Dose Schedule in Treatment of Metastatic Bone Cancer. J NucI Med. 1992; 33:1451-8.
7
8. Hosain F, Spencer RP. Radiopharmaceuticals for palliation of metastatic osseous lesions: biologic and physical background. Semin Nucl Med. 1992; 22:11–6.
8
9. Deligny CL, Gelsema WJ, Tji TG, Huigen YM, Vink HA. Bone seeking radiopharmaceuticals. Nucl Med Biol. 1990; 17:161 179.
9
10. Lewington VJ. Targeted radionuclide therapy for bone metastases. Eur J Nucl Med. 1993; 20:66-74.
10
11. Breitz H, Wendt R, Stabin M, Bouchet L, Wessels B. Dosimetry of high dose skeletal targeted radiotherapy (STR) with 177Lu-DOTMP. Cancer Biother Radiopharm. 2003; 18:225-30.
11
12. Bahrami-Samani A, Anvari A, Jalilian AR, Shirvani-Arani S, Yousefnia H, Aghamiri MR, et al. Production, quality control and pharmacokinetic studies of 177Lu-EDTMP for human bone pain palliation therapy trials. Iran J Pharmaceut Res. 2012; 11:137-44.
12
13. Abbasi IA. Preliminary studies on 177Lu-labeled sodium pyrophosphate (177Lu-PYP) as a potential bone-seeking radiopharmaceutical for bone pain palliation. Nucl Med Biol. 2012; 39:763-9.
13
14. Chakraborty S, Das T, Unni PR, Sarma HD, Samuel G, Banerjee S, et al. 177Lu labeled polyaminophosphonates as potential agents for bone pain palliation. Nucl Med Commun. 2002; 23: 67-74.
14
15. Abbasi IA. Studies on 177Lu-labeled methylene diphosphonate as potential bone-seeking radiopharmaceutical for bone pain palliation. Nucl Med Biol. 2011; 38:417–25.
15
16. Lungu V, Niculae D, Bouziotis P, Pirmettis I, Podina C. Radiolabeled phosphonates for bone metastases therapy. J Radioanalytical Nucl Chem. 2007; 273:663–7.
16
17. Das T, Chakraborty S, Unni PR, Banerjee S, Samuel G, Sarma HD, et al. 177Lu-labeled cyclic polyaminophosphonates as potential agents for bone pain palliation. Appl Radiat Isotopes. 2002; 57:177–84.
17
18. Manual For Reactor Produced Radioisotopes, IAEA-TECDOC-1340. Austria, Vienna: IAEA; 2003.
18
19. Sparks RB, Aydogan B. Comparison of the effectiveness of some common animal data scaling techniques in estimating human radiation dose. Proceeding of the sixth International Radiopharmaceutical Dosimetry Symposium; Oak Ridge. TN: Oak Ridge Associated Universities; 1996. pp. 705–16.
19
20. Bevelacqua JJ. Internal Dosimetry Primer. Radiat Prot Manage. 2005; 22:7-17.
20
21. OLINDA - Organ Level Internal Dose Assessment Code (Version 1.1), copyright Vanderbilt University; 2007.
21
22. Mitterhauser M, Toegel S. What to consider in the development of new bone seekers: mechanistic and tracer-related aspects. Nucl Med Biol. 2008; 35:817–24.
22
ORIGINAL_ARTICLE
Dual radioisotopes simultaneous SPECT of 99mTc-tetrofosmin and 123I-BMIPP using a semiconductor detector.
