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SWISS SOCIETY OF NUCLEAR MEDICINE (SGNM/SSMN) 4

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  • 1. SWISS SOCIETY OF NUCLEAR MEDICINE (SGNM/SSMN) 4th ANNUAL CONGRESS LUCERNE JUNE, 26-28 2003 Main Topic: SPECT and PET Local Organizing Committee: Congress Secretary: J. Th. Locher (President) Dr. L. D. Frey L. D. Frey Dept. of Nuclear Medicine M. Brühlmeier Kantonsspital Aarau I. Engel CH-5001 Aarau B. Hofer Phone +41/(0)62/8 38 54 90 M. Kunz Fax +41/(0)62/8 38 54 91 E-mail: lukas.frey@ksa.ch Scientific Committee: Further Information: A. Bischoff Delaloye, Lausanne Information on the detailed B. Bubeck, St. Gallen program, registration, hotel J. Th. Locher, Aarau accommodation and social program H. Steinert, Zürich is available online at: H. Maecke, Basel (Radiochemistry) www.sgnm.ch Please direct your questions to: SGNM.2003@ksa.ch Nuklearmedizin 3/2003
  • 2. A144 Abstracts, Lucerne 2003 SWISS SOCIETY OF NUCLEAR MEDICINE (SGNM/SSMN) 4th ANNUAL CONGRESS, LUCERNE, June 26-28 2003 Thursday, June 26 2003 Common Events Radiology and Nuclear Medicine Nuclear Medicine 12:00 Opening Technical Exhibition; Lunch 12:00–13:45 General Assembly Swiss Society of Radiopharmacy/Radiopharmaceutical Chemistry (SGRRC) 14:00–15:10 Scientific Session 1: Invited Lectures PET-CT: New Developments and Technical Challenges Ratib O., Los Angeles Software Algorithms in Nuclear Medicine Missimer J., PSI Villigen 15:30–16:50 Scientific Session 2: Cardiology (O1-O6) 17:00–17:30 Congress Opening and Recception Friday, June 27 2003 Common Events Radiology and Nuclear Medicine Nuclear Medicine 08:00–9:45 Scientific Session 3: Antibodies and Peptides (O7-O12) Invited Lecture Animal PET Bruehlmeier M., Aarau 10:00–11:50 The Digital Image in the Clinical Environment 12:00–13:30 Lunch 13:30–15:15 H. R. Schinz-Lecture 16:00–18:00 General Assembly Swiss Society of Nuclear Medicine (SGNM/SSNM) 20:00 Gala Dinner at the Casino Lucerne Saturday, June 28 2003 Common Events Radiology and Nuclear Medicine Nuclear Medicine 09:00–10:00 Scientific Session 4: Invited Lectures Attenuation Correction Burger C., Zurich Image Fusion Juengling F., Bern 10:00–10:30 Scientific Session 5: Posters (P1-P7) 11:00–12:45 General Assembly 11:00–12:15 Scientific Session 6: Oncology (O13-O18) Swiss Society of Radiology (SGR/SSR) 13:00 Congress Closure Nuklearmedizin 3/2003
  • 3. A145 Abstracts, Lucerne 2003 O1 Combined CT-angiogram and PET perfusion imaging for assess- O3 Prevalence of stress-induced myocardial ischemia and previous ment of CAD in a novel PET/CT: pilot feasibility study infarction in diabetic patients M Namdar, T Hany, G K von Schulthess, P A Kaufmann M Koehli1,2, D Monbaron2, J Ruiz2, JO Prior1, N Besseghir1, RC Gaillard2, A Bischof Delaloye1 Nuklearkardiologie, Universitätspital Zürich Service de Médecine Nucléaire1, Division d’Endocrinologie, Diabétologie et du Aim: An accurate, noninvasive technique for the diagnosis of coronary Métabolisme2, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland disease would be an important advance. We present the first evaluation of Objective: To analyse the prevalence of stress-induced myocardial ische- image quality of a new integrated PET/CT scanner for combined acquisi- mia and myocardial infarct in diabetic patients as determined by gated- tion of coronary anatomy and perfusion. SPECT (g-SPECT) and to evaluate the association with clinical para- Methods: 10 patients with angiographically documented coronary artery meters, ECG and ejection fraction. disease were scanned in a newly developed GE Discovery LS PET-CT Methods: G-SPECT myocardial perfusion studies of 211 diabetic patients (GEMS, Milwaukee, WI), an integration of an Advance PET and a multy- performed from 1997 to 2002 were retrospectively analysed for the row Lightspeed plus CT scanner. Contrast-enhanced CT angiography presence of stress-induced ischemia and myocardial infarct. A 2-headed (CTA) was performed with retrospective ECG-gating after injecting 120 gamma-camera (E.Cam, Siemens) and a conventional 1-day protocol (dual mL contrast media intravenously (iv) and myocardial perfusion was asses- isotope Tl-201/Tc-99m MIBI 40%, single-isotope Tl-201 27% or Tc-99m sed with 13N-ammonia (800 MBq) at rest and during adenosine stress. MIBI 33%) were used. Stress testing was performed by bicycle-ergometer Results: In the