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Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of bio-distributions of radiopharmaceutical uptake can be displayed in 3D-tomographic formats, using single photon emission computed tomography...
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... for neuroendocrine imaging was first evaluated in mixed patient groups undergoing 123 I- MIBG, 111 In-DTPA-octreotide, and 123/131 I scintigraphy (20,21,145,146). Improved diagnostic accuracy of SPECT/CT over planar and SPECT imaging has been consis- tently reported for SRS, frequently resulting in changes to management plans (147-157) ( Figure 4 and Table 4). The precise anatomic localization of radioactivity using SPECT/CT provides insight into the etiology of uptake as benign or malignant, re- ducing the number of equivocal find- ings encountered on planar imaging (148,156,157). ...
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Background:
The aim of this paper was to analyse our own semi-quantitative method of assessing focal lesions localised in pre-operative diagnostic scintigraphy of primary hyperparathyroidism (PHPT) using 99mTc-MIBI with washout and comparing these data with the result of the histopathological examination (HP).
Material and methods:
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Citations
... Single-photon emission computed tomography (SPECT) has been widely used to diagnose various kinds of human diseases, such as myocardial diseases, endocrine disorders, and central nervous system diseases, since its invention in the 1990s [1][2][3][4]. Most of the available SPECT systems are based on the well-known Anger camera with NaI (Tl) as a scintillation material, which determines the position of an event by the centroid of the scintillation light [5]. ...
Abstract Background The digital cadmium–zinc–telluride (CZT)-based SPECT system has many advantages, including better spatial and energy resolution. However, the impacts of different acquisition and reconstruction parameters on CZT SPECT quantification might still need to be validated. This study aimed to evaluate the impacts of acquisition parameters (the main energy window and acquisition time per frame) and reconstruction parameters (the number of iterations, subsets in iterative reconstruction, post-filter, and image correction methods) on the technetium quantification of CZT SPECT/CT. Methods A phantom (PET NEMA/IEC image quality, USA) was filled with four target-to-background (T/B) ratios (32:1, 16:1, 8:1, and 4:1) of technetium. Mean uptake values (the calculated mean concentrations for spheres) were measured to evaluate the recovery coefficient (RC) changes under different acquisition and reconstruction parameters. The corresponding standard deviations of mean uptake values were also measured to evaluate the quantification error. Image quality was evaluated using the National Electrical Manufacturers Association (NEMA) NU 2–2012 standard. Results For all T/B ratios, significant correlations were found between iterations and RCs (r = 0.62–0.96 for 1–35 iterations, r = 0.94–0.99 for 35–90 iterations) as well as between the full width at half maximum (FWHM) of the Gaussian filter and RCs (r = − 0.86 to − 1.00, all P values
... Along with this, patients must withdraw from interfering medications that may provoke (together with dexamethasone) a hypertension flair. Use of SPECT/CT with NP-59 scintigraphy allows precise localization of the functional activity to anatomic structures improving diagnostic interpretation (20). ...
Incidentalomas are reported in 3%-4% of patients who undergo abdominal anatomic imaging, making adrenal mass evaluation a common occurrence. An adrenal mass can be caused by a variety of pathologies, such as benign cortical and medullary tumors, malignant tumors (primary or secondary), cysts, hyperplasia, hemorrhage, or more rarely infection/inflammation processes. Functioning tumors usually have increased hormonal production but they are less common. Regardless of their functional status, some tumors have the potential to behave aggressively. Anatomic and functional imaging together with biologic evaluation play a vital role in adrenal pathology subtyping. Most patients are initially evaluated by CT or MRI, which allows for tumor characterization (to a certain extent) and can rule out malignant behavior based on the absence of tumor growth during longitudinal follow-up. In the remaining patients for whom CT or MRI fail to characterize the pathogenesis of adrenal tumors, the use of specialized molecular imaging techniques should be performed after hormonal screening. This review emphasizes well-established and emerging nuclear medicine imaging modalities and describes their use across various clinical scenarios.
