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Outpatient Radioablation Therapy for Thyroid Cancer Patients with Minimal Radiation Exposure to the Family Members.

Hee Myung PARK ; Jung Woong JANG ; Hee Chul YANG ; Young Gook KIM

Nuclear Medicine and Molecular Imaging.2007;41(3):218-225.

PURPOSE: Postoperative thyroid remnant radioablation therapy is necessary to reduce the recurrence and mortality rates as well as to prepare the patients for a proper long term surveillance of well-differentiated thyroid cancers. The radiation safety rules of the government require the patient to be isolated in a hospital if the expected radiation exposure to the family members would be greater than 5 mSv (500 mRem). The purpose was to measure the radiation received by the family members of patients who received large doses of NaI-131. MATERIAL AND METHODS: We have administered 12 therapy doses ranging from 3.70-5.55 GBq (100 to 150 mCi) to 11 patients, and released them immediately if they met the radiation safety criteria. Informed consent was obtained from the subjects prior to the therapy, and each of them agreed to follow written radiation safety instructions. TLD badges were used to measure the radiation dose received by the family members and the room adjacent to the patient's bed room during the first 72 hours. RESULTS: The average dose received by the family members who spent the most time in the closest distance with the patients was 0.04 mSv with a range of 0.01-0.17 mSv. Even the highest dose was only about 3% of the limit set by the government. The average radiation dose to the outer wall of the patient's room was 0.15 mSv. CONCLUSION: It is concluded that I-131 ablation therapy can be administered to outpatients safely to thyroid cancer patients who meet the established radiation safety criteria and follow the instructions.
Humans ; Informed Consent ; Mortality ; Outpatients* ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms*

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Increases in Doxorubicin Sensitivity and Radioiodide Uptake by Transfecting shMDR and Sodium/Iodide Symporter Gene in Cancer Cells Expressing Multidrug Resistance.

Sohn Joo AHN ; Yong Jin LEE ; You La LEE ; Chang Ik CHOI ; Sang Woo LEE ; Jeongsoo YOO ; Byeong Cheol AHN ; In Kyu LEE ; Jaetae LEE

Nuclear Medicine and Molecular Imaging.2007;41(3):209-217.

PURPOSE: Multidrug resistance (MDR) of the cancer cells related to mdr1 gene expression can be effectively treated by selective short hairpin RNA for mdr1 gene (shMDR). Sodium/iodide symporter (NIS) gene is well known to have both reporter and therapeutic gene characteristics. We have co-transfected both shMDR and NIS gene into colon cancer cells (HCT15 cell) expressing MDR and Tc-99m sestamibi and I-125 uptake were measured. In addition, cytotoxic effects of doxorubicin and I-131 therapy were also assessed after transfection. MATERIAL AND METHODS: At first, shMDR was transfected with liposome reagent into human embryonic kidney cells (HEK293) and HCT cells. shMDR transfection was confirmed by RT-PCR and western blot analysis. Adenovirus expressing NIS (Ad-NIS) gene and shMDR (Ad-shMDR) were co-transfected with Ad-NIS into HCT15 cells. Forty-eight hours after infection, inhibition of P-gycoprotein (Pgp) function by shMDR was analyzed by a change of Tc-99m sestamibi uptake and doxorubicin cytotoxicity, and functional activity of induced NIS gene expression was assessed with I-125 uptake assay. RESULTS: In HEK293 cells transfected with shMDR, mdr1 mRNA and Pgp protein expressions were down regulated. HCT15 cells infected with 20 MOI of Ad-NIS was higher NIS protein expression than control cells. After transfection of 300 MOI of Ad-shMDR either with or without 10 MOI of Ad-NIS, uptake of Tc-99m sestamibi increased up to 1.5-fold than control cells. HCT15 cells infected with 10 MOI of Ad-NIS showed approximately 25-fold higher I-125 uptake than control cells. Cotransfection of Ad-shMDR and Ad-NIS resulted in enhanced cytotoxic by doxorubicin in HCT15 cells. I-131 treatment on HCT15 cells infected with 20 MOI of Ad-NIS revealed increased cytotoxic effect. CONCLUSION: Suppression of mdr1 gene expression, retention of Tc-99m sestamibi, enhanced doxorubicin cytotoxicity and increases in I-125 uptake were achieved in MDR expressing cancer cell by co-transfection of shMDR and NIS gene. Dual therapy with doxorubicin and radioiodine after cotransfection shMDR and NIS gene can be used to overcome MDR.
Adenoviridae ; Blotting, Western ; Colonic Neoplasms ; Doxorubicin* ; Drug Resistance, Multiple* ; Gene Expression ; HEK293 Cells ; Humans ; Ion Transport* ; Kidney ; Liposomes ; RNA, Messenger ; RNA, Small Interfering ; Transfection