Objective(s): The energy resolution of a cadmium-zinc-telluride (CZT) solid-state semiconductor detector is about 5%, and is superior to the resolution of the conventional Anger type detector which is 10%. Also, the window width of the high-energy part and of the low-energy part of a photo peak window can be changed separately. In this study, we used a semiconductor detector and examined the effects of changing energy window widths for 99mTc and 123 I simultaneous SPECT. Methods: The energy “centerline” for 99mTc was set at 140.5 keV and that for 123I at 159.0 keV. For 99mTc, the “low-energy-window width” was set to values that varied from 3% to 10% of 140.5 keV and the “high-energy-window width” were independently set to values that varied from 3% to 6% of 140.5 keV. For 123I, the “low energy-window-width” varied from 3% to 6% of 159.0 keV and the high-energy-window width from 3% to 10% of 159 keV. In this study we imaged the cardiac phantom, using single or dual radionuclide, changing energy window width, and comparing SPECT counts as well as crosstalk ratio. Results: The contamination to the 123I window from 99mTc (the crosstalk) was only 1% or less with cutoffs of 4% at lower part and 6% at upper part of 159KeV. On the other hand, the crosstalk from 123I photons into the 99mTc window mostly exceeded 20%. Therefore, in order to suppress the rate of contamination to 20% or less, 99mTc window cutoffs were set at 3% in upper part and 7% at lower part of 140.5 KeV. The semiconductor detector improves separation accuracy of the acquisition inherently at dual radionuclide imaging. In, this phantom study we simulated dual radionuclide simultaneous SPECT by 99mTc-tetrofosmin and 123 I-BMIPP. Conclusion: We suggest that dual radionuclide simultaneous SPECT of 99mTc and 123I using a CZT semiconductor detector is possible employing the recommended windows.
https://aojnmb.mums.ac.ir/article_3081_486a8cfe36357e9962c6d1373940f102.pdf
2015-01-01
43
49
10.7508/aojnmb.2015.01.007
Semiconductor detector
Energy resolution
Dual radioisotopes simultaneous SPECT
123I-BMIPP
Yasuyuki
Takahashi
takaynyma2@yahoo.co.jp
1
Department of Nuclear Medicine Technology, Gunma Prefectural College of Health Sciences, Maebashi, Japan
LEAD_AUTHOR
Masao
Miyagawa
miyagawa@m.ehime-u.ac.jp
2
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
AUTHOR
Yoshiko
Nishiyama
yoshiko-527.mail@i.softbank.jp
3
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
AUTHOR
Naoto
Kawaguchi
n.kawa1113@gmail.com
4
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
AUTHOR
Hayato
Ishimura
ishimura@m.ehime-u.ac.jp
5
Department of Radiological Technology, Ehime University Hospital, Toon, Japan
AUTHOR
Teruhito
Mochizuki
tmochi@m.ehime-u.ac.jp
6
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Japan
AUTHOR
1. Dobbeleir AA, Hambys ASE, Franken PR. Influence of methodology on the presence and extent of mismatching between 99mTc-MIBI and 123I-BMIPP in myocardial viability studies. J Nucl Med. 1999; 40: 707-14.
1
2. Tamaki N, Tadamura E, Kawamoto M Magata Y, Yonekura Y, Fujibayashi Y, et al. Decreased uptake of iodinated branched fatty acid analog indicates metabolic alterations in ischemic myocardium. J Nucl Med. 1995; 36:1974-80.
2
3. Kumita S, Mizumura S, Kijima T, Machida M, Kumazaki T, Tetsuou Y, et al. ECG-gated dual isotope myocardial SPECT with 99mTc-MIBI and 123I-BMIPP in patiens with ischemic heart disease. Kaku Igaku. 1995; 32:547-55.
3
4. National Electric Manufacturers Association (NEMA). Performance Measurements of Scintillation Cameras. Standards publication NU-1–1994. Washington, DC: NEMA; 1994.
4
5. NEMA Standard Publication NU 1-2001, Performance Measurements of Scintillation Cameras. USA, Rosslyn: National Electrical Manufacturers Association; 2001.
5
6. Mizumura S, Kumita S, Kumazaki T. A study of the simultaneous acquisition of dual energy SPECT with 99mTc and 123I: Evaluation of optimal window setting with myocardial phantom. Kaku Igaku. 1995;32(2):183-90.
6
7. Hirata M, Monzen H, Suzuki T, Ogasawara M, Nakanishi A, Sumi N, et al. Evaluation of a new protocol for two-isotope 123I-BMIPP/99mTc-TF single photon emission computed tomography (SPECT) to detect myocardial damage within one hour. Jpn J Med Phys. 2009; 29:3-11.
7
8. Inoue T. Basic study of dual radionuclide data acquisition with Tc-99m and I-123 to establish quantitative brain SPECT. Ehime Medical Journal 1993; 12:228-37.
