scholarly journals An Unusual Case of Primary Hyperparathyroidism: Case Report of a Bifocal Intrathyroidal Parathyroid Carcinoma

2020 ◽  
pp. 014556132097746
Author(s):  
Maxime Damien ◽  
Alexandra Rodriguez ◽  
Pierre Kleynen ◽  
Didier Dequanter ◽  
Cyril Bouland
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Carcinoma ◽  
Photon Emission ◽  
Parathyroid Tissue ◽  
Emission Computed Tomography ◽  
Thyroid Lobe ◽  
Imaging Results ◽  
Pet Ct ◽  
Left Thyroid Lobe

Intrathyroidal parathyroid carcinoma is an extremely rare cause of primary hyperparathyroidism. We reported a 51-year old woman who presented symptoms of hypercalcemia. 99mTc sestamibi single-photon emission computed tomography/computed tomography (CT) revealed a large hypermetabolic nodule in the left thyroid lobe suggestive of hyperfunctioning parathyroid tissue. 11C-methionine positron emission tomography/computed tomography (PET/CT) and 18F-fluorocholine PET/CT confirmed the nodule in the left thyroid lobe and also revealed a hypermetabolic activity on the posterior surface of the lower left pole. The patient underwent a total thyroidectomy and parathyroidectomy, and a diagnosis of bifocal intrathyroidal parathyroid carcinoma was confirmed. We present the first reported case of bifocal intrathyroidal carcinoma and discuss the discordant imaging results.

Computerized Tomography (CT) Updates and Challenges in Diagnosis of Bone Metastases During Prostate Cancer

2020 ◽  
Vol 16 (5) ◽  
pp. 565-571
Author(s):  
Jinguo Zhang ◽  
Guanzhong Zhai ◽  
Bin Yang ◽  
Zhenhe Liu
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Bone Metastases ◽  
Computerized Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Major Complication ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Pet Ct

Prostate cancer is one of the most common cancers in men. This cancer is often associated with indolent tumors with little or no lethal potential. Some of the patients with aggressive prostate cancer have increased morbidity and early deaths. A major complication in advanced prostate cancer is bone metastasis that mainly results in pain, pathological fractures, and compression of spinal nerves. These complications in turn cause severe pain radiating to the extremities and possibly sensory as well as motor disturbances. Further, in patients with a high risk of metastases, treatment is limited to palliative therapies. Therefore, accurate methods for the detection of bone metastases are essential. Technical advances such as single-photon emission computed tomography/ computed tomography (SPECT/CT) have emerged after the introduction of bone scans. These advanced methods allow tomographic image acquisition and help in attenuation correction with anatomical co-localization. The use of positron emission tomography/CT (PET/CT) scanners is also on the rise. These PET scanners are mainly utilized with 18F-sodium-fluoride (NaF), in order to visualize the skeleton and possible changes. Moreover, NaF PET/CT is associated with higher tracer uptake, increased target-to-background ratio and has a higher spatial resolution. However, these newer technologies have not been adopted in clinical guidelines due to lack of definite evidence in support of their use in bone metastases cases. The present review article is focused on current perspectives and challenges of computerized tomography (CT) applications in cases of bone metastases during prostate cancer.

scholarly journals A Nordic survey of CT doses in hybrid PET/CT and SPECT/CT examinations

