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Radioactive Iodine Therapy in Papillary Thyroid Carcinoma with Moyamoya Disease

Andrew Dominic S. Kalaw ; Leandro C. Manalaysay

The Philippine Journal of Nuclear Medicine.2018;13(1):12-16.

Papillary thyroid carcinoma is the most common histological subtyoe if thyroid carcinoma. Management is surgical with post-operative radioodine therapy to ablate thyroid tissue remnants. Although the mangement of uncomplicated papillary thyroid carcinoma is well established,treatment of patients also affected with Moyamoya disease is limitedly describe. Theare are concerns with regards to doing radioactive iodine therapy, which might affect the seased arteries in Moyamoya disease. We report a case of a 36-year-old male with Moyamoya disease, who was subsequently diagnosed to have papillary thyroid carcinoma. After total thyroidectory, the patient underwent radioactive iodine therapy with 5.7 GBq (155.0 mCi). Post-oblation scan with SPECT of the pelvis-showed functional thyroid tissue remnants in the lower anterior neck with suspicious tracer-avid focus in the sacrum. There were no complications such as radiation-induced arteritis encountered with the patient's MOyamoya disease during post-operative high-dose radiooidine ablation and no subjective complaints even on follow-up after almost one year.
Thyroid Cancer, Papillary ; Moyamoya Disease

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Role of 18F-FDG PET/CT in the diagnostic work-up of renal cell carcinoma presenting as low back pain

Patrick Earl A Fernando ; Patricia A. Bautista

The Philippine Journal of Nuclear Medicine.2018;13(1):7-11.

Low back pain is common among adults, but back pain secondary to a metastatic carcinoma is rare. We present a case of a 71-year-old male with low back pain who was referred for a 18F-FDG PET/CT scan due to suspicious-looking skeletal lesions on MRI. On PET/CT, multiple foci of increased FDG uptake were noted in the axial and appendicular skeleton. When correlated with a non-contrast CT stonogram done 2 months prior, an exophytic lesion in the right kidney did not show FDG update; rather, it was in the left kidney where an FDG-avid focus was seen. A concomitant bone scan revealed fewer bone lesions when compared with the PET/CT findings. Biopsies of the left renal mass and a vertebral lession were consistent with metastatic renal cell carcinoma. While not a first-line diagnostic test in the management of low back pain, 18F-FDG PET/CT scan can be valuable in cases where metasis highly suspected without a known primary carcinoma site.
Low Back Pain ; Carcinoma, Renal Cell

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Role of Tc-99m MDP Bone Scintigraphy in the evaluation of suspected Chondrosarcoma from OIiier Disease: A rare case repor

Sarameth Thou ; Patricia A. Bautista ; Eduardo Erasto S. Ongkeko ; Bridget Nancy A Coote

The Philippine Journal of Nuclear Medicine.2018;13(1):19-22.

OIiier disease is a rare nonhereditary disorder characterized by multiple enchondromas in which malignant changes may occur. We report the case of a 15-year-old male with Ollier disease who presented with a large mass in the left upper arm for several months. Radiography revealed hugelytic mass in the proximal half to two-thrids of the left humerus. Bone scan showed irregularly increased tracer uptake in the head to mid shaft of the left humerus that is suggestive of malignant disease. Pathology analysis demonstrated proximal humeral chondrosarcoma, grade 1. In Ollier disease, bone scan may be used for monitoring the lessions with suspicion for malignant transpormation.
Chondrosarcoma ; Enchondromatosis

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Scintigraphic patterns of bone metastases in commonly encountered malignancies

Nicole Patricia A Hui ; Angelo 0. Martinez

The Philippine Journal of Nuclear Medicine.2018;13(1):23-27.