8
9. Bocher M, Blevis IM, Tsukerman L, Shrem Y, Kovalski G, Volokh L. A fast cardiac gamma camera with dynamic SPECT capabilities: design, system validation and future potential. Eur J Nucl Med. 2010; 37:1887-902.
9
10. Takahashi Y, Miyagawa M, Nishiyama Y, Ishimura H, Mochizuki T. Performance of a semiconductor SPECT system: comparison with a conventional Anger-type SPECT instrument. Ann Nucl Med. 2013; 27:11-6.
10
11. Jaszcak RJ, Greer KL.Improved SPECT quantification using compensation for scattered photons. J Nucl Med. 1984; 25: 893-900.
11
12. Kubo A, Nakamura K, Hashimoto J, Sammiya T, Iwanaga S, Hashimoto S, et al. Phase I clinical trial of a new myocardial imaging agent, 99mTc-PPN1011. Kaku Igaku. 1992;29(10):1165-76.
12
13. Torizuka K, Yonekura Y, Nishimura T, Tamaki N, Uehara T, Ikekubo K, et al. A Phase 1 study of betamethyl- p-(123I)-iodophenyl-pentadecanoic acid (123I-BMIPP). Kaku Igaku. 1991;28(7):681-90.
13
14. Hatakeyama R. Heart phantom with liver object. A new textbook of nuclear medicine technology 2001; 1: 243-246. (in Japanese)
14
ORIGINAL_ARTICLE
Thyroid Nodule Imaging. Status and Limitations.
Thyroid nodules are common, occurring in almost two-thirds of some populations; among these only about 7% are malignant. The most important question with any new discovered thyroid nodule is, “is this malignant?” The main arbiter of malignancy or benignity remains fine needle aspiration and the mainstay of treatment surgery. But given the resources involved, doing an FNAC or surgery in every discovered nodule would be prohibitive to impossible. The clinician must decide which nodule to investigate and which to watch in the hope that this will never turn out to be malignant. FNACs are used basically to decide which nodule to operate upon (or more importantly which to not operate upon) and clinical and imaging features are used to decide which nodule to investigate by FNAC and which to leave alone. This paper describes the various imaging options for looking at thyroid nodules and briefly discusses the advantages and disadvantages with each.
https://aojnmb.mums.ac.ir/article_3252_10e2eb618b90fd0a92cf3ba08587fcf0.pdf
2015-01-01
50
57
10.7508/aojnmb.2015.01.008
thyroid nodule imaging
Ultrasound
Nuclear Medicine
thyroid scan
Durre
Sabih
dsabih@yahoo.com
1
Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan
LEAD_AUTHOR
Kashif
Rahim
kashifrahim@gmail.com
2
Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan
AUTHOR
1. Welker MJ, Orlov D. Thyroid nodules. Am Fam Physician. 2003;67(3):559-66.
1
2. Tuttle RM, Lemar H, Burch HB. Clinical features associated with an increased risk of thyroid malignancy in patients with follicular neoplasia by fine-needle aspiration. Thyroid. 1998;8(5):377-83.
2
3. Zuberi LM, Yawar A, Islam N, Jabbar A. Clinical presentation of thyroid cancer patients in Pakistan- AKUH experience. JPMA The Journal of the Pakistan Medical Association. 2004;54(10):526-8.
3
4. McCall A, Jarosz H, Lawrence AM, Paloyan E. The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery. 1986;100(6):1128-32.
4
5. Sachmechi I, Miller E, Varatharajah R, Chernys A, Carroll Z, Kissin E, et al. Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract. 2000; 6(1):5-7.
5
6. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941-6.
6
7. Hoang JK, Lee WK, Lee M, Johnson D, Farrell S. US Features of thyroid malignancy: pearls and pitfalls. Radiographics. 2007;27(3):847-60.
7
8. Mancuso AA. Oh #*$%#! Another pesky incidental thyroid nodule! AJNR Am J Neuroradiol. 2005;26(10):2444-5.
8
9. Daumerie C, Ayoubi S, Rahier J, Buysschaert M, Squifflet JP. Prevalence of thyroid cancer in hot nodules. Ann Chir. 1998;52(5):444-8.
9
10. Mirfakhraee S, Mathews D, Peng L, Woodruff S, Zigman JM. A solitary hyperfunctioning thyroid nodule harboring thyroid carcinoma: review of the literature. Thyroid Res. 2013;6(1):7.
