Bolesti paratireoidnih žlijezda često dovode do oštećenja bubrega poput primarnog hiperparatireoidizma ili se javljaju kao posljedica insuficijencije bubrega u sekundarnom i tercijarnom ...hiperparatireoidizmu. Bolesnici razvijaju hiperkalcemiju s povišenom razinom PTH, a većina ima smanjenu mineralnu gustoću kostiju uz deformitete, bolove i sklonost prijelomima, ali i oštećenje bubrežne funkcije, nefrokalcinozu ili nefrolitijazu uz opstruktivnu uropatiju. Cilj izvješća je predstaviti nuklearno-medicinske metode u dijagnostici i liječenju bolesnika s poremećajima paratireoidnih žlijezda. Najčešće korištene slikovne metode u dijagnostici jesu ultrazvuk visoke rezolucije s obojenim doplerom, zatim SPECT/CT scintigrafija u kombinaciji s kompjutoriziranom tomografijom s tehnecij-99m sestamibijem (Tc-99m-MIBI), te po potrebi PET/CT s fluor 18-kolinom. Ultrazvuk može biti praćen ciljanom citološkom punkcijom, a iz punktata se može odrediti i razina PTH koji također služi za potvrdu dijagnoze u slučaju da citološka analiza ne pokaže pravo podrijetlo epitelnih stanica iz punktata. U odjelima nuklearne medicine određuju se i laboratorijski parametri, odnosno razina PTH u serumu, važna u praćenju bolesnika. Najčešće se koriste kombinacije nekoliko različitih slikovnih metoda za određivanje veličine, položaja i odnosa paratireoidnih žlijezdi s okolnim strukturama, a u radu su prezentirane glavne indikacije te prednosti i ograničenja svake od metoda uz slikovni materijal.
We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the absorbed dose to the surgeon ...and surgical staff. Intraoperative positron emitter detection enabled the resection of a small parathyroid gland, resulting in normal postoperative values of PTH and serum calcium in a 69-year-old woman. Calculated whole-body dose to the surgical staff and surgeons' fingers is well below the annual limits for exposed workers and the general public. Intraoperative F-FCH detection with handheld probe is a safe and feasible method for localizing small parathyroid glands.
AIMTo investigate the diagnostic accuracy of O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) and fluoromethyl-(18F)-dimethyl-2-hydroxyethyl-ammonium chloride (18F-FCH) computed tomography (CT) in patients ...with primary low-grade gliomas (LGG). METHODSThe study enrolled patients with magnetic resonance imaging (MRI)-suspected LGG. Patients underwent both 18F-FET and 18F-FCH positron emission tomography (PET)-CT. Brain PET-CT was performed according to standard protocol - 20 minutes after intravenous injection of 185 MBq of 18F-FET and 185 MBq of 18F-FCH PET. Surgery and pathohistological diagnosis were performed in the next two weeks. RESULTSWe observed significantly better concordance between tumor histology and 18F-FET PET (weighted Kappa 0.74) compared with both 18F-FCH (weighted Kappa 0.15) and MRI (weighted Kappa 0.00). Tumor histology was significantly associated with 18F-FET (odds ratio 12.87; 95% confidence interval CI, 0.49-333.70; P=0.013, logistic regression analysis). Receiver operating characteristic curve analysis comparing 18F-FCH (area under the curve AUC 0.625, 95% CI 0.298-0.884) and 18F-FET (AUC 0.833, 95% CI 0.499-0.982) showed better diagnostic properties of 18F-FET (AUC difference 0.208, 95% CI -0.145 to 0.562, P=0.248). CONCLUSIONPerforming PET-CT in patients with newly diagnosed LGG should be preceded by a selection of an appropriate radiopharmaceutical. 18F-FET seems to be more accurate than 18F-FCH in the LGG diagnosis.
Locally invasive papillary thyroid carcinoma (PTC) protrudes beyond the thyroid capsule and invades local structures. Matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) are implicated in ...local invasion and metastasis in PTC. The aim of our study was to determine expression levels of MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2 in tissue specimens of invasive and non-invasive PTC. Our hypothesis was that expression levels of these biomarkers correlate with the development of locally invasive PTC. In our single-center study we retrospectively investigated MMP and TIMP expression levels in 50 samples of thyroid tissue diagnosed as locally invasive papillary carcinoma (study group) and 30 samples of thyroid tissue diagnosed as non-invasive, non-metastatic papillary carcinoma (control group). Tissue specimens were immunohistochemically stained with primary monoclonal antibodies against MMP-1, MMP-2, MMP-9, TIMP-1, and TIMP-2. When correlating expression levels of MMPs and TIMPs in thyroid tissue, statistically significant differences were found for MMP-1 and TIMP-1 expression (p < 0.001; Mann−Whitney U test) with the highest levels of expression in the invasive PTC group. Although expression of MMP-9 and TIMP-2 was higher in invasive PTC, the differences were not statistically significant. Elevated expression of MMP-1 and TIMP-1 in tumor tissue can predict invasiveness for PTC.