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Natalie A. Bebbington ◽  
Bryan T. Haddock ◽  
Henrik Bertilsson ◽  
Eero Hippeläinen ◽  
Ellen M. Husby ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Positron Emission ◽  
Pet Ct ◽  
Clinical Purpose ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Abstract Background Computed tomography (CT) scans are routinely performed in positron emission tomography (PET) and single photon emission computed tomography (SPECT) examinations globally, yet few surveys have been conducted to gather national diagnostic reference level (NDRL) data for CT radiation doses in positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT). In this first Nordic-wide study of CT doses in hybrid imaging, Nordic NDRL CT doses are suggested for PET/CT and SPECT/CT examinations specific to the clinical purpose of CT, and the scope for optimisation is evaluated. Data on hybrid imaging CT exposures and clinical purpose of CT were gathered for 5 PET/CT and 8 SPECT/CT examinations via designed booklet. For each included dataset for a given facility and scanner type, the computed tomography dose index by volume (CTDIvol) and dose length product (DLP) was interpolated for a 75-kg person (referred to as CTDIvol,75kg and DLP75kg). Suggested NDRL (75th percentile) and achievable doses (50th percentile) were determined for CTDIvol,75kg and DLP75kg according to clinical purpose of CT. Differences in maximum and minimum doses (derived for a 75-kg patient) between facilities were also calculated for each examination and clinical purpose. Results Data were processed from 83 scanners from 43 facilities. Data were sufficient to suggest Nordic NDRL CT doses for the following: PET/CT oncology (localisation/characterisation, 15 systems); infection/inflammation (localisation/characterisation, 13 systems); brain (attenuation correction (AC) only, 11 systems); cardiac PET/CT and SPECT/CT (AC only, 30 systems); SPECT/CT lung (localisation/characterisation, 12 systems); bone (localisation/characterisation, 30 systems); and parathyroid (localisation/characterisation, 13 systems). Great variations in dose were seen for all aforementioned examinations. Greatest differences in DLP75kg for each examination, specific to clinical purpose, were as follows: SPECT/CT lung AC only (27.4); PET/CT and SPECT/CT cardiac AC only (19.6); infection/inflammation AC only (18.1); PET/CT brain localisation/characterisation (16.8); SPECT/CT bone localisation/characterisation (10.0); PET/CT oncology AC only (9.0); and SPECT/CT parathyroid localisation/characterisation (7.8). Conclusions Suggested Nordic NDRL CT doses are presented according to clinical purpose of CT for PET/CT oncology, infection/inflammation, brain, PET/CT and SPECT/CT cardiac, and SPECT/CT lung, bone, and parathyroid. The large variation in doses suggests great scope for optimisation in all 8 examinations.

scholarly journals Detection of Pulmonary Embolism with Gallium-68 Macroaggregated Albumin Perfusion PET/CT: An Experimental Study in Rabbits

2020 ◽  
Author(s):  
Aziz Gültekin ◽  
Mustafa Çağdaş Çayır ◽  
Ayşe Uğur ◽  
Ferda Bir ◽  
Doğangün Yüksel
Keyword(s):  
Computed Tomography ◽  
Ct Perfusion ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Histopathological Analysis ◽  
Macroaggregated Albumin ◽  
Pet Ct ◽  
Medicine Physician ◽  
Gallium 68 ◽  
Sensitivity Specificity

Abstract Purpose To evaluate the use of gallium-68 ( 68 Ga) macroaggregated albumin (MAA) positron emission tomography/computed tomography (PET/CT) perfusion imaging combined with Technegas single-photon emission computed tomography/computed tomography (SPECT/CT) ventilation imaging in rabbits with experimental pulmonary emboli (PE). Methods Technegas SPECT/CT ventilation and a 68 Ga-MAA PET/CT perfusion scan (V/Q scan) were performed in 12 rabbits before and one hour after artificial induction of PE. Technegas SPECT/CT and 68 Ga-MAA PET/CT images were evaluated by a nuclear medicine physician who recorded the presence, number, and location of PE on a per-lobe basis. The sensitivity, specificity, and accuracy of Technegas SPECT/CT and 68 Ga-MAA PET/CT for detecting PE were calculated using a histopathological evaluation as a reference standard. Results A total of 60 lung lobes were evaluated in 12 rabbits, and PE was detected in 20 lobes in V/Q scans and histopathological analysis. The overall sensitivity, specificity and accuracy were 100%, 100%, and 100%, respectively, for both the Technegas SPECT/CT and 68 Ga-MAA PET/CT V/Q scans. Conclusion Technegas/ 68 Ga-MAA V/Q scans have good sensitivity, specificity and accuracy in the detection of PE in this animal model study.