10
11. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167-214.
11
12. Sathekge MM, Mageza RB, Muthuphei MN, Modiba MC, Clauss RC. Evaluation of thyroid nodules with technetium-99m MIBI and technetium-99m pertechnetate. Head Neck. 2001;23(4):305-10.
12
13. Nakahara H, Noguchi S, Murakami N, Hoshi H, Jinnouchi S, Nagamachi S, et al. Technetium-99msestamibi scintigraphy compared with thallium-201 in evaluation of thyroid tumors. J Nucl Med. 1996;37(6):901-4.
13
14. Bertagna F, Treglia G, Piccardo A, Giubbini R. Diagnostic and clinical significance of F-18-FDG-PET/ CT thyroid incidentalomas. J Clin Endocrinol Metab. 2012;97(11):3866-75.
14
15. Mosci C, Iagaru A. PET/CT imaging of thyroid cancer. Clin Nucl Med. 2011;36(12):e180-5.
15
16. Hoang JK, Raduazo P, Yousem DM, Eastwood JD. What to do with incidental thyroid nodules on imaging? An approach for the radiologist. Semin Ultrasound CT MR. 2012;33(2):150-7.
16
17. Hobbs HA, Bahl M, Nelson RC, Kranz PG, Esclamado RM, Wnuk NM, et al. Journal Club: incidental thyroid nodules detected at imaging: can diagnostic workup be reduced by use of the Society of Radiologists in Ultrasound recommendations and the three-tiered system? AJR Am J Roentgenol. 2014;202(1):18-24.
17
18. Chaudhary V, Bano S. Thyroid ultrasound. Indian J Endocrinol Metab. 2013;17(2):219-27.
18
19. Kotecha S, Bhatia P, Rout PG. Diagnostic ultrasound in the head and neck region. Dent Update. 2008; 35(8): 529-30, 33-4.
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20. Koischwitz D, Gritzmann N. Ultrasound of the neck. Radiol Clin North Am. 2000; 38(5):1029-45.
20
21. Sohn YM, Kwak JY, Kim EK, Moon HJ, Kim SJ, Kim MJ. Diagnostic approach for evaluation of lymph node metastasis from thyroid cancer using ultrasound and fine-needle aspiration biopsy. AJR Am J Roentgenol. 2010;194(1):38-43.
21
22. Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH, et al. Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. Radiology. 2011; 260(3): 892-9.
22
23. Russ G, Bigorgne C, Royer B, Rouxel A, Bienvenu-Perrard M. The Thyroid Imaging Reporting and Data System (TIRADS) for ultrasound of the thyroid. J Radiol. 2011;92(7-8):701-13.
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24. Horvath E, Majlis S, Rossi R, Franco C, Niedmann JP, Castro A, et al. An ultrasonogram reporting system for thyroid nodules stratifying cancer risk for clinical management. J Clin Endocrinol Metab. 2009; 94(5): 1748-51.
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25. Kim DW, Jung SJ, Ha TK, Park HK, Kang T. Comparative Study of Ultrasound and Computed Tomography for Incidentally Detecting Diffuse Thyroid Disease. Ultrasound Med Biol. 2014.
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26. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005;237(3):794-800.
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27. Park JY, Lee HJ, Jang HW, Kim HK, Yi JH, Lee W, et al. A proposal for a thyroid imaging reporting and data system for ultrasound features of thyroid carcinoma. Thyroid. 2009; 19(11):1257-64.
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28. Anuradha C, Abhishek K, Pushpa B, Deepak A, MJ P. Positive predictive value and inter-observer agreement of TIRADS for ultrasound features of thyroid nodules. ECR 20142014.
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29. Ko SY, Lee HS, Kim EK, Kwak JY. Application of the Thyroid Imaging Reporting and Data System in thyroid ultrasonography interpretation by less experienced physicians. Ultrasonography. 2014; 33(1): 49-57.
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30. Ko SY, Lee HS, Kim EK, Kwak JY. Application of the Thyroid Imaging Reporting and Data System in thyroid ultrasonography interpretation by less experienced physicians. Ultrasonography. 2013; 33(1): 49-57.
