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Andreas Kjaer - One of the best experts on this subject based on the ideXlab platform.
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functional imaging of neuroendocrine tumors a head to head comparison of somatostatin receptor Scintigraphy 123i mibg Scintigraphy and 18f fdg pet
The Journal of Nuclear Medicine, 2010Co-Authors: Tina Binderup, Ulrich Knigge, Annika Loft, Jann Mortensen, Andreas Pfeifer, Birgitte Federspiel, Carsten Palnaes Hansen, Liselotte Hojgaard, Andreas KjaerAbstract:Functional techniques are playing a pivotal role in the imaging of cancer today. Our aim was to compare, on a head-to-head basis, 3 functional imaging techniques in patients with histologically verified neuroendocrine tumors: somatostatin receptor Scintigraphy (SRS) with 111 In-diethylenetriaminepentaacetic acidoctreotide, Scintigraphy with 123I-metaiodobenzylguanidine (MIBG), and 18 F-FDG PET.Methods:Ninety-six prospectively enrolled patients with neuroendocrine tumors underwent SRS, 123 I-MIBG Scintigraphy, and 18 F-FDG PET on average within 40 d. The functional images were fused with low-dose CT scans for anatomic localization, and the imaging results were compared with the proliferation index as determined by Ki67. Results: The overall sensitivity of SRS, 123 I-MIBG Scintigraphy, and 18 F-FDG PET was 89%, 52%, and 58%, respectively. Of the 11 SRS-negative patients, 7 were 18 F-FDG PET-positive, of which 3 were also 123 I-MIBG Scintigraphy‐ positive, giving a combined overall sensitivity of 96%. SRS also exceeded 123 I-MIBG Scintigraphy and 18 F-FDG PET based on the number of lesions detected (393, 185, and 225, respectively) and tumor subtypes. 123 I-MIBG Scintigraphy was superior to 18F-FDG PET for ileal neuroendocrine tumors, and 18 F-FDG PET was superior to 123 I-MIBG Scintigraphy for pancreaticoduodenal neuroendocrine tumors. The sensitivity of 18 F-FDG PET (92%) exceeded that of both SRS (69%) and 123 I-MIBG Scintigraphy (46%) for tumorswithap roliferation index above 15%. Conclusion: The overall sensitivity of 123 I-MIBG Scintigraphy and 18 F-FDG PET was low compared with SRS. However, for tumors with a high proliferation rate, 18 F-FDG PET had the highest sensitivity. The results indicate that, although SRS should still be the routine method, 18 F-FDG PET provides complementary diagnostic information and is of value for neuroendocrine tumor patients with negative SRS findings or a high proliferation index.
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fever of unknown origin prospective comparison of diagnostic value of 18f fdg pet and 111in granulocyte Scintigraphy
European Journal of Nuclear Medicine and Molecular Imaging, 2004Co-Authors: Andreas Kjaer, Annemette Lebech, Annika Eigtved, Liselotte HojgaardAbstract:The diagnostic work-up in patients with fever of unknown origin (FUO) is often challenging and frequently includes nuclear medicine procedures. Whereas a role for leucocyte or granulocyte Scintigraphy in FUO is generally accepted, a possible role of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in these patients remains to be established. To study this, we compared prospectively, on a head-to-head basis, the diagnostic value of FDG-PET and indium-111 granulocyte Scintigraphy in patients with FUO. Nineteen patients with FUO underwent both FDG-PET and 111In-granulocyte Scintigraphy within 1 week. FDG-PET scans and granulocyte scintigrams were reviewed by different doctors who were blinded to the result of the other investigation. The diagnostic values of FDG-PET and granulocyte Scintigraphy were evaluated with regard to identification of a focal infectious/inflammatory or malignant cause of FUO. The sensitivity of granulocyte Scintigraphy and FDG-PET were 71% [95% confidence interval (CI): 37–85%] and 50% (CI: 16–84%), respectively. The specificity of granulocyte Scintigraphy was 92% (71–100%), which was significantly higher than that of FDG-PET, at 46% (34–62%). Positive and negative predictive values for granulocyte Scintigraphy were both 85%. Positive and negative predictive values for FDG-PET were 30% and 67%, respectively. 111In-granulocyte Scintigraphy has a superior diagnostic performance compared to FDG-PET for detection of a localised infectious/inflammatory or neoplastic cause of FUO. The poorer performance of FDG-PET is in particular attributable to a high percentage of false positive scans, leading to low specificity.