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Diagnostic Performance of Combined Single Photon Emission Computed Tomographic Scintimammography and Ultrasonography Based on Computer-Aided Diagnosis for Breast Cancer.

Kyung Hoon HWANG ; Jun Gu LEE ; Jong Hyo KIM ; Hyung Ji LEE ; Kyong Sik OM ; Byeong Il LEE ; Duckjoo CHOI ; Wonsick CHOE

Nuclear Medicine and Molecular Imaging.2007;41(3):201-208.

PURPOSE: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). MATERIALS AND METHODS: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. RESULTS: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. CONCLUSION: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.
Breast Neoplasms* ; Breast* ; Complement System Proteins ; Diagnosis* ; Diagnosis, Differential ; Humans ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography*

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Correlation between Semiquantitative Myocardial Perfusion Score and Absolute Myocardial Blood Flow in 13N-Ammonia PET.

Byeong Il LEE ; Kye Hun KIM ; Jung Young KIM ; Su Jin KIM ; Jae Sung LEE ; Jung Joon MIN ; Ho Chun SONG ; Hee Seung BOM

Nuclear Medicine and Molecular Imaging.2007;41(3):194-200.

PURPOSE: 13N-ammonia is a well known radiopharmaceutical for the measurement of a myocardial blood flow (MBF) non-invasively using PET-CT. In this study, we investigated a correlation between MBF obtained from dynamic imaging and myocardial perfusion score (MPS) obtained from static imaging for usefulness of cardiac PET study. METHODS: Twelve patients (11 males, 1 female, 57.9+/-8.6 years old) with suspicious coronary artery disease underwent PET-CT scan. Dynamic scans (6 min: 5 sec X 12, 10 sec X 6, 20 sec X 3, and 30 sec X 6) were initiated simultaneously with bolus injection of 11 MBq/kg 13N-ammonia to acquire rest and stress image. Gating image was acquired during 13 minutes continuously. Nine-segment model (4 basal walls, 4 mid walls, and apex) was used for a measurement of MBF. Time activity curve of input function and myocardium was extracted from ROI methods in 9 regions for quantification. The MPS were evaluated using quantitative analysis software. To compare between 20-segment model and 9-segment model, 6 basal segments were excluded and averaged segmental scores were used. RESULTS: There are weak correlation between MBF (rest, 0.18-2.38 ml/min/g; stress, 0.40-4.95 ml/min/g) and MPS (rest 22-91%, stress, 14-90%), however the correlation coefficient between corrected MBF and MPS in rest state was higher than stress state (rest r=0.59; stress r=0.80). As a thickening increased, correlation between MBF and MPS also showed good correlation at each segments. CONCLUSIONS: Corrected and translated MPS as its characteristics using 13N-ammonia showed good correlation with absolute MBF measured by dynamic image in this study. Therefore, we showed MPS is one of good indices which reflect MBF. We anticipate PET-CT could be used as useful tool for evaluation of myocardial function in nuclear cardiac study.
Coronary Artery Disease ; Female ; Humans ; Male ; Myocardium ; Perfusion*

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Use of 18F-FDG PET/CT in Second Primary Cancer.

Joon Young CHOI ; Byung Tae KIM

Nuclear Medicine and Molecular Imaging.2007;41(3):185-193.