... The single photon emission computed tomography (SPECT) has been widely used to diagnose various kinds of human diseases such as myocardial diseases, endocrine disorders, central nervous system diseases, and so on since its invention in the 1990s [1][2][3][4]. Most of the available SPECT systems are based on the well-known Anger camera with NaI (Tl) as a scintillation material, which determines the position of an event by the centroid of the scintillation light [5]. ...
Background
Various acquisition and reconstruction parameters may affect the accuracy of the absolute SPECT quantification. However, many of the impacts of these parameters have not well been studied. This study aimed to evaluate the impacts of acquisition parameters (main energy window and acquisition time per frame) and reconstruction parameters (the number of iterations and subsets in iterative reconstruction, post-filter, and image correction methods) on the technetium quantification of the cadmium-zinc-telluride based SPECT/CT system.
Methods
A phantom (PET NEMA/IEC image quality, USA) was filled with a 16:1 sphere-to-background activity concentration ratio of technetium and all spheres had 132400.81Bq/ml of radioactivity. Mean uptake values (calculated mean concentrations for spheres) were measured to evaluate the recovery coefficient (RC) changes under different acquisition and reconstruction parameters. Corresponding standard deviations of mean uptake values were also measured to evaluate the quantification error. Image quality was evaluated using the National Electrical Manufacturers Association (NEMA) NU 2-2012 standard.
Results
For six spheres of the phantom, significant correlations were found between iterations and RCs (r=0.60~0.98 for 1~35 iterations, r=0.96~0.99 for 35~90 iterations, all P-values <0.05) as well as between the full width at half maximum (FWHM) of the Gauss filter and RCs (r=-0.90～-1.00, all P-values <0.05). 1~35 iterations had higher regression coefficients compared with those of 35~90 iterations (0.67~1.16 vs. 0.02~0.17). The AC (attenuation correction)+SC (scatter correction) +RR (resolution recovery correction) combination had more close to 100% RCs (42.42%~98.04%) with better image quality (31.52%~83.57%) than those of other correction combinations (all P-values <0.05). No significant statistical difference was found between the 15% energy window and the 20% energy window (P-value=0.061), nor between the 5 seconds/frame and 120 seconds/frame of acquisition time (P-value=0.943) in terms of RCs.
Conclusions
The CZT-SPECT/CT showed a good quantification accuracy of technetium. The favorable acquisition parameters may be 15% energy window and 40 seconds/frame of acquisition time. The favorable reconstruction parameters could be 35 iterations, 20 subsets, the AC+SC+RR correction combination, and FWHM 0.7mm of Gauss filter.
... Due to the weak radiation dose, Tc-99m O4 is preferred. Tc-99m O4 is a radionuclide which is reliable, easily accessible, widely used in clinical nuclear medicine applications [16][17][18][19][20][21][22][23][24][25] . ...
Objective: Oxidative/nitrosative stress may be triggered by various sources, and ionizing radiation may also initiate oxidative/nitrosative stress.
This is the first study; we aimed to investigate the induction of oxidative and nitrosative stress due to ionizing radiation in patients undergoing Tc99m pertechnetate thyroid scintigraphy.
Method: Totally 26 patients (16 female,10 male) undergoing Tc-99m
pertechnetate thyroid scintigraphy were included in this study. The patients were aged between 20 and 50 years (58.0±16.3 years). The blood samples were taken from patients 20 minutes after intravenous injection of Tc99m pertechnetate in the dose used clinically (5 miliCurie) before the patients were taken to the thyroid imaging. Control group was selected from 30 healthy subjects (15 female,15 male). The control group was aged between 17 and 72 years (57.0±14.0 years). The blood samples were taken both patients and control group for measuring antioxidant enzymes (catalase and superoxide dismutase), malondialdehyde, nitric oxide, and nitrotyrosine as oxidative/nitrosative stress biomarkers.
