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Today, the most important treatment methods for cancer are chemotherapy, surgical intervention, and radiotherapy. In recent years, many studies on radioimmunotherapy have been carried out. New drugs and treatment strategies are constantly being researched, and targeted cancer therapy is the treatment with the highest efficacy and negligible side effects compared to other methods. Breast cancer is the most common type of cancer in women. Human epidermal growth factor receptor 2 (HER2) is overexpressed in 20-30% of breast cancer cases. Trastuzumab is a humanized monoclonal antibody of recombinant DNA origin targeting the HER2 protein. In this study, the pharmaceutical part of a new radiopharmaceutical to be used in breast cancer treatment was prepared. For this purpose, molecular insertion studies were conducted to show the binding sites between Trastuzumab and different chelating agents (DOTA, DTPA, EDTA and MAG3) in silico. Then, these chelating agents were complex, and characterization studies were carried out.

Thyroglobulin (Tg), a glycoprotein that is synthesized in normal thyroid, is a significant biochemical marker of residual thyroid tissue or recurrent/metastatic disease in differentiated thyroid cancers (DTC). In this manuscript, the metabolic characteristics of Tg and various Tg assay methods were briefly described. The value of Tg concentration in presurgical evaluation of DTC patients, the diagnostic performance of Tg measurement in fine needle aspiration biopsy wash-outs from suspicious lesions, and the role of postoperative stimulated and supressed Tg values in guiding the decision-making process for therapy options and the outcome of ablation were summarized. The value of Tg in clinical management of patients with DTC was analysed according to recent procedure guidelines including debating issues like follow-up of patients with lobectomy or rare clinical pictures like Tg negative tumors.

Positron emission tomography (PET) is a tomographic imaging method that shows three-dimensional distribution of radiopharmaceuticals which are labelled with positron emitter radionuclides. Today most widely used PET radiopharmaceutical F-18 flourodeoxyglucose is an F-18 labelled glucose analogue, and it is trapped by membrane glucose transporters to viable cells. F-18 fluorodeoxyglucose (FDG) uptake is proportional to glucose consumption of the tissue. In several type of cancers, increased glucose consumption is seen due to increased GLUT expression and hexokinase activity. F-18 FDG PET is a proved sensitive method in the diagnosis, staging, restaging and treatment response evaluation for several oncological disease. This practice guideline aims to help nuclear medicine physicians, physicists and technicians as persons who apply, evaluate and report F-18 FDG PET/CT by providing general information of F-18 FDG PET/CT. Additionally it is focused to provide standardization of quality of diagnostic imaging and harmonization of obtained quantitative information.

Malignant melanoma is still among the most fatal cancers worldwide with increasing incidence. Lymphoscintigraphy and gamma probe guided sentinel lymph node detection is an established procedure which has a great impact in disease management of malignant melanoma. Sentinel lymph node biopsy determines the nodal stage of the disease and invasion of the sentinel lymph node is the most important prognostic factor. In parallel to the latest technological developments in the recent years, novel hybrid imaging modalities such as SPECT/CT as well as intraoperative gamma cameras and hybrid detectors have been introduced. This procedure guideline is aimed to inform especially nuclear medicine physicians about the methods for detection of sentinel lymph nodes in malignant melanoma patients as well as to provide the state of art technique suitable for local standards in accordance with the current literature.

Sentinel lymph node (SLN) detection by lymphoscintigraphy (LS) and using intraoperative gamma probe is the mostly important prognostic factor in patients with breast cancer. Sentinel lymph node biopsy (SLNB) is a procedure that collaborated by nuclear medicine, surgical oncology and pathology medical disciplines, scientifically proven and established into routine. The aim of this guideline is to inform current knowledge about standart LS and SLN procedure and indications in breast cancer and to lead for nuclear medicine practitioners. The recommendations in this guide has been prepared by ‘Turkish Society of Nuclear Medine Oncology Task Group’ members.

Assessing response to treatment is an important parameter in oncology practice and there is a growing body of evidence for use of F-18 fludeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) to evaluate response during or after the treatment. The use of FDG PET/CT for this indication is increasing due to its advantages such as enabling rapid evaluation of all lesions and body parts in a single session, assessing viability in residual masses, not being limited to size measurements and low inter-observer variability. Many evaluation criteria have been proposed for standardization and interpretation of PET/CT findings. This guideline aims to provide a brief overview of proposed criteria and assist Nuclear Medicine Physicians in interpreting FDG PET/CT findings for the evaluation of the response.