This review focuses on the use of 18F-FDG PET/CT to evaluate second primary cancers. The emergence of a second primary cancer is an important prognostic factor in cancer patients. The early detection of a second primary cancer and the appropriate treatment are essential for reducing the morbidity and mortality associated with these tumors. Integrated 18F-FDG PET/CT, which can provide both the metabolic and anatomic information of a cancer, has been shown to have a better accuracy in oncology than either CT or conventional PET. The whole body coverage and high sensitivity of 18F-FDG PET/CT along with its ability to provide both metabolic and anatomic information of a cancer make it suitable for evaluating a second primary cancer in oncology. Whole body 18F-FDG PET/CT is useful for screening second primary cancers with a high sensitivity and good positive predictive value. In order to rule out the presence of a second primary cancer or an unexpected metastasis, further diagnostic work-up is essential when abnormal findings indicative of a second primary cancer are found on the PET/CT images. PET/CT is better in detecting a second primary tumor than conventional PET.
Fluorodeoxyglucose F18* ; Humans ; Mass Screening ; Mortality ; Neoplasm Metastasis ; Neoplasms, Second Primary* ; Positron-Emission Tomography and Computed Tomography*

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Sequential Change of Hypometabolic Metastasis from Non-small-cell Lung Cancer on Brain FDG-PET/CT.

Soon Ah PARK ; Sei Hoon YANG ; Chung Yong YANG ; Keum Ha CHOI

Nuclear Medicine and Molecular Imaging.2009;43(5):505-507.

A 60-year-old woman, who had non-small-cell lung cancer (NSCLC) in left lower lobe underwent brain F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for evaluation of cerebral metastasis. On follow-up FDG-PET/CT, only hypometaolic lesion was detected and progressed in right frontal lobe at 6 months and 10 months, later. Hypermetabolic metastasis was not detected even at last scan time of FDG-PET/CT. Brain MRI showed brain metastasis in right frontal lobe. As might be expected, the physician should take cerebral metastasis into consideration even though there is only hypometabolic change on subsequent FDG-PET/CT in patients with NSCLC.
Brain ; Electrons ; Female ; Follow-Up Studies ; Frontal Lobe ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Neoplasm Metastasis

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Two Cases of Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis on F-18 FDG PET/CT.

Soon Uk CHOI ; Eun Sil KIM ; Soyon KIM ; Chang Min YU ; Se Han LEE ; Hee Jae HYUN ; Hyo Jin LEE ; Seung Yup KIM

Nuclear Medicine and Molecular Imaging.2009;43(5):499-504.

F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET/CT) plays an important role in diagnosis of malignant tumors and adds to conventional imaging in the staging of pertoneal carcinomatosis. However, false positive cases resulting from benign disease such as tuberculosis may occur. We report two cases of peritoneal tuberculosis on F-18 FDG PET/CT which showed multiple hypermetabolic foci in the mesentery and peritoneum with increased serum cancer antigen 125 (CA 125). Subsequent F-18 FDG PET/CT showed a disappearance of pathologic uptake following treatment with anti-tuberculosis drugs.
Carcinoma ; Mesentery ; Peritoneum ; Peritonitis, Tuberculous ; Positron-Emission Tomography ; Tuberculosis

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Brown Tumor Shown Flare Phenomenon On Bone Scan After Parathyroidectomy.

Kwang Ho SHIN ; Seol Hoon PARK ; Sora BAEK ; Sun Young CHAE ; Jung Min KOH ; Jae Seung KIM ; Dae Hyuk MOON ; Jin Sook RYU

Nuclear Medicine and Molecular Imaging.2009;43(5):495-498.

Brown tumor is the benign bone lesion consists of woven bone and fibrous tissue without matrix, which develop due to chronic excessive osteoclastic activity such as hyperparathyroidism. Usually they appear with normal uptake or occasionally focally increased uptake on bone scan. We present a case with brown tumor shown more increased uptake and more number of lesions on bone scan after parathyroidectomy, and lesser increased uptake on serial bone scans without any other treatment through several months. This finding is thought to be similar to 'flare phenomenon' which is occasionally seen after treatment of metastatic bone lesions of malignant cancer, and may represent curative process of brown tumor with rapid normal bone formation.
Hyperparathyroidism ; Osteoclasts ; Osteogenesis ; Parathyroidectomy

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Production and Evaluation of Immunoreactivity of Poly Lysine-Tagged Single Chain Fragment Variable (ScFv) Lym-1 Antibody for Direct Conjugation to Fluorescence Dye.