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31. Smith-Bindman R, Lebda P, Feldstein VA, Sellami D, Goldstein RB, Brasic N, et al. Risk of thyroid cancer based on thyroid ultrasound imaging characteristics: results of a population-based study. JAMA Intern Med. 2013;173(19):1788-96.
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32. Alexander EK, Cooper D. The importance, and important limitations, of ultrasound imaging for evaluating thyroid nodules. JAMA Intern Med. 2013; 173(19): 1796-7.
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33. Tay SY, Chen CY, Chan WP. Sonographic criteria predictive of benign thyroid nodules useful in avoiding unnecessary ultrasound-guided fine needle aspiration. J Formos Med Assoc. 2014; pii: S0929- 6646(14)00109-0.
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34. Vinayak S, Sande JA. Avoiding unnecessary fine-needle aspiration cytology by accuractely predicting the benign nature of thyroid nodules using ultrasound. J Clin Imaging Sci. 2012;2:23.
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35. Brito JP, Gionfriddo MR, Al Nofal A, Boehmer KR, Leppin AL, Reading C, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab. 2014;99(4):1253-63.
35
36. Kim JY, Kim SY, Yang KR. Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1-2 cm in diameter. Eur J Radiol. 2013;82:321-6.
36
37. McCarthy M. US thyroid cancer rates are epidemic of diagnosis not disease, study says. BMJ. 2014; 348: g1743.
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39. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A "normal" finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531-8.
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40. Lee YS, Lim H, Chang HS, Park CS. Papillary thyroid microcarcinomas are different from latent papillary thyroid carcinomas at autopsy. J Korean Med Sci. 2014;29(5):676-9.
40
41. Ahn SS, Kim EK, Kang DR, Lim SK, Kwak JY, Kim MJ. Biopsy of thyroid nodules: comparison of three sets of guidelines. AJR Am J Roentgenol. 2010;194:31-7.
41
42. Moon HJ, Kim EK, Kwak JY. Malignancy risk stratification in thyroid nodules with benign results on cytology: combination of thyroid imaging reporting and data system and bethesda system. Ann Surg Oncol. 2014;21(6):1898-903.
42
43. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol. 2002;178(3):687-91.
43
ORIGINAL_ARTICLE
F-18 FDG PET/CT imaging of primary hepatic neuroendocrine tumor
Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare neoplasms. Herein, we report a case of a 70-year-old man with a hepatic mass. The non-contrast computed tomography (CT) image showed a low-density mass, and dynamic CT images indicated the enhancement of the mass in the arterial phase and early washout in the late phase. F18- fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and fused PET/CT images showed increased uptake in the hepatic mass. Whole-body 18F-FDG PET images showed no abnormal activity except for the liver lesion. Presence of an extrahepatic tumor was also ruled out by performing upper gastrointestinal endoscopy, total colonoscopy, and chest and abdominal CT. A posterior segmentectomy was performed, and histologic examination confirmed a neuroendocrine tumor (grade 1). The patient was followed up for about 2 years after the resection, and no extrahepatic lesions were radiologically found. Therefore, the patient was diagnosed with PHNET. To the best of our knowledge, no previous case of PHNET have been detected by 18F-FDG PET imaging.
https://aojnmb.mums.ac.ir/article_3039_4a2483fca523ed9165ac461ce52bdb66.pdf
2015-01-01
58
60
10.7508/aojnmb.2015.01.009
F-18 FDG
Neuroendocrine tumor
primary hepatic neuroendocrine tumor
PET
Katsuya
Mitamura
katsuya@med.kagawa-u.ac.jp
1
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
AUTHOR
Yuka
Yamamoto
yuka@kms.ac.jp
2
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
LEAD_AUTHOR
Kenichi
Tanaka
k_tanaka@med.kagawa-u.ac.jp
3
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
AUTHOR
Takayuki
Sanomura
sanomura@med.kagawa-u.ac.jp
4
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
AUTHOR
Makiko
Murota
mwada@kms.ac.jp
5
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
AUTHOR
Yoshihiro
Nishiyama
nisiyosi@kms.ac.jp
6
Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
AUTHOR
1. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 25825 cases in the United States. J Clin Oncol. 2008; 26:3063-72.
1
2. Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010; 39:707-12.