Enfeksiyon hastalıkları hala dünyada temel sağlık problemlerinden birini oluşturmaktadır. Enfeksiyonun erken aşamalarda teşhisi ve kanser veya inflamasyon gibi diğer patolojilerden ayrımı, enfeksiyonu akut aşamalarda tedavi etmede kritik rol oynamaktadır. Enfeksiyon teşhisinde kullanılan görüntüleme yöntemleri tüm vücut görüntüsü alabilme, enfeksiyonu odağını ve evresini tespit edebilme ve hastalığı izleyebilme gibi avantajlara sahiptir. Enfeksiyon tedavisinde çeşitli antibiyotikler kullanılmasına rağmen, klinikte antibiyotiklerin ciddi yan etkileri ve antimikrobiyal direnç gelişimi gibi problemler mevcuttur. Çalışmamızda enfeksiyon için teranostik bir ajan geliştirme amacıyla gram pozitif bakterilere karşı etkili ikinci nesil oksazolidinon antibiyotiği olan tedizolid, 177Lu radyonüklidi ile radyoişaretlenmiştir. Radyoiaşretleme, oda koşullarında gerçekleştirilmiş ve işaretleme etkinliği ile stabilitesi, kağıt kromatografisi ve HPLC ile değerlendirilmiştir. Yüksek radyoişaretleme verimi elde etmek için optimum inkübasyon süresi 60 dakika olarak bulunmuştur. 177Lu-TDZ çözeltisindeki radyokimyasal safsızlıkları belirleme amacıyla kağıt kromatografisi için farklı mobil ve sabit fazlar test edilmiş ve sabit faz olarak ITLC-SG uygun bulunmuştur. Ayrıca amonyum hidroksit: metanol: su ve DTPA çözeltileri mobil faz olarak seçilmiştir. HPLC kromatogramında serbest 177Lu ve 177Lu-TDZ kompleksinin alıkonma sürelerine bağlı olarak iki farklı pik gözlenmiştir. Ne yazık ki, radyoişaretleme stabilitesi testlerinin sonuçlarında %80'in üzerinde saflık değerleri elde edilememiştir, bu nedenle radyoişaretleme ortamına şelatla yapıcı ajan eklenmesi önerilmiştir., Infection is still one of the major health problems all around the world. Early diagnosis and differentiation of infection from other pathological conditions such as cancer and inflammation play a critical role in treating the infection in acute stages. Imaging techniques in the infection diagnosis present some advantages such as the ability to image the whole body, the detection of focal location and stage, and following up of infection. Although various antibiotics can be used in the treatment, there are some problems including serious side effects of antibiotics or the development of antimicrobial resistance in the clinics. In our study, tedizolid, a second-generation oxazolidinone antibiotic against gram-positive bacteria infections, was radiolabeled with 177Lu radionuclide to develop a theranostic agent for infection. The radiolabeling was performed under room conditions, and labeling efficiency and stability were evaluated by paper chromatography and HPLC. The optimum incubation period was found as 60 min to obtain high radiolabeling efficiency. Different mobile and stationary phases were tested for paper chromatography to determine the radiochemical impurities in 177Lu-TDZ solution, and ITLC-SG was found to be proper as the stationary phase. In addition, ammonium hydroxide: methanol: water and DTPA solutions were chosen as mobile phase. In the HPLC chromatogram, two different peaks were observed depending on retention times of the free 177Lu and 177Lu-TDZ complex. Unfortunately, over 80% purity values were not obtained in the results of radiolabeling stability analyses, therefore the addition of a chelating agent in the radiolabeling condition was suggested to increase the stability.

Infection is one of the important burdens on the health care system, not only due to leading morbidity and mortality but also because of the development of antibiotic resistance. Although the infection can be diagnosed by imaging techniques, more effective agents including radiopharmaceuticals may be required to image deep-seated infections. Imaging also plays a critical role in the choosing of optimum treatment options and following treatment. Theranostic agents offer many advantages such as monitoring the biodistribution and targeting of therapeutic agents, as well as rapid diagnosis and treatment. Colistin, a cationic peptide, leads to bacterial death through interaction with lipopolysaccharides in the cell wall of bacteria. In our study,177Lu as radionuclide part and colistimethate sodium (a prodrug of colistin, CMS) as pharmaceutic part were chosen to prepare a radiopharmaceutical for imaging and treatment of infections.177Lu-CMS complex was formed under room condition, and radiolabeling efficiency was determined by paper and high-performance liquid chromatography. The effect of the filtration process on radiolabeling was evaluated among the labeling efficiencies of filtered and un-filtered complexes. The different incubation times (5, 30, and 60 min) effect on the radiolabeling process was also evaluated. Moreover, in vitro stability of177Lu-CMS complex in saline solution was assessed during 7 days. According to the results, desired radiolabeling efficiency was not obtained under tested conditions and stability studies. Therefore, various modifications such as the addition of chelating agents or stabilizers in the radiolabeling procedure should be made to increase the radiolabeling stability. Further studies regarding radiolabeling are surely needed, and our studies are continuing. © 2022 Marmara University Press.

68 Ga-DOTATATE PET/CT is a well-known modality in diagnosis, staging, and in predicting therapy response of neuroendocrine tumors. We present a case of 63-year-old woman with diagnosis of pancreas neuroendocrine tumor showing 68 Ga-DOTATATE uptake in a lymph node in left axilla. It was diagnosed as capillary hemangioma after biopsy. 68 Ga-DOTATATE uptake in bone hemangiomas is well-known; however, its uptake in a nodal hemangioma is worth to know as it might change the clinical perspective.

WOS: 000446711000001, PubMed ID: 30317832, Objective: Radioiodine is the most specific radionuclide for differentiated thyroid carcinoma (DTC) imaging. Despite its high specificity and sensitivity, false-positive I-131 uptake could be seen on whole body scan (WBS) that may lead to misdiagnosis and unnecessary radioiodine treatment. In this study, we aimed to present the I-131 WBS and concomitant single photon emission computed tomography/computed tomography (SPECT/CT) images of unexpected false-positive radioiodine uptake along with the patients' clinical outcomes and the contribution of SPECT/CT imaging. Methods: I-131 WBSs of 1507 patients with DTC were retrospectively reviewed, and anticipated I-131 uptakes (like in breasts or thymus) were excluded from the study. The unexpected false-positive I-131 uptakes with concomitant SPECT/CT imaging were included in the study. Results: Twenty-one patients had 23 unexpected I-131 uptakes on WBS and concomitant SPECT/CT imaging. The vast majority (87%) of these cases were seen on post-therapeutic I-131 WBS. Most of the false-positive I-131 uptakes could be explained by SPECT/CT and radiologic findings, and were secondary to non-thyroid conditions (bronchiectasis, lung infection, subcutaneous injection into gluteal fatty tissue, aortic calcification, benign bone cyst, vertebral hemangioma, recent non-thyroid surgical procedure site, rotator cuff injury, mature cystic teratoma and ovarian follicle cyst). However, the possible reasons of 9 false-positive I-131 uptakes could not be explained by radiologic findings. Conclusion: We suggest that false-positive I-131 uptake and its underlying mechanisms (inflammation, trapping, increased perfusion, etc.) must be kept in mind in patients with thyroid cancer and unexpected findings must be considered together with serum thyroglobulin levels, SPECT/CT and radiologic findings in order to avoid misdiagnosis and unnecessary radioiodine treatment.

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision of whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method for determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histologic nodal staging and avoids overtreating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This document is designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. Preparation of this guideline was carried out by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial (SENT) Committee.

