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Transarterial 188 rhenium-HDD-lipiodol conjugate in the treatment of inoperable hepatocellular carcinoma

De Jesus Emelyn M ; Ogbac Ruben V ; Lim Eddie A ; Estrada Francis M ; Barrenechea Emerita A ; San Luis Jr Teofilo OL

The Philippine Journal of Nuclear Medicine.2011;6(2):37-43.

This is a descriptive study to assess the safety and efficacy of 188 Rhenium-HDD-Lipiodol conjugate in treating patients with unresectable hepatocellular carcinoma. Eight patients with inoperable hepatocellular carcinoma with liver lesions ranging from 1.8 x 2.0 cm to 12.7 x 70 cm participated in the study. 188 Rhenium-HDD-Lipiodol conjugate was administered to the patients via femoral catheter based on the radioactivity that was eluted from the generator. Corresponding whole body scintigraphic images, which showed significant tracer uptake in the liver lesions, were obtained at 24, 48 and 72 hours after 188 Rhenium-HDD-lipiodol administration. Follow-up CT scans in six patients showed progressive disease in three patients and stable disease in three patients. Two patients had re-treatment due to progression of liver lesions. Follow-up scintigraphy after re-treatment showed decrease in tracer uptake in liver lesions on one patient, while the other showed diffuse tracer uptake. Post-ttherapy symptoms were minimal: mild to moderate epigastric pain in two, nausea and vomiting in one, while the rest are asymptomatic. Karnofsky performance status of patients three months after the therapy ranged from 20-90%. Two of the eight patients are still living at the time this paper was written. Radionuclide therapy aided in the prolongation of life and improvement of its quality for some patients. 188 Rhenium-HDD-Lipiodol radio conjugate provides promising results in treating inoperable hepatocellular carcinoma.
Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; CARCINOMA, HEPATOCELLULAR

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Patients with abnormal myocardial perfusion scintigraphy and normal coronary angiography: A review

San Juan Carlo Jose S

The Philippine Journal of Nuclear Medicine.2011;6(2):44-49.

This research paper reviews six studies of various designs involving abnormal myocardial perfusion scintigraphic findings correlated with a normal or insignificant coronary angiography. Such results have typically been called "false-positive" and these studies either report their incidence or explore their validity. Findings have shown that abnormal myocardial perfusion studies may reflect occult cases of ischemia that are not evident or are underestimated by conventional coronary angiography, such as subcritical stenoses or myocardial microvascular dysfunction. These findings should be enough cause for further investigation by an attending physician or initiation of preventive medical intervention.
Human ; Male ; Female ; MYOCARDIAL PERFUSION IMAGING ; CORONARY ANGIOGRAPHY ; FALSE POSITIVE REACTIONS ; DIAGNOSTIC ERRORS ; MISDIAGNOSIS

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Man with situs inversus

Bautista Sheila Rose A

The Philippine Journal of Nuclear Medicine.2011;6(2):50-52.

This is a case of a 47-year-old male, diagnosed with situs inversus with dextrocardia, who had episodes of chest heaviness. He was referred for a myocardial perfusion imaging using the rest and stress protocol. SPECT short axis, vertical and horizontal long axis projections were acquired after injection of Tc99m Tetrofosmin. One hundred eighty degree imaging was performed on a dual-head camera from the left anterior oblique to right posterior oblique, instead of the usual right anterior oblique to left posterior oblique. Results showed mild stress-induced myocardial ischemia in the apex. Non-invasive cardiac imaging acquisition in this case requires protocol adjustment to correctly acquire and process the data.
Human ; Male ; Middle Aged ; SITUS INVERSUS ; CONGENITAL ABNORMALITIES ; DEXTROCARDIA ; HEART DEFECTS, CONGENITAL ; MYOCARDIAL PERFUSION IMAGING ; CARDIAC IMAGING TECHNIQUES ; TOMOGRAPHY, EMISSION-COMPUTED, SINGLE-PHOTON

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Resolving hypoplastic dilemma: Lung perfusion scintigraphy in a case of congenital cystic adenomatoid malformation (CCAM)

Bautista Raneil Joseph F ; Obaldo Jerry M

The Philippine Journal of Nuclear Medicine.2011;6(2):53-55.