scholarly journals EANM dosimetry committee series on standard operational procedures: a unified methodology for 99mTc-MAA pre- and 90Y peri-therapy dosimetry in liver radioembolization with 90Y microspheres

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Carlo Chiesa ◽  
Katarina Sjogreen-Gleisner ◽  
Stephan Walrand ◽  
Lidia Strigari ◽  
Glenn Flux ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Absorbed Dose ◽  
Calibration Method ◽  
Emission Computed Tomography ◽  
Pet Ct ◽  
Improve Calculation ◽  
Voxel Dosimetry ◽  
Lung Shunt

AbstractThe aim of this standard operational procedure is to standardize the methodology employed for the evaluation of pre- and post-treatment absorbed dose calculations in 90Y microsphere liver radioembolization. Basic assumptions include the permanent trapping of microspheres, the local energy deposition method for voxel dosimetry, and the patient–relative calibration method for activity quantification.The identity of 99mTc albumin macro-aggregates (MAA) and 90Y microsphere biodistribution is also assumed. The large observed discrepancies in some patients between 99mTc-MAA predictions and actual 90Y microsphere distributions for lesions is discussed. Absorbed dose predictions to whole non-tumoural liver are considered more reliable and the basic predictors of toxicity. Treatment planning based on mean absorbed dose delivered to the whole non-tumoural liver is advised, except in super-selective treatments.Given the potential mismatch between MAA simulation and actual therapy, absorbed doses should be calculated both pre- and post-therapy. Distinct evaluation between target tumours and non-tumoural tissue, including lungs in cases of lung shunt, are vital for proper optimization of therapy. Dosimetry should be performed first according to a mean absorbed dose approach, with an optional, but important, voxel level evaluation. Fully corrected 99mTc-MAA Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) and 90Y TOF PET/CT are regarded as optimal acquisition methodologies, but, for institutes where SPECT/CT is not available, non-attenuation corrected 99mTc-MAA SPECT may be used. This offers better planning quality than non dosimetric methods such as Body Surface Area (BSA) or mono-compartmental dosimetry. Quantitative 90Y bremsstrahlung SPECT can be used if dedicated correction methods are available.The proposed methodology is feasible with standard camera software and a spreadsheet. Available commercial or free software can help facilitate the process and improve calculation time.

scholarly journals Splenosis Mimicking Peritoneal Seeding of Advanced Colon Cancer Can Be Identified by Spleen SPECT/CT and FDG PET/CT

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1045
Author(s):  
Ji Young Lee ◽  
Hee-Sung Song ◽  
Jimin Han
Keyword(s):  
Computed Tomography ◽  
Colon Cancer ◽  
Fdg Pet ◽  
Treatment Plan ◽  
Photon Emission ◽  
Hepatic Metastases ◽  
Emission Computed Tomography ◽  
Peritoneal Seeding ◽  
Pet Ct ◽  
Fdg Pet Ct

This case report demonstrates that Tc-99m labeled heat-damaged red blood cell single-photon emission computed tomography/computed tomography (spleen SPECT/CT) and F-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) could noninvasively confirm splenosis mimicking peritoneal seeding of advanced sigmoid colon cancer with hepatic metastases, and played a crucial role in determining the treatment plan.

scholarly journals 18Fluorocholine PET/CT scanning with arterial phase-enhanced CT is useful for persistent/recurrent primary hyperparathyroidism: first UK case series results

2019 ◽  
Vol 101 (7) ◽  
pp. 501-507 ◽  
Author(s):  
I Christakis ◽  
S Khan ◽  
GP Sadler ◽  
FV Gleeson ◽  
KM Bradley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Primary Hyperparathyroidism ◽  
Single Photon ◽  
Photon Emission ◽  
Case Series ◽  
Emission Tomography ◽  
Arterial Phase ◽  
Emission Computed Tomography ◽  
Positron Emission