Procedure guidelines for scintigraphic detection of sentinel node in breast cancer are presented. The paper was written by several experts in this field on behalf of the European Association of Nuclear Medicine Oncology and Dosimetry committees and approved by the Executive Committee.

The purpose of this study was to evaluate whether the degree of technetium-99m methoxyisobutylisonitrile (MIBI) uptake and its retention in delayed imaging in small cell lung cancer (SCLC) was correlated with the response to multiagent chemotherapy and to investigate if there was a relationship between the survival time of patients with SCLC and Tc-99m MIBI SPECT tumor uptake parameters at the time of diagnosis.Between 1998 and by December 2004, 40 patients with SCLC were studied with Tc-99m MIBI SPECT at the time of diagnosis. The patients were classified by a follow-up CT as good responders (complete or partial remission) and poor responders (stable disease or progressive disease). Following i.v. administration of 740 MBq Tc-99m MIBI, SPECT imaging at 30 minutes (early) and 2 hours (delayed) was performed. Regions of interests were placed over the tumors and contralateral normal lung tissue on one transverse section. The uptake ratio of the lesion to that in the contralateral normal lung was obtained from early images (early ratio; ER) as well as delayed images (delayed ratio; DR). The retention index (RI%) was measured as: RI% = [(DR-ER)/ER] x 100. Tc-99m MIBI tumor uptake parameters were compared with chemotherapeutic response and survival time.Of 40 patients, 29 patients were good responders (72.5%) and 11 patients were poor responders (27.5%). RI% of Tc-99m MIBI SPECT in the group of good response was significantly higher than in that with poor response (p0.05). On the other hand, there was no significant difference between the two groups with respect to ER or DR values. Four of 40 patients were still alive with disease (10%). The patient survival time varied from 1 to 70 months (mean survival time = 12.9 +/- 13.4 months). There was no significant difference between the survival time of patients with respect to ER or DR of Tc-99m MIBI SPECT imaging. When median RI% was accepted as a cut-off value (-3.85%), patients with higher RI% values had a longer survival time (12 months) when compared with those with low RI% (8 months), p0.05.Our results suggest that Tc-99m MIBI SPECT could accurately predict the chemotherapy response in patients with SCLC. RI% of Tc-99m MIBI SPECT is recommended to differentiate patients with a poor response to chemotherapy and good responders, and RI% of Tc-99m MIBI SPECT appears as the only parameter that may be useful in predicting the survival of patients with SCLC.

99mTc-sestamibi (MIBI) is a well-known tumour imaging agent. Its retention within tumour cell mitochondria is related to perfusion and to the magnitude of the electrical gradient, reflecting cell viability. Several internal cell factors modulate this uptake; for example, multidrug resistance membrane proteins (Pgp and MRP1) and anti-apoptotic BCl-2 protein of the outer mitochondrial membrane can limit retention of MIBI. At the early stage of cell apoptosis, the electrical driving forces of MIBI uptake are impaired, and influx and accumulation are reduced. It seems clear that MIBI can be used before treatment to detect drug resistance, assess anti-apoptotic status and predict treatment efficacy. Although it has been suggested that MIBI might be used to monitor tumour response to treatment, MIBI is unable to differentiate tumours with ongoing apoptosis from those developing drug resistance.

Multidrug resistance (MDR) is a major problem in lung cancer. Tc-99m methoxyisobutyl isonitrile (MIBI) has been demonstrated to be a non-invasive marker to diagnose MDR1 related P-glycoprotein (Pgp) and multidrug resistance-associated protein (MRP) expression in various solid tumors. The aim of this study was to evaluate the relationship between the degree of Tc-99m MIBI uptake and its retention on delayed images and the response to chemotherapy in lung cancer. Twenty-three patients (1 woman and 22 men, age range 40–67 years) with lung cancer (9 small cell and 14 non-small cell) were examined with Tc-99m MIBI imaging before chemotherapy. After i.v. administration of 740 MBq Tc-99m MIBI, planar and SPECT imaging at 30 minutes and 2 hours was performed. Tumor to normal lung uptake ratio (T/N) and percent retention were measured. Response to chemotherapy was evaluated according to follow-up CT and grouped as complete responders (CR), partial responders (PR) and non-responders (NR). Clinical follow-up and CT evaluation revealed that 12 patients had partial remission, 4 patients had complete remission and 7 patients had no-remission after chemotherapy. Statistically, there was no significant correlation between early (30 min), delayed (2 hr) T/N ratios and percent retention of Tc-99m MIBI with chemotherapeutic response of the lung cancer among the three groups (p>0.05). Results of the current study imply that Tc-99m MIBI uptake and the retention index may not correlate with chemotherapy response in lung cancer, so that the accuracy of this method needs to be verified in a larger series with additional investigation at the molecular level.

Twenty-five patients were treated for osteosarcoma of the extremity at Ege University Hospital. Eight of them were metastatic. All patients received cisplatin, doxorubicin, ifosfamide, and methotrexate preoperatively. Twenty-three patients underwent surgery at around week 15 (11-18 weeks). All but one underwent limb-sparing surgery. While good responders continued to receive the same drugs, poor responders were given the same regimen before 1996, but high-dose ifosfamide alone after 1996. For all patients the projected event-free survival (EFS) rates were 63.5% at 2 years and 53% at 5 years. The projected overall survival (OS) rates were 72% at 2 years and 62% at 5 years. For nonmetastatic patients, 5-year EFS and OS rates were 67% as compared with metastatic patients (25 and 50%)(p =. 01 for EFS; p > .05 for OS). The results show that nonmetastatic patients with osteosarcoma of the extremity have favorable prognosis on this therapy regimen, allowing a high rate of limb-sparing surgery.