2
3. Park CH, Chung JW, Jang SJ, Chung MJ, Bang S, Park SW, et al. Clinical features and outcomes of primary hepatic neuroendocrine carcinomas. J Gastroenterol Hepatol. 2012; 27:1306-11.
3
4. Donadon M, Torzilli G, Palmisano A, Del Fabbro D, Panizzo V, Maggioni M, et al. Liver resection for primary hepatic neuroendocrine tumours: report of three cases and review of the literature. Eur J Surg Oncol. 2006; 32(3):325-8.
4
5. Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer. 1997;79:813-29.
5
6. Maggard MA, O’Connell JB, Ko CY. Updated population-based review of carcinoid tumors. Ann Surg. 2004; 240:117-22.
6
7. Critchley M. Octreotide scanning for carcinoid tumors. Postgrad Med J. 1997;73:399-402.
7
8. Severi S, Nanni O, Bodei L, Sansovini M, Ianniello A, Nicoletti S, et al. Role of 18FDG PET/CT in patients treated with 177Lu-DOTATATE for advanced differentiated neuroendocrine tumors. Eur J Nucl Med Mol Imaging. 2013; 40:881-8.
8
9. Binderup T, Knigge U, Loft A, Federspiel B, Kjaer A. 18F-fluorodeoxyglucose positron emission tomography predicts survival of patients with neuroendocrine tumors. Clin Cancer Res. 2010; 16:978-85.
9
10. Garin E, Le Jeune F, Devillers A, Cuggia M, de Lajarte-Thirouard AS, Bouriel C, et al. Predictive value of 18F-FDG PET and somatostatin receptor scintigraphy in patients with metastatic endocrine tumors. J Nucl Med. 2009;50:858-64.
10
ORIGINAL_ARTICLE
SPECT-CT fusion in the diagnosis of hyperparathyroidism
Objective(s): In this study, we aimed to analyze the relationship between the diagnostic ability of fused single photon emission computed tomography/computed tomography (SPECT/CT) images in localization of parathyroid lesions and the size of adenomas or hyperplastic glands. Methods: Five patients with primary hyperparathyroidism (PHPT) and 4 patients with secondary hyperparathyroidism (SHPT) were imaged 15 and 120 minutes after the intravenous injection of technetium99mmethoxyisobutylisonitrile (99mTc-MIBI). All patients underwent surgery and 5 parathyroid adenomas and 10 hyperplastic glands were detected. Pathologic findings were correlated with imaging results. Results: The SPECT/CT fusion images were able to detect all parathyroid adenomas even with the greatest axial diameter of 0.6 cm. Planar scintigraphy and SPECT imaging could not detect parathyroid adenomas with an axial diameter of 1.0 to 1.2 cm. Four out of 10 (40%) hyperplastic parathyroid glands were diagnosed, using planar and SPECT imaging and 5 out of 10 (50%) hyperplastic parathyroid glands were localized, using SPECT/CT fusion images. Conclusion: SPECT/CT fusion imaging is a more useful tool for localization of parathyroid lesions, particularly parathyroid adenomas, in comparison with planar and or SPECT imaging.
https://aojnmb.mums.ac.ir/article_3163_9d639060ce5c6a0d9c4376d112cf2b17.pdf
2015-01-01
61
65
10.7508/aojnmb.2015.01.010
SPECT-CT
fusion image
hyperparathyroidism
technetium-99m-MIBI parathyroid scintigraphy
Yoshio
Monzen
monzen.so@s9.dion.ne.jp
1
Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
LEAD_AUTHOR
Akihisa
Tamura
a-tamura85796@pref.hiroshima.lg.jp
2
Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
AUTHOR
Hajime
Okazaki
h-okazaki88790@pref.hiroshima.lg.jp
3
Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
AUTHOR
Taichi
Kurose
t-kurose88075@pref.hiroshima.lg.jp
4
Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
AUTHOR
Masayuki
Kobayashi
m-kobayashi85643@pref.hiroshima.lg.jp
5
Department of Radiology, Hiroshima Prefectural Hospital, Hiroshima, Japan
AUTHOR
Masatsugu
Kuraoka
m-kuraoka85759@pref.hiroshima.lg.jp
6
Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan
AUTHOR
1. Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006; 238:264-71.