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Scintigraphy in Patients with Fever of Unknown Origin
2002Co-Authors: Andreas Kjaer, Annemette LebechAbstract:111In-granulocyte Scintigraphy is often used as a diagnostic tool in patients with fever of unknown origin (FUO). However, its diagnostic performance has been studied in only a limited number of investigations, with most having been published more than 10 y ago; in addition, a broad range of sensitivities and specificities has been reported. Therefore, the aim of this study was to investigate the diagnostic value of granulocyte Scintigraphy in patients fulfilling the criteria of FUO. Also studied was whether increased peripheral leukocyte count or C-reactive protein (CRP) level could be used to select patients for Scintigraphy to raise the diagnostic value. Methods: For 31 patients with true FUO who underwent granulocyte Scintigraphy at a third-line referral hospital between 1995 and 2000, the files and Scintigraphy findings were reviewed retrospectively to test the ability of Scintigraphy to identify infection or chronic inflammatory bowel disease as the cause of FUO. In addition, leukocyte counts and CRP values were recorded. Results: Scintigrams were true-positive in 6 cases, false-positive in 4 cases, true-negative in 19 cases, and false-negative in 2 cases. Sensitivity was 75%, specificity was 83%, the predictive value of a scintigram showing positive findings was 60%, and the predictive value of a scintigram showing negative findings was 90%. Leukocyte counts did not differ between patients with true-positive and true-negative scintigrams. In contrast, CRP was elevated in all patients with true-positive scintigrams but in only half the patients with truenegative scintigrams. However, if only patients with elevated CRP were used for calculation of test performance, the test performance was not improved. Conclusion: 111In-granulocyte Scintigraphy seems to have a reasonable sensitivity and specificity in cases of FUO, when one takes into account that 111 In-granulocyte Scintigraphy is not a first-line test. The high predictive value of a scintigram showing negative findings may be especially valuable for ruling out an infectious cause of FUO. Neither peripheral leukocyte count nor CRP levels seem useful for selection of patients on whom Scintigraphy should be performed.
Daniele Gasparini - One of the best experts on this subject based on the ideXlab platform.
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localization of parathyroid enlargement experience with technetium 99m methoxyisobutylisonitrile and thallium 201 Scintigraphy ultrasonography and computed tomography
European Journal of Nuclear Medicine and Molecular Imaging, 1994Co-Authors: Onelio Geatti, Brahm Shapiro, Pier Giuseppe Orsolon, Gianni Proto, Ugo Paolo Guerra, Francesco Antonucci, Daniele GaspariniAbstract:Technetium-99m methoxyisobutylisonitrile (MIBI), like thallium-201, has recently been introduced as a myocardial perfusion agent and is now also showing very promising results in parathyroid scintigrapy. The results of 201Tl/99mTc-pertechnetate and 99mTc-MIBI/99mTc-pertechnetate subtraction Scintigraphy, ultrasonography and computed tomography are presented in a series of 43 patients operated on for hyperparathyroidism. All four imaging modalities were confirmed to be reliable, Scintigraphy being the most accurate. Sensitivities ranged from 81% to 95%, that of 99mTc-MIBI being the highest. Moreover this tracer, which has more favourable physical and also biochemical properties, yielded images of superior quality. This allowed localization of the lesion by visual inspection only in as many as 86% of the patients with positive 99mTc-MIBI/99mTc-pertechnetate subtraction Scintigraphy. We believe that the higher sensitivity, superior image quality and lower cost of 99mTc-MIBI imaging will make 99mTc-MIBI the new radiopharmaceutical of choice for parathyroid Scintigraphy (when one takes into account the stability of labelling with large activities it is possible to perform three or four cardiac studies together with one parathyroid scintigraphic examination using one lyophililzed vial).