Amaç: Çalışmamızda, sol ventrikül (SV) fonksiyonlarının değerlendirilmesinde ‘miyokart perfüzyon gated SPECT’ (GSPECT) yönteminin güvenilirliği araştırıldı, GSPECT ile hesaplanan sol ventrikül ejeksiyon fraksiyonu (SVEF) ortalaması planar ‘equilibrium gated radyonüklid ventrikülografi’ (ERVG) ve ekokardiyografi (EKO) ile elde edilen değerlerle karşılaştırıldı. Çalışma planı: Koroner arter hastalığı (KAH) şüphesi olan miyokart perfüzyonu ve SV fonksiyonlarının değerlendirilmesi için iki gün Tc99m-MIBI protokolü ile GSPECT ve ERVG görüntülemeleri yapılan 48 hasta geriye dönük olarak incelendi. GSPECT Myometrix yazılımı ile SVEF, Cedars-Sinai Quantitatif Gated SPECT (QGS) analiz programı ile duvar hareket ve kalınlık skorları belirlendi. ERVG görüntülemesinde sol ön oblik görüntüleri kullanılarak SVEF değerleri hesaplandı. GSPECT ve ERVG görüntülerinde; SV duvar hareketleri görsel olarak değerlendirilerek skorlandı. Olguların EKO ile belirlenen SVEF değerleri ve duvar hareket bilgileri ile karşılaştırıldı. Bulgular: Olguların GSPECT ile hesaplanan ortalama SVEF ile ERVG verileri arasında iyi derecede korelasyon bulundu. EKO ile ölçülen nümerik SVEF değeri olan 30 olgunun; GSPECT ve EKO ile hesaplanan SVEF değerleri arasında belirgin fark olmadığı görüldü. Kırk sekiz hastadan elde edilen 240 segment incelendiğinde, görsel duvar hareketleri açısından GSPECT ile ERVG arasında %77.5 segmentte, GSPECT ile EKO arasında %75.4 segmentte uyum saptandı. Görsel olarak normokinetik segmentlerde hesaplanan hareket ve kalınlık skorları, kontraksiyon kusuru izlenen segmentlere oranla belirgin yüksek bulundu. Sonuç: GSPECT’in SV fonksiyonlarının değerlendirilmesi amacıyla klinik pratikte güvenle kullanılabileceği, kantitatif olarak hesaplanan duvar hareket ve kalınlık skorlarının görsel değerlendirmeyi desteklediği düşünülmektedir., Objectives: in this study, we investigated the reliability of gated myocardial perfusion single-photon emission comput- erized tomography (GSPECT) for the evaluation of left ven- ricle (LV) function. We compared left ventricle ejection frac- on (LVEF) calculated with GSPECT with the values derived rom planar equilibrium-gated radionuclide ventriculography ERVG) and echocardiography (ECHO). Study design: Forty-eight patients with suspected coronary artery disease (CAD), who were referred for evaluation of myocardial perfusion and LV function and underwent two-day 99mTc-MIBI protocol GSPECT and ERVG, were examined etrospectively. LVEF was calculated with GSPECT Myome- rix software, and wall motion and thickness were calculated with QGS analysis program. in the ERVG study, LVEF val- ues were calculated using left anterior oblique images. in the GSPECT and ERVG study, wall motion was evaluated visu- ally and scored. LVEF values and wall motion data measured with ECHO were noted. Results: For all cases, there was a significant correlation between LVEF values calculated by GSPECT and ERVG. Numerical LVEF values of 30 patients measured with ECHO howed no significant difference from the values measured with GSPECT. When 240 segments obtained from 48 patients were examined, the correlation between GSPECT and ERVG was 77.5% and between GSPECT and ECHO was 75.4% by visual wall motion analysis. Quantitatively calculated wall motion and thickness scores of segments visually defined as normokinetic were significantly higher than segments visually defined as having contraction defect. Conclusion: GSPECT can be used safely in clinical practice or the evaluation of LV function. Quantitatively calculated wall motion and thickness scores are promising methods to verify he visual evaluation.

Technetium-99m-sestamibi ( 99m Tc-MIBI) imaging is a well-established modality in oncologic investigations. The current study aimed to investigate whether any relationship could be found between 99m Tc-MIBI uptake and local perfusion in malignant bone and soft-tissue tumours. It also aimed to compare 99m Tc-MIBI images with those of technetium-99m-methylene diphosphonate ( 99m Tc-MDP) bone scintigraphy with regard to the activity distribution pattern, intensity and lesion extension. The study group included 24 patients with various bone and soft-tissue tumours. Three-phase bone scintigraphy and 99m Tc-MIBI studies were performed within the same week before any surgical and therapeutic intervention. Images were evaluated visually and quantitatively using regions of interest (ROIs) over the lesion and adjacent normal tissue. The 99m Tc-MIBI study was positive with varying degrees of uptake (range, 1.4-5.3). The mean 99m Tc-MIBI uptake and 99m Tc-MDP blood-pool and osseous phase activity ratios were 2.5±0.5, 2.8±1.0 and 5.5±4.0, respectively. The correlation between the 99m Tc-MIBI uptake and blood-pool ratios was 0.70 (P

In this study, we investigated prospectively the diagnostic role of 99 Tc m -MIBI for staging and for predicting the therapeutic response of stage IV neuroblastoma compared wth 131 I-MIBG imaging and 99 Tc m -MDP bone scintigraphy. Nine patients (4 girls and 5 boys aged 1-7 years) with suspected or proven stage IV neuroblastoma were studied with 99 Tc m -MIBI at initial diagnosis and after 12-18 months of multidrug therapy. After the injection of 80 MBq.kg -1 99 Tc m -MIBI, early (10 min) and delayed (1 h) images were obtained. The data were correlated with 131 I-MIBG scans, bone scintigraphy, ultrasound, computed tomography and/or magnetic resonance imaging, and bone marrow biopsy. Eight of nine primary tumours and 41 metastatic lesions were detected by 131 I-MIBG scintigraphy. None of the primary lesions demonstrated significant 99 Tc m -MIBI accumulation. Sestamibi was positive in 16 of 41 MIBG-avid metastatic lesions. After six courses of multidrug chemotherapy, 30 131 I-MIBG-avid neuroblastoma metastases that were 99 Tc m -MIBI-negative at the time of diagnosis still did not show significant sestamibi accumulation. Follow-up demonstrated that all lesions that were 99 Tc m -MIBI-avid at the time of diagnosis remained negative. Of these 16 lesions, seven were positive for 131 I-MIBG accumulation with no reduction in size, and nine showed resolution after therapy. New metastatic foci detected by MIBG scintigraphy did not accumulate 99 Tc m -MIBI. Clinical evaluation of patients with no 99 Tc m -MIBI uptake in primary and secondary sites of neuroblastoma confirmed that they were resistant to multidrug chemotherapy. All 99 Tc m -MIBI-positive lesions, irrespective of clinical outcome, demonstrated significant clearance of tracer on the delayed images. We conclude that 99 Tc m -MIBI has no role in the staging of neuroblastoma. Sestamibi is a well-documented transport substrate for P-glycoprotein-related multidrug resistance and serial imaging may provide prognostic information on the therapeutic value of chemotherapy.