Congenital cystic adenomatoid malformation is a rare bronchopulmonary malformation resulting from an arrest in lung development between 4th and 7th week of fetal life. It typically presents as respiratory distress in the neonatal period and recurrent pulmonary infections in adults; and is sometimes associated with other congenital abnormalities [especially CCAM Type II]. Chest roentgenograms and CT scan are the usual modalities of choice in its initial evaluation and histopathology done post-operatively establishes the diagnosis. Ventilation-Perfusion [VQ] scintigraphy is of paramount importance in the routine assessment of CCAM patients but is often disregarded. This paper presents the incremental value of doing a lung perfusion scintigraphy and aims to emphasize the significance of performing a VQ scan in such cases.
Human ; Female ; Adult ; RADIONUCLIDE IMAGING ; SCINTIGRAPHY ; DIAGNOSTIC IMAGING ; CYSTIC ADENOMATOID MALFORMATION OF LUNG, CONGENITAL ; CONGENITAL CYSTIC ADENOMATOID MALFORMATION OF LUNG ; LUNG DISEASES ; TOMOGRAPHY SCANNERS, X-RAY COMPUTED

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Ventillation-perfusion scan findings of pulmonary artery sarcoma

Flores Ferdinand L

The Philippine Journal of Nuclear Medicine.2011;6(2):56-58.

Pulmonary artery sarcoma is a rare tumor of the cardiovascular system with only a few hundred cases reported in the literature. Because of its rarity and the similarity of its presentation to that of pulmonary thromboembolic disease, the diagnosis of pulmonary artery sarcoma is often not considered early in patients presenting with recurrent or chronic pulmonary emboli. In the last decade, heightened clinical suspicion and improved diagnostic modalities have allowed the diagnosis to be made prior to surgery. We present a case of a 29-year-old female with syncope in whom pulmonary artery sarcoma was diagnosed with highlights on the importance of performing a pre- and post-operative VQ scan in such cases.
Human ; Female ; Adult ; NEOPLASMS ; PULMONARY ARTERY ; BLOOD VESSELS ; CARDIOVASCULAR SYSTEM

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Bone metastases in 21 patients with differentiated thyroid carcinoma: The influence of age and response to therapy

Puguon Elyzel B ; Bandong Irene S

The Philippine Journal of Nuclear Medicine.2012;7(2):6-12.

Bone metastases in differentiated thyroid carcinoma occur in 3-5%of patients. When present, overall 10-year survival rate drops to 13-21%. Although rarely curative, radioactive iodine therapy for bone metastases has been found to improve survival especially in patients younger than 45 years of age. This study aims to investigate the diagnostic circumstances and influence of age on the outcome of patients with bone metastases from differentiated thyroid carcinoma recently managed in one institution. Between November 2001 and October 2007, 21 patients were managed for bone metastases from differentiated thyroid carcinoma. A review of medical records was performed. Of 21 patients, 7 patients were less than or equal to 45 years of age (35.29 plus minus 8.16 years), and were classified as group 1 (stage II "low risk", WHO classification). The rest, 14 patients, were greater than or equal to 45 years old (63.14 plus minus 7.73 years and formed group 2 (stage IV, "high risk", WHO classification). Complete and partial remission was more frequently noted with group I (5 of 7 or 71.4% of patients) than with group II (6 of 14 or 42.9% of patients). Although remission can be observed in both age groups, patients younger than 45 years old at the diagnosis of bone metastases show a better response to therapy.
Human ; Male ; Female ; THYROID NEOPLASMS

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Estimating kidney depth among Filipino adults using Tonnesen, Taylor, and Inoue algorithms

Velasco Dominic N ; Ogbac Michele D ; Fernandez Jerome F

The Philippine Journal of Nuclear Medicine.2012;7(1):1-5.

Nuclear medicine departments use the camera-based method for determining glomerular filtration rate (GFR) with 99mTc-DPTA. Camera based techniques provide a fast and convenient way of determining GFR with excellent reproducubility however its accuracy remains in question. The accuracy of camera-based renal scintigraphy depends on an attenuation correlation from estimating for renal depth and an attenuation correction from estimating for renal depth and an attenuation coefficient. Algorithms were formulated by Tonnesen, Taylor, and Inoue to calculate the estimated renal depth through multiple stepwise linear regression analysis. The goal of this study was to analyze the accuracy of these algorithms in Filipino patients. Renal depth was determined from CT scans of 41 consecutive patients. We calculated the mean absolute error of the estimated kidney depths and compared them with each other to determine the accuracy of each algorithm. The Tonnesen algorithm had the highest mean absolute error of 1.25 cm plus minus 0.88 cm in the left kidney estimates while the Taylor algorithm had the lowest mean absolute error of 0.81 cm plus minus 0.58 cm in the left kidney estimate and 1.04 cm plus minus 0.82 cm in the right kidney estimate (p-value = 0.01 left kidney estimates and p-value = 0.02 right kidney estimates). The Tonnesen algorithm was the least accurate in predicting kidney depth. There was no significant difference between the Taylor and Inoue algorithms, which were more accurate in predicting kidney depth
Human ; Male ; Female ; KIDNEY ; UROGENITAL SYSTEM ; URINARY TRACT ; GLOMERULAR FILTRATION RATE ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC TECHNIQUES, UROLOGICAL ; KIDNEY FUNCTION TESTS ; RENAL SCINTIGRAPHY

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Prospective study on the effectiveness of different diet protocols in decreasing interfering abdominal activity among Filipinos undergoing 99mTc tetrofosmin resting myocardial perfusion imaging study

Aldovino Sheila Rose B

The Philippine Journal of Nuclear Medicine.2012;7(1):6-10.