Jae Ho JUNG ; Tae Hyun CHOI ; Kwang Sun WOO ; Wee Sup CHUNG ; Joo Hyun KANG ; Su Young JEONG ; Chang Woon CHOI ; Sang Moo LIM ; Gi Jeong CHEON

Nuclear Medicine and Molecular Imaging.2009;43(5):487-494.

PURPOSE: Small size of recombinant scFv antibody has many advantages such as rapid blood clearances and improved targeting antibodies to tumor region. On the other hand owing to small size, number of amino group is insufficient in conjugation with chelator and fluorescence labeling. This study is to introduce poly lysine tag to the C-terminal end of scFv lym-1 sequence for fluorescence chelator conjugation. MATERIALS AND METHODS: Poly lysine scFv lym-1 gene, cloned into pET-22b (+) vector, was expressed in E. coli BL21 (DE3) strain. Antibody purification was performed with Ni-NTA column and then size exclusion column chromatography. Expression and purification levels of poly lysine tagged scFv lym-1 antibody were confirmed by western blot analysis. I-124, I-125, I-131 and Tc-99m were used for radiolabeling of purified poly lysine scFv lym-1. Flow cytometry analysis of FITC conjugated poly lysine scFv lym-1 was performed for confirmation of immunoreactivity of human Burkitt`s lymphoma cells. RESULTS: Poly lysine scFv lym-1 antibody was purified through two steps and identified as molecular weight of 48 KDa. Radiolabeling yields of I-124, I-125, I-131 and Tc-99m into poly lysine scFv lym-1 were >99%, >99%, >95% and >99%, respectively. Flow cytometry analysis of poly lysine scFv and scFv lym-1 was showed similar immunoreactivity to human Burkitt`s lymphoma cells. CONCLUSION: Poly lysine tag was useful for the sufficient number of amino groups to scFv lym-1 antibody for chelator conjugation with minimizing loss of immunoreactivity.
Antibodies ; Blotting, Western ; Chromatography ; Clone Cells ; Flow Cytometry ; Fluorescein-5-isothiocyanate ; Fluorescence ; Hand ; Humans ; Lymphoma ; Lysine ; Molecular Weight ; Sprains and Strains

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The Synthesis of the Stable IVDU Derivative for Imaging HSV-1 TK Expression.

Eun jung KIM ; Tae Hyun CHOI ; Soon Hyuk AHN ; Byoung Soo KIM ; Hyun PARK ; Gi Jeong CHEON ; Hak June RHEE ; Gwang Il AN

Nuclear Medicine and Molecular Imaging.2009;43(5):478-486.

PURPOSE: 5-iododeoxyuridine analogues have been exclusively developed for the potential antiviral and antitumor therapeutic agents. In this study, we synthesized carbocyclic radioiododeoxyuridineanalogue (ddIVDU) and carbocyclic intermediate as efficient carbocyclic radiopharmaceuticals. MATERIALS AND METHODS: The synthesis is LAH reduction, hetero Diels-Alder reaction as key reactions including Pd(0)-catalyzed coupling reaction together with organotin. MCA-RH7777 (MCA) and MCA-tk (HSV1-tk positive) cells were treated with various concentration of carbocyclic ddIVDU, and GCV. Cytotoxicity was measured by the MTS methods. For in vitro uptake study, MCA and MCA-tk cells were incubated with 1uCi of [(125)I]carbocyclic ddIVDU. Accumulated radioactivity was measured after various incubation times. RESULTS: The synthesis of ddIVDU and precursor for radioiodination were achieved from cyclopentadiene in good overall yield, respectively. The radioiododemetallation for radiolabeling gave more than 80% yield with > 95% radiochemical purity. GCV was more toxic than carbocyclic ddIVDU in MCA-tk cells. Accumulation of [(125)I]carbocyclic ddIVDU was higher in MCA-tk cells than MCA cells. CONCLUSION: Biological data reveal that ddIVDU is stable in vitro, less toxic than ganciclovir (GCV), and selective in HSV1-tk expressed cells. Thus, this new carbocyclic nucleoside, referred to in this paper as carbocyclic 2',3'-didehydro-2',3'-dideoxy-5- iodovinyluridine (carbocyclic ddIVDU), is a potential imaging probe for HSV1-tk.
Cycloaddition Reaction ; Ganciclovir ; Herpesvirus 1, Human ; Idoxuridine ; Radioactivity ; Radiopharmaceuticals

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