Renaud Ciappuccini - One of the best experts on this subject based on the ideXlab platform.
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dual phase 99mtc sestamibi Scintigraphy with neck and thorax spect ct in primary hyperparathyroidism a single institution experience
Clinical Nuclear Medicine, 2012Co-Authors: Renaud Ciappuccini, Julia Morera, Pierre Pascal, J P Rame, Natacha Heutte, Nicolas Aide, Emmanuel Abi, Yves Reznik, Stephane ArdeAbstract:PURPOSE: To assess the diagnostic value of dual-phase (99m)Tc sestamibi Scintigraphy with neck and thorax single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with primary hyperparathyroidism, and to analyze the relationships between SPECT/CT data and serum calcium or parathyroid hormone (PTH) concentrations. MATERIALS AND METHODS: (99m)Tc sestamibi Scintigraphy was performed in 94 consecutive patients. Images included early and delayed planar neck images and delayed neck and thorax SPECT/CT. Scintigraphy was scored positive or negative. RESULTS: Fifty-nine sestamibi studies (63%) were positive. SPECT/CT demonstrated a single focus in 56 patients, in usual parathyroid sites in 80% of cases and in unusual sites in the remaining 20% (retrotracheal area, 7%; intrathyroidal, 9%; mediastinum, 4%), and double foci in 3. Serum calcium values were higher in patients with a positive Scintigraphy than in those with a negative Scintigraphy (2.80 vs. 2.66 mmol/L, P = 0.001) with similar figures for serum PTH values (129 vs. 107 pg/mL, P = 0.0649). In patients with a measurable parathyroid adenoma on integrated CT scan (n = 43), the greatest axial diameter of the adenoma was correlated to serum calcium (r = 0.405, P < 0.0071) or PTH concentrations (r = 0.589, P < 0.0001). Fifty-four patients underwent surgery, 45 with a positive, and 9 with a negative preoperative Scintigraphy, resulting in a sensitivity of 92% (95% CI: 80-98) and a specificity of 83% (95% CI: 36-100). CONCLUSIONS: Dual-phase (99m)Tc sestamibi Scintigraphy with SPECT/CT enables to identify a parathyroid adenoma in about two-thirds of patients with primary hyperparathyroidism and allows the surgeon to plan appropriate surgery. The likelihood of Scintigraphy to be positive is affected by calcium or PTH concentrations.
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Dual-Phase 99mTc Sestamibi Scintigraphy With Neck and Thorax SPECT/CT in Primary Hyperparathyroidism: a Single-Institution Experience
Clinical Nuclear Medicine, 2012Co-Authors: Renaud Ciappuccini, Julia Morera, Pierre Pascal, J P Rame, Natacha Heutte, Nicolas Aide, Yves Reznik, Emmanuel Babin, Stéphane BardetAbstract:Purpose: To assess the diagnostic value of dual-phase 99mTc sestamibi Scintigraphy with neck and thorax single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with primary hyperparathyroidism, and to analyze the relationships between SPECT/CT data and serum calcium or parathyroid hormone (PTH) concentrations. Materials and Methods: 99mTc sestamibi Scintigraphy was performed in 94 consecutive patients. Images included early and delayed planar neck images and delayed neck and thorax SPECT/CT. Scintigraphy was scored positive or negative. Results: Fifty-nine sestamibi studies (63%) were positive. SPECT/CT demonstrated a single focus in 56 patients, in usual parathyroid sites in 80% of cases and in unusual sites in the remaining 20% (retrotracheal area, 7%; intrathyroidal, 9%; mediastinum, 4%), and double foci in 3. Serum calcium values were higher in patients with a positive Scintigraphy than in those with a negative Scintigraphy (2.80 vs. 2.66 mmol/L, P = 0.001) with similar figures for serum PTH values (129 vs. 107 pg/mL, P = 0.0649). In patients with a measurable parathyroid adenoma on integrated CT scan (n = 43), the greatest axial diameter of the adenoma was correlated to serum calcium (r = 0.405, P < 0.0071) or PTH concentrations (r = 0.589, P < 0.0001). Fifty-four patients underwent surgery, 45 with a positive, and 9 with a negative preoperative Scintigraphy, resulting in a sensitivity of 92% (95% CI: 80-98) and a specificity of 83% (95% CI: 36-100). Conclusions: Dual-phase 99mTc sestamibi Scintigraphy with SPECT/CT enables to identify a parathyroid adenoma in about two-thirds of patients with primary hyperparathyroidism and allows the surgeon to plan appropriate surgery. The likelihood of Scintigraphy to be positive is affected by calcium or PTH concentrations.