Introduction: Bone scan is the modality of choice for evaluation of bone metases in asymptomatic patients primary malignancy. The distribution and pattern of bone metases in prostate, breast, and lung malignancies are investigated using bone scan results. This could aid future interpretation of bone scans and narrow down the differential diagnoses by establishing the likely regional location of metastatic bone disease in commonly encountered malignancies. Materials and methods: Chart review of a total of 411 patients with histologically proven malignant disease, who underwent bone scan in the Division of Nuclear Medicine of the Philippine Heart Center for the first time from October 2013 to October 2016, was conducted. Results: Out of 411 patients, 149 had metastatic bone disease; 42 (28.2%) had lung cancer, 26 (17.4%) had prostate cancer, 60 (40.3%) had breast cancer, while the remaining 21 (14.1%) had other primary malignancies. Majority of the lessions were multiple and were found in the ribs, vertebrae and pelvic bones for lung cancer; ribs, lower thoraric and lumbar vertebrae, and pelvic bones for prostate and breast cancer. Conclusion There was no scintigraphic pattern attributable to a particular malignancy but rather, sites of predilection were observed in this study. The top 3 regions of distribution of bone metasis were as follows: for lung cancer, 1. ribs, 2. vertebrae, 3. pelvic bones; for prostate cancer,1. lower thoracic and lumbar vertebrae, 2. pelvic bones; 3. ribs; for breast cancer, 1. lower thoracic and lumbar vertebrae, 2. ribs, 3. pelvic bones. Involvement of the long bones wasw highest among lung and prostate cancers; whereas metasis to the sternum was most commonly seen in breast cancer.
Neoplasms

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Association of lymphovascular invasion with metastasis (loco-regional lymph node or distant) among adult Filipino patients with papillary thyroid carcinoma: A case control study

Eric Ray D. Linchangco ; Irene S. Bandong ; Gerard Fabian L. Goco

The Philippine Journal of Nuclear Medicine.2018;13(2):38-43.

Background/Objective: Papillary thyroid carcinoma is the most common type of thyroid cancer. Treatment includes surgery and remnant ablation with radioactive iodine theraphy while follow-up monitoring includes I- 131 whole body scans land thyroglobulin monitoring. Lymphovascular invasion (LVI) has been used as a predictor of metastasis in different cancers. Therefore, it might be useful in predicting metastasis in patients with papillary thyroid carcinoma since metastasis in this type of carcinoma travels via the lymphatic route. The purpose of this study was to determine the association of LVI with metastasis among patients with papillary thyroid carcinoma Methodology: Records of patients with papillary thyroid carcinoma (histopathologic reports, thyroglobulin levevls and I-131 whole body scans) were reviewed. Univariate and multivariate anlyses were performed. Results: A total of 108 subjects were recruited for this study, 47 (43.5%) of which had LVI. There was no association found between LVI and metastasis on baseline (p=0.72) and follow-up scans (p=0.07). However, there was an association between metastasis resolution on follow-up scans and high-dose radioactive treatment (p=0.02) regarless of presence or absence of LVI. Conclusion There was a significant association of the presence of LVI with elevated thyroglobulin levels (p-value<0.0001). A significant association was also seen with LVI and dose of activity with resolution of thyroid remnant, locoregional lymph node and distant metastasis (p=0.02). Even though no association jwas seen between LVI and metastasis, a robust percentage of patients with LVI were positive for metastasis on whole body scans.
Thyroid Cancer, Papillary

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Correlation of left ventricular eccentricity index with other scintigraphic parameters on gated myocardial perfusion single photon emission computed tomography

Danieson R. Lampano ; Jerry M. Obaldo

The Philippine Journal of Nuclear Medicine.2018;13(2):29-37.

Background: Left ventricular (LV) eccentricity index (EI) is a measure of the LV shapre obtained with a commonly used quantitative software for mycardial perfusion scintigraphy (MPS). However, there are limited studies evaluating its correlation with other MPS parameters, for which this study was done. Methodology: All patients who underwent 99mTc-sestamibi stress MPS from 2013 to 2015 were screened. A total of 353 patients, 228 (65%) males and 125 (35%) females, met the inclusion criteria. One hundred twenty-nine (37%) underwent exercise stress while 224 (63%) were given dipyridamole. Spearman's rho correlation was used to determine the correlation of rest and post-stress EI with the other study variables. Results: Among males, rest EI showed negative correlation with summed stress score (SSS) (rs = -0.182, p<0.005), transient ischemic dilatation (TID) (rs=-0.172, p=0.009), rest LV end-diastolic volume (EDV) (rs=-0.291, p < 0.001), rest LV end-systolic volume (ESV)(rs=-0.316, p < 0.001), p0-st-streSS LVEDV (rs= -0.218, p < 0.001), and post-stress LVESV (rs= -0.331, p < 0.001). There was positive correlation with rest LV ejection fraction (EF) (rs= 0.291,p < 0.001) and post-stress LVEF (r5 = 0. 336, p < 0. 001). No sig11ifico11t relationship with any of the MPS parameters was observed among females. For both exercise and dipyridamole groups. EI exhibited negative correlation with SSS, and rest and stress LVESV; and positive cotrelation with rest and post-stress LVEF. Significant relationship with rest and stress LVEDV was only observed in the dipyridamole group. Conclusions This study shows that EI is correlated with most, if not all, of the MPS parameters with different levels of association depending on the patient's sex and the type of stress employed. More spherical LV is correlated with more severe perfusion defects, larger LV cavity volumes and poorere LV systolic function.
Technetium Tc 99m Sestamibi ; Dipyridamole