Results: In this study, we found that activities of antioxidant enzymes
increased in patients compared to control (p<0.05). Further,
malondialdehyde levels as an indicator of oxidative stress were higher in patients than control group (p<0.05).The levels of nitric oxide and
nitrotyrosine as nitrosative stress biomarkers also increased in patients compared to control groups (p<0.05).
Conclusions: We thought that Tc-99m pertechnetate might cause an
increase in reactive oxygen and nitrogen species and may cause
oxidative/nitrosative damage at the cellular level. Our results indicated that the dose of Tc-99m pertechnetate given in these patients undergoing thyroid scintigraphy could be tolerable.
... In a UK-based study, Aspinall et al. 15 found that surgeon-performed ultrasound had an accuracy of 86% in detecting the position of parathyroid adenomas in outpatient clinics. It should be borne in mind that apart from its value in localising primary parathyroid adenomas, 99m Tc-sestamibi-SPECT/CT is vital for identifying major parathyroid ectopias 16 and parathyroid glands in secondary hyperparathyroidism. 17,18 The present study found none of the patient had evidence of ectopic parathyroid glands. ...
... Our surgeon operator (PRST) had a 100% repeatability record for ultrasound identification of parathyroid adenomas. We did not examine inter-observer variability for any of the modalities in the present study but a review by Wong et al. 16 reported an inter-observer agreement of SPECT/CT to be high (j value ¼ 0.91). Another issue surrounds that of training; whereas training is available for surgeons to learn parathyroid ultrasonography in the US, 19 there exists no such formal training programmes in the UK. ...
Background:
Primary hyperparathyroidism arising from parathyroid adenoma is one of the most common endocrine disorders treated by endocrine surgeons. The adenoma is commonly identified by imaging techniques. The present study evaluated the performance of a portable ultrasound machine (Sonosite MicroMaxx) operated by a surgeon, departmental ultrasound and 99mTc-sestamibi-SPECT/CT by a radiologist in the identification of parathyroid adenomas.
Methods:
Patient case notes were retrieved from medical records and imaging from picture archiving and communication system over the period from 2006 to 2012. 99mTc-sestamibi-SPECT/CT and departmental ultrasound images were reported by a nuclear radiologist. The ability of each imaging technique in localising parathyroid adenomas was referenced against the actual adenomas identified from parathyroidectomy.
Results:
With reference to the actual site of the lesion, surgeon-performed ultrasound accurately localised the site of the lesion in 30/33 (90.1%) of cases with a sensitivity of 86.7%, departmental ultrasound accurately localised the site of the lesion in 21/26 (80.1%) of cases with a sensitivity of 79.2%. In 6/75 patients where 99mTc-sestamibi-SPECT/CT did not localise the lesion, departmental ultrasound did not localise any lesions correctly, while surgeon-performed ultrasound successfully located the adenoma in three (50%) of these six patients. Patients whose parathyroid adenomas identified by the surgeon were more likely to have shorter length of stay in hospital: odds ratio = 0.53 (95% confidence interval = 0.30-0.92, p = 0.025).
Conclusions:
Surgeon-performed ultrasound for immediately pre-operative localisation improves identification of parathyroid adenomas and reduces length of stay in hospital, lending support for the use of this technique by endocrine surgeons.
... Somatostatin receptors are over expressed in MTC and thus allows the use of radiolabeled somatostatin analogues for scintigraphic imaging before and after treatment for proper staging and follow-up of these patients [4,5]. Recently, SPECT-CT γ-cameras have become widely available which allows the fusion of anatomical CT and functional SPECT modalities [6,7]. SPECT-CT is used to optimize somatostatin-receptor scintigraphic protocols for MTC imaging. ...