1
2. Even-SapirE, Flusser G, Lerman H, Lievshitz G, Metser U. SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med. 2007;48:319-24.
2
3. Shafiei B, Hoseinzadeh S, Fotouhi F, Malek H, Azizi F, Jahed A, et al. Preoperative 99mTcsestamibi scintigraphy in patients with primary hyperparathyroidism and concomitant nodular goiter: comparison of SPECT-CT, SPECT, and planar imaging. Nucl Med commun. 2012; 33:1070-6.
3
4. Ciappuccini R, Morera J, Pascal P, Rame JP, Heutte N, Aide N, et al. Dual-phase 99mTc-sestamibi scintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin Nucl Med.2012;37:223-8.
4
5. Papathanassiou D, Flament JB, Pochart JM, Patey M, Marty H, Liehn JC, et al. SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery. Clin Nucl Med. 2008; 33: 394-7.
5
6. Li L, Chen L, Yang Y, Han J, Wu s, Bao Y, et al. Giant anterior mediastinal parathyroid adenoma. Clin Nucl Med. 2012; 37: 889-91.
6
7. Torregrosa JV, Palomar MR, Pons F, Sabater L, Gilabert R, LIovera J, et al. Has double-phase MIBI scintigraphy usefulness in the diagnosis of hayperparathyroidism?. Nephrol Dial Transplant.1998; 13: 37-40.
7
8. Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012; 26: 794-803.
8
9. Carpentier A, Jeannotte S, Verreault J, Lefebvre B, Bisson G, Mongeau CJ, et al. Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between Technetium-99m-MIBI uptake and oxyphil cell count. J Nucl Med. 1998; 39: 1441-4.
9
10. Erbil Y, Kapran Y, Işsever H, Barbaros U, Adalet I, Dizdaroğlu F, et al. The positive effect of adenoma weight and oxyphil cell content on preoperative localization with 99mTc-sestamibi scanning for primary hyperparathyroidism. Am J Surg. 2008; 195: 34-39.
10
ORIGINAL_ARTICLE
High dose radioiodine outpatient treatment: an initial experience in Thailand
Objective(s): The aim of this study was to determine whether high-dose radioactive iodine (Na131I) outpatient treatment of patients with thyroid carcinoma is a pragmatically safe approach, particularly for the safety of caregivers. Methods: A total of 79 patients completed the radiation-safety questionnaires prior to receiving high-dose radioactive iodine treatment. The questionnaire studied the subjects’ willingness to be treated as outpatients, along with the radiation safety status of their caregivers and family members. In patients, who were selected to be treated as outpatients, both internal and external radiation exposures of their primary caregivers were measured, using thyroid uptake system and electronic dosimeter, respectively. Results: Overall, 62 out of 79 patients were willing to be treated as outpatients; however, only 44 cases were eligible for the treatment. The primary reason was that the patients did not use exclusive, separated bathrooms. The caregivers of 10 subjects, treated as outpatients, received an average radiation dose of 138.1 microsievert (mSv), which was almost entirely from external exposure; the internal radiation exposures were mostly at negligible values. Therefore, radiation exposure to caregivers was significantly below the public exposure limit (1 mSv) and the recommended limit for caregivers (5 mSv). Conclusion: A safe 131I outpatient treatment in patients with thyroid carcinoma could be achieved by selective screening and providing instructions for patients and their caregivers.
https://aojnmb.mums.ac.ir/article_3427_d0797f9d071853dcf0568f7011dc7a02.pdf
2015-01-01
66
71
10.7508/aojnmb.2015.01.011
radioactive iodine
Radiation Exposure
thyroid carcinoma
Radiation Protection
Danupon
Nantajit
dnantajit@gmail.com
1
Office of Atoms for Peace;
Chulabhorn Hospital, Bangkok, Thailand
AUTHOR
Sureerat
Saengsuda
sureeratsae@hotmail.com
2
Rajavithi Hospital, Bangkok, Thailand
AUTHOR
Pattama
NaNakorn
pattama@oaep.go.th
3
Office of Atoms for Peace, Bangkok, Thailand
AUTHOR
Yuthana
Saengsuda
yuthanasae@yahoo.com
4
Rajavithi Hospital;
College of Medicine, Rangsit University, Bangkok, Thailand
LEAD_AUTHOR
1. United States. Dept. of Energy. Office of Scientific and Technical Information. Regulatory analysis on criteria for the release of patients administered radioactive material. Final report. Oak Ridge, Tenn.: United States. Dept. of Energy. Office of Scientific and Technical Information; distributed by the Office of Scientific and Technical Information, U.S. Dept. of Energy; 1997. Available from: www.osti.gov/scitech/servlets/purl/453778.