Introduction Redo parathyroidectomy for persistent/recurrent primary hyperparathyroidism is associated with a higher risk of complications and should be planned only with convincing localisation. We assessed whether 18fluorocholine positron emission tomography/computed tomography could identify parathyroid adenoma(s) in patients with persistent/recurrent primary hyperparathyroidism and negative conventional scans. Materials and methods A departmental database was used to identify patients with failed localisation attempts (sestamibi single photon emission computed tomography/computed tomography and/or computed tomography/magnetic resonance imaging and/or selective parathyroid hormone sampling) after previous unsuccessful surgery for primary hyperparathyroidism. 18Fluorocholine positron emission tomography was performed in all patients and redo surgery offered to those with positive findings. Results 18Fluorocholine positron emission tomography incorporating arterial and portal phase enhanced computed tomography was performed in 12 patients with persistent/recurrent primary hyperparathyroidism (four men and eight women). Seven patients (58%) were cured after excision of adenomas located in ectopic positions (n = 3) or in anatomical position (n = 4). Five patients (42%) had persistent hypercalcaemia and repeat 18fluorocholine scan confirmed that the area highlighted on preoperative scans was excised. The arterial phase enhancement of the computed tomography was significantly different between cured and not-cured patients (P = 0.007). All seven cured patients had either a strong or weak enhancing pattern on computed tomography. Standardised uptake value at 60 minutes in patients with successful surgery (range 2.7–15.7, median 4.05) was higher than in patients with failed surgery (range 1.8–5.8, median 3.2) but was not statistically significant (P = 0.300). Discussion 18fluorocholine scanning can identify elusive parathyroid adenomas, including those that are ectopic, and is useful in the management of patients with persistent/recurrent primary hyperparathyroidism when first-line scans are negative. The grading of the arterial phase of computed tomography can help to differentiate between true adenomas and false positive targets (lymph nodes).

scholarly journals The 2020 national diagnostic reference levels for nuclear medicine in Japan

2020 ◽  
Vol 34 (11) ◽  
pp. 799-806
Author(s):  
Koichiro Abe ◽  
Makoto Hosono ◽  
Takayuki Igarashi ◽  
Takashi Iimori ◽  
Masanobu Ishiguro ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Nuclear Medicine ◽  
Radiation Dose ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Diagnostic Reference Levels ◽  
Reference Levels ◽  
Positron Emission ◽  
Pet Ct

Abstract The diagnostic reference levels (DRLs) are one of several effective tools for optimizing nuclear medicine examinations and reducing patient exposure. With the advances in imaging technology and alterations of examination protocols, the DRLs must be reviewed periodically. The first DRLs in Japan were established in 2015, and since 5 years have passed, it is time to review and revise the DRLs. We conducted a survey to investigate the administered activities of radiopharmaceuticals and the radiation doses of computed tomography (CT) in hybrid CT accompanied by single photon emission computed tomography (SPECT)/CT and positron emission tomography (PET)/CT. We distributed a Web-based survey to 915 nuclear medicine facilities throughout Japan and survey responses were provided by 256 nuclear medicine facilities (response rate 28%). We asked for the facility's median actual administered activity and median radiation dose of hybrid CT when SPECT/CT or PET/CT was performed for patients with standard habitus in the standard protocol of the facility for each nuclear medicine examination. We determined the new DRLs based on the 75th percentile referring to the 2015 DRLs, drug package inserts, and updated guidelines. The 2020 DRLs are almost the same as the 2015 DRLs, but for the relatively long-lived radionuclides, the DRLs are set low due to the changes in the Japanese delivery system. There are no items set higher than the previous values. Although the DRLs determined this time are roughly equivalent to the DRLs used in the US, overall they tend to be higher than the European DRLs. The DRLs of the radiation dose of CT in hybrid CT vary widely depending on each imaging site and the purpose of the examination.

Accuracy of Dual Phase Single-Photon Emission Computed Tomography/Computed Tomography in Primary Hyperparathyroidism: Correlation with Serum Parathyroid Hormone Levels

2016 ◽  
Vol 67 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Wade Koberstein ◽  
Christopher Fung ◽  
Kristy Romaniuk ◽  
Jonathan T. Abele
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid ◽  
Serum Pth

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.

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