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HbA1c and Myocardial lschemia detected via Myocardial Perfusion Scintigraphy in type 2 Diabetes Mellitus

Henry G. Canizares ; Allanbert G. Sampana ; Michele D. Ogbac

The Philippine Journal of Nuclear Medicine.2018;13(2):45-53.

Background/Objective: Coronary Artery Disease (CAD) is the leading cause of mortality among patients with type 2 diabetes mellitus. Several studies evaluated glycemic control and MPS resultswith good correlation. In the Philippines, data concerning this matter are few, hence this study. Methodology: This is a cross-sectional study of selected Filipino patients with type 2 diabetes mellitus without previous cardiac events who underwent stress or pharmacologic stress MPS (TI-201 or Tc-99m sestamibi) over an 18-month period at the Philippine Heart Center. Electrocardiogram and 2D echocardiogram results were also noted. Patients were grouped into adequate glycemic control (HbA1c<7.0%) and inadequate glycemic control (HbA1c >7.0%). Binary logistic regression was computed to determine association of glycemic control to MPS defects. Results: A total of 206 subjects (114 HBa1C <7.0%, 92 with HbA1c ? 7.0%), were included in the study; with male predominance. Mean HbA1c values showed direct correlation; the higher the HbA1c values, the more MPS defects. Inadequate glycemic control group had significanlty higher subjects with mild and moderate to severe degree of myocardial ischemia (p<0.001). the relative risk of having a significant CAD in the inadequate glycemic control group is 4.30 times more than their counterpart (p<0.001). Factoring the duration of inadequate glycemic control to > 10 years, relative risk increased to 7.63 Conclusion The study shows that patients with type 2 diabetes mellitus with inadequate glycemic control have increased MPS defects and highter relative risk for having significant CAD. Diabetic patients with inadequate glycemic control for > 10 years have an even higher risk of having significant CAD.
Myocardial Perfusion Imaging ; Coronary Artery Disease ; Diabetes Mellitus, Type 2 ; Glycated Hemoglobin ; Diabetes Complications

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High- vs. low-dose radio-iodine therapy for initial thyroid remnant ablation in post-thyroidectomized patients with non-metastatic differentiated thyroid cancer: A meta-analysis

Joel C. Mendoza ; Irene S. Bandong

The Philippine Journal of Nuclear Medicine.2018;13(2):54-61.