1
2. Grigsby PW, Siegel BA, Baker S, Eichling JO. Radiation exposure from outpatient radioactive iodine (131I) therapy for thyroid carcinoma. JAMA. 2000;283(17):2272-4.
2
3. Protection. ICoR. Release of patients after therapy with unsealed radionuclides. Ann ICRP. 2004;34(2):v-vi, 1-79.
3
4. International Commission on Radiological Protection., International Atomic Energy Agency.Release of patients after radionuclide therapy. Vienna, Austria: International Atomic Energy Agency; 2009.
4
5. Pacilio M, Bianciardi L, Panichelli V, Argiro G, Cipriani C. Management of 131I therapy for thyroid cancer: cumulative dose from in-patients, discharge planning and personnel requirements. Nucl Med Commun. 2005; 26(7):623-31.
5
6. Remy H, Coulot J, Borget I, Ricard M, Guilabert N, Lavielle F, et al. Thyroid cancer patients treated with 131I: radiation dose to relatives after discharge from the hospital. Thyroid. 2012; 22(1):59-63.
6
7. International Atomic Energy Agency. Nuclear medicine in thyroid cancer management : a practical approach. Vienna: International Atomic Energy Agency; 2009.
7
8. Azizmohammadi Z, Tabei F, Shafiei B, Babaei AA, Jukandan SM, Naghshine R, et al. A study of the time of hospital discharge of differentiated thyroid cancer patients after receiving iodine-131 for thyroid remnant ablation treatment. Hell J Nucl Med. 2013; 16(2):103-6.
8
9. Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. 2011; 21(4):335-46.
9
10. Hennessey JV, Parker JA, Kennedy R, Garber JR. Comments regarding Practice Recommendations of the American Thyroid Association for radiation safety in the treatment of thyroid disease with radioiodine. Thyroid. 2012; 22(3):336-7.
10
11. Gilliland FD, Hunt WC, Morris DM, Key CR. Prognostic factors for thyroid carcinoma. A populationbased study of 15,698 cases from the Surveillance, Epidemiology and End Results (SEER) program 1973-1991. Cancer. 1997; 79(3):564-73.
11
12. Marriott CJ, Webber CE, Gulenchyn KY. Radiation exposure for ‘caregivers’ during high-dose outpatient radioiodine therapy. Radiat Prot Dosimetry. 2007; 123(1):62-7.
12
13. Barrington SF, Kettle AG, O’Doherty MJ, Wells CP, Somer EJ, Coakley AJ. Radiation dose rates from patients receiving iodine-131 therapy for carcinoma of the thyroid. Eur J Nucl Med. 1996; 23(2):123-30.
13
14. de Carvalho JW, Sapienza M, Ono C, Watanabe T, Guimaraes MI, Gutterres R, et al. Could the treatment of differentiated thyroid carcinoma with 3.7 and 5.55 GBq of (131I)NaI, on an outpatient basis, be safe? Nucl Med Commun. 2009; 30(7):533-41.
14
15. Venencia CD, Germanier AG, Bustos SR, Giovannini AA, Wyse EP. Hospital discharge of patients with thyroid carcinoma treated with 131I. J Nucl Med. 2002; 43(1):61-5.
15
16. Leslie WD, Havelock J, Palser R, Abrams DN. Largebody radiation doses following radioiodine therapy. Nucl Med Commun. 2002; 23(11):1091-7.
16
17. Culver CM, Dworkin HJ. Radiation safety considerations for post-iodine-131 thyroid cancer therapy. J Nucl Med. 1992; 33(7):1402-5.
17
18. Siegel JA, Kroll S, Regan D, Kaminski MS, Wahl RL. A practical methodology for patient release after tositumomab and (131)I-tositumomab therapy. J Nucl Med. 2002; 43(3):354-63.
18