Liselotte Hojgaard - One of the best experts on this subject based on the ideXlab platform.
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functional imaging of neuroendocrine tumors a head to head comparison of somatostatin receptor Scintigraphy 123i mibg Scintigraphy and 18f fdg pet
The Journal of Nuclear Medicine, 2010Co-Authors: Tina Binderup, Ulrich Knigge, Annika Loft, Jann Mortensen, Andreas Pfeifer, Birgitte Federspiel, Carsten Palnaes Hansen, Liselotte Hojgaard, Andreas KjaerAbstract:Functional techniques are playing a pivotal role in the imaging of cancer today. Our aim was to compare, on a head-to-head basis, 3 functional imaging techniques in patients with histologically verified neuroendocrine tumors: somatostatin receptor Scintigraphy (SRS) with 111 In-diethylenetriaminepentaacetic acidoctreotide, Scintigraphy with 123I-metaiodobenzylguanidine (MIBG), and 18 F-FDG PET.Methods:Ninety-six prospectively enrolled patients with neuroendocrine tumors underwent SRS, 123 I-MIBG Scintigraphy, and 18 F-FDG PET on average within 40 d. The functional images were fused with low-dose CT scans for anatomic localization, and the imaging results were compared with the proliferation index as determined by Ki67. Results: The overall sensitivity of SRS, 123 I-MIBG Scintigraphy, and 18 F-FDG PET was 89%, 52%, and 58%, respectively. Of the 11 SRS-negative patients, 7 were 18 F-FDG PET-positive, of which 3 were also 123 I-MIBG Scintigraphy‐ positive, giving a combined overall sensitivity of 96%. SRS also exceeded 123 I-MIBG Scintigraphy and 18 F-FDG PET based on the number of lesions detected (393, 185, and 225, respectively) and tumor subtypes. 123 I-MIBG Scintigraphy was superior to 18F-FDG PET for ileal neuroendocrine tumors, and 18 F-FDG PET was superior to 123 I-MIBG Scintigraphy for pancreaticoduodenal neuroendocrine tumors. The sensitivity of 18 F-FDG PET (92%) exceeded that of both SRS (69%) and 123 I-MIBG Scintigraphy (46%) for tumorswithap roliferation index above 15%. Conclusion: The overall sensitivity of 123 I-MIBG Scintigraphy and 18 F-FDG PET was low compared with SRS. However, for tumors with a high proliferation rate, 18 F-FDG PET had the highest sensitivity. The results indicate that, although SRS should still be the routine method, 18 F-FDG PET provides complementary diagnostic information and is of value for neuroendocrine tumor patients with negative SRS findings or a high proliferation index.