Tc-99m sestamibi, originally developed for myocardial studies, has been used as a tumor-seeking agent. Recently, the agent also was reported to be a functional tracer to predict multidrug resistance-related p-glycoprotein expression in tumor tissue. The current report presents the authors' experience with sestamibi tumor scintigraphy in a neuroblastoma. Although I-131 MIBG tumor imaging and Tc-99m MDP bone scanning accurately demonstrated the extent of the disease, Tc-99m sestamibi showed no accumulation in primary and metastatic foci. Lack of sestamibi uptake was initially thought to be suggestive of failure to respond to chemotherapy because of p-glycoprotein expression. However, the patient responded well to chemotherapy and complete remission was achieved. The failure of Tc-99m sestamibi to detect a neuroblastoma and the lack of sestamibi accumulation in the tumor may not always be related to chemotherapy resistance.

The aim of this study was to evaluate the value of three-phase dynamic bone scintigraphy (TPBS) in the assessment of the response of bone sarcomas to pre-operative chemotherapy and to correlate serial scintigraphic changes with histological findings. The study group comprised 27 patients (osteogenic sarcoma, n = 20; Ewing's sarcoma, n = 5; malignant fibrous histiocytoma, n = 2) with a mean age of 19.2 years. All patients received 99Tcm-methylene diphosphonate TPBS before and after pre-operative chemotherapy. Each phase of the imaging procedure was interpreted qualitatively and quantitatively. The percentage of tumour necrosis was analysed on resection materials following surgery. Histologically, 12 patients were non-responsive (tumour necrosis less than 90%) and 15 patients were responsive (tumour necrosis more than 90%). A decrease in the tumour blood flow ratio and extension were the most notable findings in the responders. The mean change in the tumour blood flow ratio following therapy was 58.7 +/- 8.3% and 19.9 +/- 26.6% (P < 0.005) in responders and non-responders respectively. The accuracy of three-phase imaging and static bone scintigraphy was 88% and 74% respectively. Since bone scintigraphy is a valuable technique owing to its ability to detect distant metastases in clinically early disease, TPBS should be helpful in monitoring therapy effects without any additional cost or radiation dose.

The aim of this study was to determine the utility of 99Tcm-tetrofosmin cardiac imaging in patients with previous myocardial infarction and with significant coronary artery disease (CAD) compared with that of 201Tl cardiac imaging. Sixteen patients (14 males, 2 females) were studied by same-day exercise-rest 99Tcm-tetrofosmin imaging and exercise, rest and reinjection 201Tl cardiac imaging. For each study, semi-quantitative visual analysis was performed in 20 segments using a 4-point scale. The regional distribution and defect reversibility with the two tracers were compared with the results of coronary angiography. A total of 320 segments were analysed. There was a statistically significant concordance between the numbers of fixed and reversible segments in both studies in myocardial segments supplied by totally occluded coronary arteries (Group 1), as well as in segments supplied by significantly stenosed coronary vessels (Group 2). The exercise and rest uptake of both 99Tcm-tetrofosmin and 201Tl in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow was significantly lower compared with segments supplied by totally occluded coronary arteries with efficient collateral flow (P < or = 0.05). When the uptake of both tracers was analysed according to each major vascular territory, the mean exercise and rest uptake grades of 99Tcm-tetrofosmin and 201Tl were similar. There was also no significant difference in defect reversibility between the two tracers. Discordant results were observed in the territory of the right coronary artery in Group 1 (mean exercise grade of 99Tcm-tetrofosmin = 2.26 +/- 0.7 and of 201Tl = 1.92 +/- 0.8; P < or = 0.001) and in Group 2 (mean grade of 99Tcm-tetrofosmin = 0.79 +/- 0.65 and of 201Tl = 0.95 +/- 0.65; P < or = 0.05). The results of the present study indicate that the overall diagnostic utility of 99Tcm-tetrofosmin in the identification of individual stenosed vessels is comparable with 201Tl in both patients with totally occluded coronary arteries and those with significantly stenosed vessels. The regional distribution of both tracers was lower in myocardial segments supplied by totally occluded coronary arteries with poor collateral flow.