The use of high- or low-dose radio-iodine therapy (RAIT) for initial thyroid remnant ablation in post-thyroidectomised patients diagnosed with differentiated thyroid cancer (DTC) with no distant metastases has long been a subject of much debate. Meta-analyses and systematic reviews have been previously made using both randomised control trials (RCTs) and observational studies without due regard to differences in study design. Hence, amore focused meta-analysis of available RCTs alone was conducted to determine the presence of a compelling difference between the initial remnant ablation success rates of high- and low-dose RAIT in post-thyroidectomised DTC patient without distant demtastases. An extensive search of PubMed and Cochrane Central register of RCTs (up to August 2013) was performed by two reviewers, which was completed by hand search of referencesfrom releveangt articles and review papers published from 1996 to 2012. The two reviewers independtly selected eligible studies, with disagreement resolved by consensus. The inclusion criteria were as follows: (a) randomised controlled trials, (b) post-thyroidectomised adult subjects diagnosed with well differentiated thyroid cancer and no evidence of distant metastases, and (c) subject randomisation into 30-50 mCi or 100 mCi 131I treatment groups. Studies were exluded if (a) the full text of the study is not available, (b) the study is in another language other than English, and (c) if the data on relative risk was not available or could not be derived from the study. Of eight published RCTs on radio-iodine therapy as of August 2013, only 5 were eligible for this meta-analysis; namely those by JOhansen et al. (1991), Bal et al. (1996), Zaman et al. (2006), Maenpaa et al. (2008) and Caglar et al. (2012). The same two reviewers independenty extracted data from the full text of the selected five studies. Two-by-two tables comparing frequencies of successful and failed remnant ablation using low-dose (30-60 mCi) and high-dise (100 mCi) RAIT were derived from the published results of the included studies, and the weighted and pooled relative risks for successful remnant ablation were computed via the Mantel-Haenszel method using a fixed effects model (cx = 5%). Subgroup analyses were performed based on different definitions of a successful remnant ablation. The pooled relative risk (-0.03) was statistically insignificant (p=0.54) and had poor precision (95% confidence interval of {-0.12,0.06}) even when adjustments to the varied definitions of a successful ablation were performed. Thus, using available RCTs that compare high- and low-dose RAIT for remnant ablation of DTC, there is an apparent trend favoring higher success rates using high-dose RAIT. However, the lack of well designed RCTs precludes recommending high-dose initial RAI ablation, and encourages the present practice of individualized.
Meta-Analysis ; Thyroid Neoplasms ; Iodine Radioisotopes

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A systematic review and meta-analysis on the diagnostic accuracy of whole-body PET /CT for distant metastases in breast cancers

Sagisag M. Dadap ; Michele D. Ogbac ; Dominic N. Velasco

The Philippine Journal of Nuclear Medicine.2019;14(1):28-36.

Background: Breast cancer is the second most common malignancy globally. This study is a systematic review and meta-analysis assessing whole-body PET/CT using 18F-FDG in detecting breast carcinoma distant metastases as an update to the study of Xu et al. Objective: To determine the diagnostic accuracy of whole-body PET/CT in distant metastasis detection among breast cancer patients. Methods: The MEDLINE database was systematically searched for articles evaluating whole-body PET/CT in distant metastasis detection among breast cancer patients. Sensitivity, specificity, likelihood ratios and predictive values were derived by the three independent readers. Summary receiver operating characteristic curves were plotted. Results: Fifteen studies (n=4175) were included with pooled sensitivities, specificities, positive and negative likelihood ratios, positive and negative predictive values (with 95% confidence intervals) of 0.98 (0.97-0.99), 0.98 (0.98-0.99), 86.6 (63.6-117.9), 0.01 (0.01-0.02), 0.94 (0.92-0.95) and 0.99 (0.995-0-.998), respectively. Pooled positive and negative predictive values with a prevalence of 13.6% are 0. 93 and 0.99, respectively. Conclusion Whole-body PET/CT with 18F-FDG provides excellent detection of distant metastases in breast cancer and is recommended in assessing patients in earlier stages of the disease, not only in the later stages, especially in more aggressive tumors.
Fluorodeoxyglucose F18 ; Carcinoma ; Meta-analysis ; Breast Neoplasms

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Initial experience with Gallium-68 and Lutetium-177 prostate-specific membrane antigen theranostics for prostate cancer in the Philippines: A case series

Miguel Antonio C. Catangui ; Patricia A Bautista ; Emily Mia C. Acayan ; Raquel Marie R. Cabatu-Key

The Philippine Journal of Nuclear Medicine.2019;14(1):11-15.

In the Philippines, prostate cancer is the third most common malignancy among men. Over time, it tends to recur and/or progress to metastatic castration-resistant prostate cancer, wherein conventional therapies no longer work. Taking advantage of the high expression of prostate-specific membrane antigen (PSMA) on prostate cancer cells, 68GA- and 177 Lu-PSMA theranostics provides a targeted approach to imaging and therapy. With it's availabity in our country, patients now have an appealing and accessible treatment option. In this paper, we present five cases of metastatic castration-resistant prostate cancer, who have undergone 68Ga-PSMA PET/CT scans and 177Lu-PSMA radioligand therapies in the Philippines, to showcase the usefulness of theranostics in the local setting.
Positron Emission Tomography Computed Tomography ; Precision Medicine ; Prostatic Neoplasms ; Philippines

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