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fever of unknown origin prospective comparison of diagnostic value of 18f fdg pet and 111in granulocyte Scintigraphy
European Journal of Nuclear Medicine and Molecular Imaging, 2004Co-Authors: Andreas Kjaer, Annemette Lebech, Annika Eigtved, Liselotte HojgaardAbstract:The diagnostic work-up in patients with fever of unknown origin (FUO) is often challenging and frequently includes nuclear medicine procedures. Whereas a role for leucocyte or granulocyte Scintigraphy in FUO is generally accepted, a possible role of fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in these patients remains to be established. To study this, we compared prospectively, on a head-to-head basis, the diagnostic value of FDG-PET and indium-111 granulocyte Scintigraphy in patients with FUO. Nineteen patients with FUO underwent both FDG-PET and 111In-granulocyte Scintigraphy within 1 week. FDG-PET scans and granulocyte scintigrams were reviewed by different doctors who were blinded to the result of the other investigation. The diagnostic values of FDG-PET and granulocyte Scintigraphy were evaluated with regard to identification of a focal infectious/inflammatory or malignant cause of FUO. The sensitivity of granulocyte Scintigraphy and FDG-PET were 71% [95% confidence interval (CI): 37–85%] and 50% (CI: 16–84%), respectively. The specificity of granulocyte Scintigraphy was 92% (71–100%), which was significantly higher than that of FDG-PET, at 46% (34–62%). Positive and negative predictive values for granulocyte Scintigraphy were both 85%. Positive and negative predictive values for FDG-PET were 30% and 67%, respectively. 111In-granulocyte Scintigraphy has a superior diagnostic performance compared to FDG-PET for detection of a localised infectious/inflammatory or neoplastic cause of FUO. The poorer performance of FDG-PET is in particular attributable to a high percentage of false positive scans, leading to low specificity.
Stephane Arde - One of the best experts on this subject based on the ideXlab platform.
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dual phase 99mtc sestamibi Scintigraphy with neck and thorax spect ct in primary hyperparathyroidism a single institution experience
Clinical Nuclear Medicine, 2012Co-Authors: Renaud Ciappuccini, Julia Morera, Pierre Pascal, J P Rame, Natacha Heutte, Nicolas Aide, Emmanuel Abi, Yves Reznik, Stephane ArdeAbstract:PURPOSE: To assess the diagnostic value of dual-phase (99m)Tc sestamibi Scintigraphy with neck and thorax single-photon emission computed tomography/computed tomography (SPECT/CT) in patients with primary hyperparathyroidism, and to analyze the relationships between SPECT/CT data and serum calcium or parathyroid hormone (PTH) concentrations. MATERIALS AND METHODS: (99m)Tc sestamibi Scintigraphy was performed in 94 consecutive patients. Images included early and delayed planar neck images and delayed neck and thorax SPECT/CT. Scintigraphy was scored positive or negative. RESULTS: Fifty-nine sestamibi studies (63%) were positive. SPECT/CT demonstrated a single focus in 56 patients, in usual parathyroid sites in 80% of cases and in unusual sites in the remaining 20% (retrotracheal area, 7%; intrathyroidal, 9%; mediastinum, 4%), and double foci in 3. Serum calcium values were higher in patients with a positive Scintigraphy than in those with a negative Scintigraphy (2.80 vs. 2.66 mmol/L, P = 0.001) with similar figures for serum PTH values (129 vs. 107 pg/mL, P = 0.0649). In patients with a measurable parathyroid adenoma on integrated CT scan (n = 43), the greatest axial diameter of the adenoma was correlated to serum calcium (r = 0.405, P < 0.0071) or PTH concentrations (r = 0.589, P < 0.0001). Fifty-four patients underwent surgery, 45 with a positive, and 9 with a negative preoperative Scintigraphy, resulting in a sensitivity of 92% (95% CI: 80-98) and a specificity of 83% (95% CI: 36-100). CONCLUSIONS: Dual-phase (99m)Tc sestamibi Scintigraphy with SPECT/CT enables to identify a parathyroid adenoma in about two-thirds of patients with primary hyperparathyroidism and allows the surgeon to plan appropriate surgery. The likelihood of Scintigraphy to be positive is affected by calcium or PTH concentrations.