Thallium-201 ( 201 Tl) imaging has been widely used to differentiate post-therapy reactions from residual viable tumour or local recurrence. However, the ability of 201 Tl to discriminate between tumour and post-therapy changes with superimposed infection/inflammation is unclear. This experimental study investigated the localization of 201 Tl in infected/inflamed tissues. Twenty-four rats infected with Staphylococcus aureus and 10 rats injected with a standard volume of saline solution (SS) into the thigh muscles were studied. Twenty-four hours after microorganism or SS administration, 18 MBq 201 Tl was injected intravenously. Images were recorded at 20 min and 3 h post-injection. The increased tracer uptake was evaluated qualitatively and quantitatively by calculating the ratios (L/C) derived from regions of interest drawn over the lesion and the contralateral thigh muscle. After the imaging procedure, histopathological examination was also performed. Whereas the control group showed no abnormal accumulation of activity, the infected rats demonstrated markedly increased activity, especially on the 20 min images. The mean L/C ratios for the 20 min and 3 h images for the infected rats were 2.18 ± 0.20 and 1.52 ± 0.04, respectively (P < 0.0005). In conclusion, positive uptake due to an infective process may limit the use of 201 Tl in studies monitoring response to tumour therapy. Although delayed imaging may help to overcome this limitation, further investigations among a large series of patients are required in order to improve the reliability of 201 Tl imaging in oncology

In this experimental study, the utility of 99 Tc m -polyclonal human immunoglobulin ( 99 Tc m -HIG) for localizing acute and chronic phases of inflammatory lesions was investigated. Three groups of rats were inoculated with Staphylococcus aureus in the right thigh. Then, 24 h (group I, n = 12), 48 h (group II, n = 12) and 72 h (group III, n = 12) post-inoculation, the rats received 40 MBq 99 Tc m -HIG into the jugular vein. In addition, two control rats were studied at 24 h after inoculation of sterile saline. Both visual and quantitative evaluations were undertaken. The acute and chronic stages of inflammation were determined by pathological examination. The mean (±S.D.) lesion/contralateral uptake ratios at 4 and 24 h after 99 Tc m -HIG injection were: group I, 1.22 ± 0.1 and 2.12 ± 0.16; group II, 1.15 ± 0.08 and 2.25 ± 0.16; group III, 1.06 ± 0.09 and 2.08 ± 0.14. In conclusion, the acute and chronic phases of infection showed non-significant differences in 99 Tc m -HIG uptake ratios.

GOKCE, SABAN CAKIR/0000-0003-2586-3243 WOS: A1995QL18900015 PubMed: 7750222 Myositis ossificans is primarily a disorder of adolescents or adults, whereby an area of muscle mass undergoes progressive ossification. Its radiographic and scintigraphic appearances have been well documented. In this paper, a case of histopathologically demonstrated myositis ossificans in the proximal thigh with unexpected TI-201 accumulation was presented.

We evaluated the feasibility of 99Tcm-methoxyisobutylisonitrile (MIBI) as a tumour localizing agent in patients with palpable breast masses in comparison with mammography and ultrasonography (US). Forty-one patients with palpable masses were studied. An additional 12 women with no palpable breast anomaly also underwent 99Tcm-MIBI breast study. Multiple views were obtained and semiquantitative evaluation was applied. Mammography and US revealed all of the malignant breast masses but differential diagnosis of fibroadenomas could not be achieved. Twenty-five of 27 breast carcinomas were detected using 99Tcm-MIBI scintigraphy. Two patients with invasive lobular carcinoma showed absent MIBI accumulation. Eight of 14 axillary lymph-node metastases showed positive uptake (57%). Twelve of 14 patients with pathologically proven benign breast lesions did not demonstrate any MIBI accumulation. Focal MIBI uptake could be observed in two fibroadenomas. The sensitivity and the specificity of semiquantitative MIBI analysis were 93 and 86%, respectively. Subjective grading offered no additional help in the further differentiation of malignant breast masses. There was no significant difference between histopathological types of breast carcinomas and uptake grades. Our results indicate that 99Tcm-MIBI scintigraphy may provide additional information in the differentiation of malignant pathologies from benign lesions in patients with palpable breast anomalies.

In this study 201Tl planar scintigraphy and single photon emission computed tomography (SPECT) were performed in 92 patients with solitary lung lesions in order to distinguish malignant versus benign and metastatic masses and to evaluate the radiotherapy response of 15 primary lung carcinomas. Semiquantitative and quantitative analyses were carried out and the results were compared with histopathological diagnosis. The overall sensitivity, specificity and accuracy of semiquantitative analysis were 56, 71 and 58%, and quantitative evaluations were 88.8, 100 and 92%, respectively. Retention indexes (RI) derived from the early and delayed images were 2.9 +/- 1.3 for primary lung carcinomas, -2.78 +/- 0.9 for benign conditions and -2.3 +/- 1.5 for metastatic pulmonary lesions. 201Tl scintigraphy seems to be a sensitive modality for differentiating malignancies from benign conditions since the difference between those two pathologies is significant. However, this procedure has a limited value in distinguishing metastatic pulmonary lesions from benign pathologies, and in tissue characterization of primary lung carcinomas. On the other hand, a good correlation was observed between 201Tl lung scintigraphy and clinical diagnostic examination during postradiotherapy follow-up of inoperable pulmonary neoplasia.

The accurate diagnosis of a sentinel node in melanoma includes a sequence of procedures from different medical specialities (nuclear medicine, surgery, oncology, and pathology). The items covered are presented in 11 sections and a reference list: (1) definition of a sentinel node, (2) clinical indications, (3) radiopharmaceuticals and activity injected, (4) dosimetry, (5) injection technique, (6) image acquisition and interpretation, (7) report and display, ( 8) use of dye, ( 9) gamma probe detection, (10) surgical techniques in sentinel node biopsy, and (11) pathological evaluation of melanoma-draining sentinel lymph nodes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "general consensus" and similar expressions. The recommendations are designed to assist in the practice of referral to, performance, interpretation and reporting of all steps of the sentinel node procedure in the hope of setting state-of-the-art standards for good-quality evaluation of possible spread to the lymphatic system in intermediate-to-high risk melanoma without clinical signs of dissemination.