SAŽETAK
Dezmoidni tumori su rijetke benigne tvorbe podrijetla vezivnog tkiva koje sporo rastu, ne metastaziraju, ali mogu invadirati okolna tkiva. Cilj izvješća je prikaz bolesnice s dezmoidnim ...tumorom razvijenim u ležištu lijevog režnja štitnjače nakon prethodnoga operacijskog zahvata totalne tireoidektomije zbog multinodularne guše s ekstirpacijom adenoma paratireoidne žlijezde u istom aktu. Zbog promuklosti i osjećaja bolnosti u ležištu štitnjače dvije godine nakon inicijalnog zahvata kod bolesnice je učinjen kontrolni ultrazvuk vrata koji verificira slabo ograničen, nehomogen, pretežno izoehogen čvor tvrde konzistencije u ležištu lijevog režnja štitnjače koji je po svojim ehografskim karakteristikama bio suspektan na malignu promjenu. Ciljana citološka punkcija opisuje rijetke vretenaste stanice, ali bez drugih elemenata za pobližu diferencijaciju. Stoga je ultrazvučni pregled dopunjen drugim slikovnim radiološkim metodama (kompjutorizirana tomografija i magnetska rezonancija) koje postavljaju sumnju na paragangliom ili adenom paratireoidne žlijezde, ali se nije mogla sa sigurnošću isključiti ni promjena druge etiologije. Zbog navedenog kod bolesnice je preporučena kirurška ekscizija koja je bila zahtjevna zbog tvrdoće navedene tvorbe. Patohistološki nalaz je odgovarao ekstraabdominalnoj fibromatozi, odnosno dezmoidnom tumoru s mogućom pojavom recidiva. Iako je dezmoidni tumor općenito benigna bolest, ponekad može biti lokalno invazivan s infiltracijom okolnih struktura oponašajući sliku malignog procesa uz otežanu potpunu kiruršku eksciziju koja je terapija izbora. Štoviše, unatoč potpunom uklanjanju čest je recidiv bolesti pa bolesnike s dezmoidnim tumorom treba povremeno kontrolirati.
We aimed to assess the additional value of SPECT/CT over planar lymphoscintigraphy (PI) in sentinel node (SN) detection in malignancies with different lymphatic drainage such as breast cancer, ...melanoma, and pelvic tumors.
From 2010 to 2013, 1,508 patients were recruited in a multicenter study: 1,182 breast cancer, 262 melanoma, and 64 pelvic malignancies (prostate, cervix, penis, vulva). PI was followed by SPECT/CT 1-3 h after injection of (99m)Tc-colloid particles. Surgery was performed the same or next day.
Significantly more SNs were detected by SPECT/CT for breast cancer (2,165 vs. 1,892), melanoma (602 vs. 532), and pelvic cancer (195 vs. 138), all P < 0.001. The drainage basin mismatch between PI and SPECT/CT was 16.5% for breast cancer, 11.1% for melanoma, and 51.6% for pelvic cancers. Surgical adjustment was 17% for breast cancer, 37% for melanoma, and 65.6% for pelvic cancer.
SPECT/CT detected more SNs and changed the drainage territory, leading to surgical adjustments in a considerable number of patients in all malignancies studied but especially in the pelvic cancer group because of this group's deep lymphatic drainage. We recommend SPECT/CT in all breast cancer patients with no SN visualized on PI, all patients with melanoma of the head and neck or trunk, all patients with pelvic malignancies, and those breast cancer and melanoma patients with unexpected drainage on PI.
Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) provides unique information about the metabolic behavior of the malignant tumors, independent of morphological criteria. This ...technique is more sensitive in imaging lymphoma prior to therapy than conventional computed tomography (CT) imaging and Ga-67 scintigraphy. FDG-PET performed in patients with lymphoma offers important additional information on the presence of viable disease in residual masses of the tumor. It is also of great value in assessing therapy response in patients with Hodgkin s disease and non-Hodgkin s lymphoma, because of its ability to differentiate between fibrosis and active tumor. More studies are needed to assess the value of this method in long-term follow-up. In our institution this method is mostly used for clarification of residual post-therapy abnormalities that fall under the category of unconfirmed/uncertain complete remission. Our preliminary data on 14 patients indicate that this non-invasive, metabolic imaging is superior to CT and other conventional diagnostic methods in the post-therapy staging of lymphoma.
The aim of this prospective observational study was to examine the benefit of a fluorine-18-L-dihydroxyphenylalanine (F-DOPA) PET/computed tomography (CT) scan in patients with medullary thyroid ...carcinoma (MTC) in terms of increased calcitonin levels.
Twenty-eight MTC patients after initial total thyreoidectomy with increasing follow-up calcitonin levels suggestive for active disease after negative conventional imaging findings (neck ultrasound or thorax, abdomen, pelvis multislice computed tomography as standard imaging) were scanned using F-DOPA PET/CT from November 2012 to April 2016. The mean calcitonin level was 108.5 (range: 6.7-290) pmol/l and the mean carcinoembryonic antigen level was 15.7 (range: 1.1-221.9) μg/l. The mean follow-up period was 19.7 months.
F-DOPA PET/CT was positive in 16 out of 28 (57%) patients, mostly because of metabolically active neck and mediastinal lymph nodes metastases. Previously unknown bone metastases were found in six patients. A positive scan was reported in four patients (25% of positive scans) with a very low calcitonin value of less than 49.9 pmol/l. PET/CT findings led to a change of management and therapy in 16 out of 28 patients, with surgical procedure performed in eight patients, radiotherapy in five patients, and chemotherapy in two patients.
F-DOPA PET/CT is a clinically useful modality in MTC whenever the calcitonin level is increased. There is a clear trend toward more positive scans with the higher calcitonin values, but patients with moderately elevated calcitonin values should also be taken into consideration for molecular imaging with F-DOPA PET/CT as the tumor burden in these patients is probably low, enabling further therapy to be individualized and consequently more efficient.
PDF