... Fusion SPECT-CT images improve image quality, show correct topography and morphological characteristics of metastatic lesions and provide exact differential diagnosis of the physiological from abnormal uncertain "hot" spots, thus increasing diagnostic accuracy of somatostatin-receptor SPECT studies [6][7][8]. Radionuclide targeting of somatostatin receptors for internal radiation therapy provides another therapeutic approach in advanced symptomatic non-operable MTC [8,10]. ...
Scintigraphy is a medical examination performed in gamma cameras after the detection of gamma ray emissions from radioactive isotopes. It can acquire static or dynamic planar images, including whole-body sweep scans or tridimensional images after the reconstruction of multiple-angle planar acquisitions (single-photon emission computed tomography—SPECT). After radiation emission, a few steps are necessary before imaging reconstruction including collimation to improve spatial resolution, signal amplification, and a computational positioning system. Hybrid equipment is available to simultaneously acquire SPECT images and anatomic images through a conventional computed tomography (SPECT-CT).KeywordsScintigraphyPlanarSPECTSPECT-CT
Adrenal masses are a frequent finding in clinical practice. Many of them are incidentally discovered with a prevalence of 4% in patients undergoing abdominal anatomic imaging and require a differential diagnosis. Biochemical tests, evaluating hormonal production of both adrenal cortex and medulla (in particular, mineralocorticoids, glucocorticoids and catecholamines), have a primary importance in distinguishing functional or non-functional lesions. Conventional imaging techniques, in particular computerized tomography (CT) and magnetic resonance imaging (MRI), are required to differentiate between benign and malignant lesions according to their appearance (size stability, contrast enhanced CT and/or chemical shift on MRI). In selected patients, functional imaging is a non-invasive tool able to explore the metabolic pathways involved thus providing additional diagnostic information. Several single photon emission tomography (SPET) and positron emission tomography (PET) radiopharmaceuticals have been developed and are available, each of them suitable for studying specific pathological conditions. In functional masses causing hypersecreting diseases (mainly adrenal hypercortisolism, primary hyperaldosteronism and pheochromocytoma), functional imaging can lateralize the involvement and guide the therapeutic strategy in both unilateral and bilateral lesions. In non-functioning adrenal masses with inconclusive imaging findings at CT/MR, [18F]-FDG evaluation of tumor metabolism can be helpful to characterize them by distinguishing between benign nodules and primary malignant adrenal disease (mainly adrenocortical carcinoma), thus modulating the surgical approach. In oncologic patients, [18F]-FDG uptake can differentiate between benign nodule and adrenal metastasis from extra-adrenal primary malignancies.
Identification of cervical metastatic lymph nodes (LN) on I-131 post-ablation whole-body planar scans (WBS) for cancer staging is crucial for patients with papillary thyroid cancer (PTC). The existing deep network is plagued by instability in finding the under-represented LN classes on highly complex WBS, where end-to-end tuned models that can account for this uncertainty region for multi-class locations are needed. Hence, as a key contribution of this study, we designed a novel leveraging segmentation network with input guidance (LSIG) end-to-end training model without pre and post-processing features that can learn ideal parameter settings depending on the quantity of multiple-object instances. To improve the co-occurrence of classes and control the false positive regions, we proposed a re-weighting negative control (RNC) mechanism that combines two key components, namely the re-weighting (Rw) term and the negative control function (NcF). This unified approximation of weighted training would leverage the network to control and learn the desired weights of true positives towards the LN region. As an end-to-end network training, we utilize a Unet-like convolution neural network (CNN) model. The performance of the LSIG is compared with the CNN-based networks, based on the ground truth (GT) mask developed using post-ablation single-photon emission computed tomography (SPECT/CT). Furthermore, the effectiveness of the two components used in the LSIG framework is evaluated on WBS datasets. Our proposed LSIG with a fully guided (Fg) LS-FgCNN model yielded a superior performance with high AUC value of 94.9%, which is 14.6% higher than the previous network for PTC.