Aerosol nebulization is and most effective ways of treating airway diseases especially in children. Failure of inhaled asthma treatment is mainly due to inadequate deposition of drugs in the peripheral area of the lungs. The aim of this study was to compare the efficacy of a traditional mask and that of a new spacer mouth-mask (Nebula, Markos Mefar, Italy) when used with a jet nebulizer, by measuring aerosol deposition in the lungs, oropharynx, upper airways, and gastrointestinal tract. Twelve children without respiratory disease aged between 8 and 13 years were included in the study. Aerosol inhalation was performed using a jet nebulizer with 2 mL of saline solution containing 20 Mci of Tc99m-DTPA. The first group initially performed aerosol inhalation using a traditional facemask and then, one week later, using the new spacer mouth-mask. The second group performed aerosol inhalation using the new spacer mouth-mask first and then, one week later, using a traditional mask. Scintigraphic ventilation images were then obtained, and aerosol deposition in the trachea, oropharynx, lungs and stomach was measured. In the first group, the radioaerosol deposition in the peripheral lung area using the new spacer mouth-mask was greater 97.8 +/- 7.0 vs. 68.5 +/- 7.9 (p = 0.04). On the other hand, the oropharyngeal radioaerosol deposition was greater using the traditional mask: 50.2 +/- 5.2 vs 20.3 +/- 11.8 (p = 0.028). Similarly, in the second group the peripheral lung deposition was greater and the oropharyngeal deposition was less using the new spacer mouth-mask: 97.3 +/- 9.4 vs. 70.2 +/- 11.2 and 20.7 +/- 8.9 vs. 46.3 +/- 16.8 (p = 0.028 and 0.046 respectively). In conclusion, the new design of the spacer mouth-mask allows greater aerosol deposition in the peripheral lung area and less in other parts such as the oropharyngeal area, the central airways and the stomach.

Tc-99m HMPAO SPECT was used to evaluate regional blood flow in one monozygotic twin who had angiographically proven moyamoya disease. Focal and global reduced regional cerebral perfusion were observed in both patients with Tc-99m HMPAO SPECT studies. There was good correlation between the localization and degree of regional cerebral blood flow abnormalities and the severity and stage of clinical symptoms on angiography. These results suggest that Tc-99m HMPAO SPECT is a useful method in the detection of hemodynamic abnormalities in moyamoya disease.

In vitro studies have demonstrated that (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) is a transport substrate of multidrug resistance (MDR)-related proteins. The aim of this clinical study was to evaluate whether (99m)Tc-MIBI scintigraphy was a functional imaging tool for in vivo detection of multidrug resistance-associated protein (MRP) expression in osteosarcoma and to investigate the role of MRP and (99m)Tc-MIBI imaging to predict the clinical outcome. We also examined whether the scintigraphic parameters would help to distinguish the functional capacity of P-glycoprotein (Pgp) and MRP.Twenty-four patients with a diagnosis of osteosarcoma were studied before neoadjuvant chemotherapy. Tumor-to-background ratios of both early (10 min) and delayed (1 h) images and the percentage washout rate (WR%) of (99m)Tc-MIBI were calculated. Immunohistochemical analysis of MRP and Pgp was performed on biopsy specimens, and the response to preoperative chemotherapy was assessed by histopathologic examination.Fifteen of 24 osteosarcoma samples in our series (62.5%) showed significant expression of MRP. The level of MRP expression was significantly correlated with the WR% of (99m)Tc-MIBI (r = 0.58, P = 0.003), and the WR% of (99m)Tc-MIBI was significantly faster in patients with high MRP expression than in those with a low MRP score (P = 0.007). The clearance rate of (99m)Tc-MIBI was significantly slower in tumor samples with negative or low expression of both Pgp and MRP (16% +/- 6.2%) when compared with osteosarcomas with high expression of both proteins (31.7% +/- 8.7%) (P = 0.001). There was not a significant difference between the WR% of (99m)Tc-MIBI in tumors with coexpression of both proteins and in tumors with high expression of either Pgp or MRP. Both the rate of MRP expression and the WR% of (99m)Tc-MIBI were significantly correlated with response rate.Our results suggest that the WR% of (99m)Tc-MIBI is correlated with MRP expression. Both the WR% of (99m)Tc-MIBI and MRP expression are correlated with therapy response. (99m)Tc-MIBI can be used as a general probe for functional imaging of both Pgp and MRP; however, it is not capable of differentiating the functional status of either MDR-related glycoprotein.

This multicentric study aimed to bring neuroblastoma patients together under IPOG-NBL-92 protocol and evaluate the results within the period between 1992 and 2001 in Izmir. Sixty-seven neuroblastoma patients from 4 pediatric oncology centers in Izmir were included in the study. IPOG-NBL-92 protocol modified from German Pediatric Oncology (GPO)-NB-90 protocol was applied: Patients in stage 1 received only surgery, while surgery plus 4 chemotherapy courses (cisplatin, vincristine, ifosfamide) were given in stage 2 and surgery plus 6 chemotherapy courses (cisplatin, vincristine, ifosfamide, epirubicin, cyclophosphamide) were given in stages 3 and 4 patients. In patients who were kept in complete remission (CR), a maintenance therapy of one year was applied. Radiotherapy was given to the primary site following induction chemotherapy plus surgery in stages 3 and 4 patients with partial remission (PR). The stages of the patients were as follows: 5% in stage 1, 39% in stage 3, 49% in stage 4, and 7% in stage 4S. Primary tumor site was abdomen in 88% of cases. CR rates were as 100% in stage 1, 76% in stage 3, 35% in stage 4, and 75% in stage 4S. Relapse was observed in 32% of patients in a median of 19 months. The median follow-up time for survivors was 33 (17-102) months. Five-year OS rate was 31% and the EFS rate was 30% in all patients. Five-year overall and event-free survival rates were 63 and 30% in stage 3, but 6 and 5%, respectively, in stage 4 patients. Univariate analysis established that the age, stage, primary tumor site, and high LDH and NSE levels conferred a significant difference. The IPOG-NBL-92 protocol has proved to be satisfactory with tolerable toxicity and reasonable CR and survival rates. However, more effective treatments suitable to Turkey's social and economic conditions are urgently needed for children over 1 year of age with advanced neuroblastoma.