Myocardial perfusion imaging is one of the common diagnostic modalities used today for non-invasive diagnosis and evaluation of ischemia and myocardial infarction. However, this study may be time consuming due to delays mostly caused by diaphragmatic and intraabdominal artifacts. In this study, the effectiveness of different diets given to 120 patients pre-resting scan were evaluated through heart to liver ratio. Results showed that chocolate milk (H:L= 1.35 plus minus 0.28) is superior to water (H:L = 0.98 plus minus 0.32), null (H:L = 0.95 plus minus 0.39) and milk diet (H:L = 0.95 plus minus 0.27). However, lemon juice (H:L =1.14 plus minus 0.40) and milk with water (H:L = 1.16 plus minus 0.24) has no significant difference in effect with chocolate milk group. Thus patient may be given the choice of taking lemon juice, chocolate milk, or milk with water. This will help give good quality images while decreasing the waiting time of the patient.
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; MYOCARDIAL PERFUSION IMAGING ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING ; CARDIAC IMAGING TECHNIQUES ; MYOCARDIAL REPERFUSION

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Relationship of body mass index and related anthropometric measurements on the image quality of thallium-201 and technetium-99m sestamibi myocardial perfusion imaging

Bautista Raneil Joseph F ; Obaldo Jerry M

The Philippine Journal of Nuclear Medicine.2012;7(1):11-17.

The study aims to determine the relationship of body mass index (BMI) and related anthropometric measurements on the image quality of Tl-201 and Tc-99m sestamibi myocardial perfusion scans (MPS). A total of 163 scans were analyzed. A blinded experienced physician performed visual analysis on the scans image quality on two different occasions. Quantitative parameter used was the heart-to-lung ratio (HLR). Regression analysis was done to determine the association of HLR with BMI and myocardial tracer uptake, ROC curves were generated to establish BMI and HLR cut-off points. Increasing BMI was associated with visually poorer images in the Tl-201 MPS group (p 0.003) but not for the Tc-99m MPS group (p 0.065). It was also associated with decrease HLR and myocardial tracer upatake for both tracers (p <0.001). ROC curves revealed BMI cut-off points of 28 (Tl-201 p 0.000; Tc99m sestamibi p 0.004) for both procedures; HR cut-off values of 3.0 for Tl-201 )p 0.295) and 2.5 for Tc-99m sestamibi (p 0.875). the image quality of Tl-201 scans begins to deteriorate at a BMI of 28 and HLR of 3.0 with myocardial count density reduction (less than or equal to 6000 counts) translating to visually poorer images. On the other hand , image quality of Tc-99m sestamibi scans also tend to deteriorate similarly at a BMI of 28. However, in contrast to Tl-201, the lower HLR cut-off of 2.5 suggests a relatively higher myocardial count density (greater than or equal to 9000 counts) rendering the image quality to be still satisfactory for subjective assessment.
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; MYOCARDIAL PERFUSION IMAGING ; MYOCARDIAL SCINTIGRAPHY ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING ; CARDIAC IMAGING TECHNIQUES ; BODY MASS INDEX

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The role of 18F-FDG PET in the evaluation of treatment for lymphoma: Philippine setting

Bautista Patricia A

The Philippine Journal of Nuclear Medicine.2012;7(1):18-22.

PET is essential for the post-treatment assessment of lymphomas because a negative PET scan after treatment is required for a complete remission and curative outcome. Functional imaging with 18F-FDG PET enables evaluation of the early metabolic changes rather than the moprphologic changes of the lymphoma occurring later. Among 186 patients diagnosed with Hodgkin's Disease or Non-Hodgkin's Lymphoma who were referred to the PET Center in this institution from April 2002 to June 2010, 35 patients were included in this study. All 14 patients who only had end-of-chemotherapy scans without midcycle scans had no tumor recurrence on subsequent scan/s, with a median follow-up of 17.5 months. Of the remaining 21 patients, 11 patients had positive studies, 9 had negative studies and 1 had an indeterminate study of the midcycle scans. All the patients obtained similar results on the subsequent scans, excluding 5 with no follow-up scans, with median follow-ups of 13 months for the PET-positive patients and 23 months for the PET-negative patients. These results support the strong prognostic value of PET for aggressive lymphomas, whether the imaging is performed at the end of therapy or after only a few cycles of chemotherapy. PET has consistently been shown to identify positive respondents with higher survival probabilities and longer progression-free survival periods from non-responders on subsequent scans.
Human ; Male ; Female ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; LYMPHOMA ; NEOPLASMS ; NEOPLASMS BY HISTOLOGIC TYPE

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