Amiodarone hydrochloride, which is used in life-threatening cardiac tachyarrhythmia, has been known to cause amiodarone induced pulmonary toxicity (AIPT) as a complication. In this study we aimed to investigate the clinical value of technetium-99m diethylene triamine penta-acetic acid (DTPA) aerosol lung scintigraphy in patients with AIPT in comparison with gallium-67 (Ga-67) scan. The study group included 26 cases, 7 patients with diagnosis of AIPT (Group A), 8 patients receiving amiodarone therapy but without AIPT (Group B) and 11 healthy subjects as a control group (Group C). All patients underwent Ga-67 and Tc-99m-DTPA aerosol scintigraphy in addition to various laboratory tests, Ga-67 scintigraphy was positive in 4 of 7 AIPT patients but quite normal in Group B. A positive correlation was found (r = 0.52, p0.05) between kep values determined by Tc-99m-DTPA aerosol scintigraphy and the cumulative dose of amiodarone. The mean kep values were 2.04% +/- 0.85%/min, 1.30% +/- 0.42%/min and 0.86% +/- 0.19%/min for groups A, B and C, respectively. The mean clearance rate of group A was significantly faster than that of normals (p0.0005) and group B (p = 0.028). In addition, there was a significant difference between groups B and C (p = 0.015). In conclusion, Ga-67 lung scintigraphy is a useful method for the detection of AIPT but Tc-99m-DTPA aerosol scintigraphy offers better results than Ga-67 scintigraphy. Early changes in Tc-99m-DTPA clearance may be observed in patients receiving amiodarone. The kep value in patients with AIPT is noticeably increased with respect to the control group. With its favorable physical properties, low cost, lower radiation burden and its ability to be used as an objective measure for the pulmonary clearance rate, Tc-99m-DTPA aerosol scintigraphy appears to be promising in patients receiving amiodarone therapy.

The occurrence of multidrug resistance (MDR), which is in part due to the overexpression of P-glycoprotein (Pgp), is a major problem in neoadjuvant therapy of malignant musculoskeletal tumours. The aim of this study was to investigate the role of technetium-99m hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy for functional imaging of the MDR1 phenotype in patients with musculoskeletal sarcomas. We aimed to compare 99mTc-MIBI uptake and washout kinetics with the expression of Pgp and with chemotherapy response. Twenty-five patients (16 males and 9 females, aged between 8 and 65 years) with malignant musculoskeletal tumours were studied. After injection of 555-740 MBq 99mTc-MIBI, dynamic flow images of the involved area were obtained for 3 min, and planar images were acquired at 10 min and 1 h. From the dynamic images, a tumour perfusion index (TPI) was obtained using Patlak-Rutland analysis. Tumour to background (T/B) ratios of both early and delayed images and percent wash-out rate (WR%) of 99mTc-MIBI were calculated. Immunohistochemical analysis of Pgp was performed on biopsy specimens and the degree of expression was graded according to a semiquantitative scoring system, from 0 to 6. After neoadjuvant therapy, tumour response was assessed by examining the ratio of viable cells and by detecting percent necrosis. Scintigraphic results were compared with Pgp status and therapy response. Irrespective of the Pgp status, all patients showed significant perfusion and 99mTc-MIBI uptake in early images. There was not a significant correlation between T/B ratios of early and delayed images and Pgp expression. We observed a positive correlation between WR% and Pgp status (r=0.61, P0.01), and the wash-out rate of 99mTc-MIBI was significantly higher in patients with high Pgp expression than in those with a low Pgp score (33% +/- 9% vs 17% +/- 9%). Therapy response was determined in 21 of 25 patients, and in only 5 of 21 cases was the percent necrosis more than 90%. Neither Pgp expression rate nor WR% was found to show a significant correlation with percent necrosis in the bulk tumour specimens. In conclusion, the initial uptake of 99mTc-MIBI in bone and soft tissue sarcomas did not correlate with Pgp expression. A relationship was found between the wash-out rate of 99mTc-MIBI and the Pgp score, with a significant difference in WR% being observed between patients with high and patients with low Pgp expression.

The aim of this investigation was to test for the scintigraphic detection of metastases of malignant melanoma with a new radiopharmaceutical, 99 Tc m -glutathione ( 99 Tc m -GSH), in comparison with 99 Tc m -anti-melanoma antibody ( 99 Tc m -AMAb). Glutathione was labelled with 99 Tc m by a Sn 2+ reduction method with an efficiency of > 99% as determined by instant thin layer chromatography (ITLC). Anti-melanoma antibody was obtained as a kit from SORIN (Italy) and labelled with 99 Tc m O - 4 . Forty-three patients with a total of 55 biopsy-proven metastatic melanoma foci, 1 ocular melanoma and 20 benign pathologic foci, also confirmed by ultrasound, computed tomography and magnetic resonance imaging, were included in the study after giving their informed consent. Following the intravenous (i.v.) injection of 500 MBq 99 Tc m -AMAb, scintigraphic images of the involved areas were obtained 6 h post-injection. Three days later, the same patients were given 500 MBq 99 Tc m -GSH i.v. and images were obtained 6 and 24 h post-injection. The images were classified as positive (focal abnormal accumulation) or negative. Quantitative evaluation was also applied. Regions of interest were drawn over the involved areas and nearby soft tissues and the target-to-nontarget (T/NT) ratios obtained with 99 Tc m -AMAb (T/NT: 1.92 ± 0.2) and 99 Tc m -GSH (T/NT: 1.84 ± 0.2) were compared (0.1 < P ≤ 0.3). The sensitivity (and specificity) of 99 Tc m -AMAb and 99 Tc m -GSH in the detection of malignant melanoma metastases were 91% (95%) and 84% (90%), respectively. Compared with 99 Tc m -AMAb, the advantages of 99 Tc m -GSH are lower levels of blood radioactivity, lower costs and easy in-house preparation. In conclusion, our results show that 99 Tc m -GSH is a potentially useful radiopharmaceutical for the detection of metastases of malignant melanoma.

The uptake of 1-131 MIBG In neuroblastoma is well-established In imaging studies. 1-131 MIBG scintigraphy of a patient with neuroblastoma Illustrated doughnut appearance, which is a well-recognized bone scan finding mostly In giant-cell tumor of bone. This finding was probably caused by central necrosis and hemorrhage, and surrounding viable tumor tissue.