CTA the entire coronary tree could be visualized in all pati- (40%) or with a pharmacological agent completed by low-intensity physi- ents up to the mid segment. CTA and PET correctly identified a stenosis re- cal exercise (44%). lated reversible defect in 3 patients and an irreversible perfusion defects Results: Among these 211 patients, 120 (57%) men, aged 64 ± 10 years; without lesion (after angioplasty/stenting) in 2 patients. In one patient a 120 (57%) had an abnormal g-SPECT result (ischemia 41%, infarct 8%, coronary occlusion was correctly documented. In the remaining five pati- ischemia+infarct 12%). The prevalence of stress-induced ischemia was ents clinically non-relevant calcifications were detected by CTA and PET. similar between patients with (53%) or without (57%) angina during stress Conclusions: Considering our first experiences with the new integrated testing (p = 0.7). Stress-induced ST segment depression was observed in PET/CT technique combined assessment of coronary lesion anatomy and 82% of the patients with g-SPECT ischemia vs. 46% of those with normal its pathophysiological severity seems to be feasible. g-SPECT (OR = 4.1, p = 0.001). The prevalence of positive g-SPECT was higher in men than in women (OR = 1.3, p = 0.05). The prevalence O2 Gated 99mTc-tetrofosmin SPECT to characterize fixed defects as of infarction was greater in the eldest patients (p = 0.048). The systolic arterial pressure during stress was lower in patients having infarct versus artifact myocardial defects than in those with no defects (p = 0.02). S Fleischmann, M Namdar, P Köpfli, P A Kaufmann The mean ejection fraction was 50% for patients with perfusion defects Nuklearkardiologie, Universitätspital Zürich vs. 58% for those with no defects (p = 0.004). An increasing number of Aim: Fixed perfusion-scan defects may result from attenuation artifacts. irreversible defects was associated with a decrease in ejection fraction Gated 99mTc-tetrofosmin SPECT may help differentiate myocardial infarc- (p <0.0001). tion (MI) from artifact. Fixed defects with decreased function (wall motion Conclusions: The prevalence of positive g-SPECT was 57% in diabetic and thickening) probably represent MI, whereas attenuation artifacts have patients addressed for the evaluation of coronary artery disease (CAD). normal function or not markedly reduced function Angina during stress testing was not informative for the presence of CAD. Methods: Ungated resting and gated stress 99mTc-tetrofosmin SPECT was ST depression was present in 82% of the subjects with a positive g-SPECT. performed in 153 consecutive patients referred for evaluation of coronary A positive g-SPECT was associated with a lower ejection fraction. This disease. From resting and summed gated stress images, 107 patients (70%) confirms the importance of g-SPECT in assessing myocardial perfusion were identified with isolated fixed defects. Function of the defects was as- and long-term prognosis in diabetic patients. sessed subjectively from gated stress images and results were correlated with clinical (history and/or ECG Q-waves) evidence of MI. Results: Of 62 patients with fixed defects and clinical MI, 60 (97%) had abnormal defect function. Of 45 patients with fixed defects but no clinical O4 Abnormal myocardial blood flow (MBF) response to cold pressor MI, 16 (36%) had decreased function of the defect, possibly indicating testing (CPT) in post-menopausal women with and without coronary silent MI. In 29 of the 45 patients (64%) with no clinical MI, defect func- risk factors – relation to MBF at rest tion was normal. Because most (90%) of fixed defects with normal systo- JO Prior1,2, TH Schindler1, MA Oxilia-Estigarribia1, L Nathan 1, AD Facta1, M Inubushi1, lic function occurred in men with inferior fixed defects (86%) or women A Bischof Delaloye2, HR Schelbert1 with anterior fixed defects (3%), these were most likely attenuation arti- UCLA School of Medicine1, Los Angeles, USA; facts. By reclassifying patients with fixed defects and normal function as Centre Hospitalier Universitaire Vaudois (CHUV)2, Lausanne normal, patients with unexplained fixed defects (no clinical MI) decreased Aim: To define the MBF response to CPT and adenosine as indices of the from 29% to 10%. integrated and mostly endothelial-dependent (CPT) and endothelial-inde- Conclusions: Gating provides a considerable added value to 99mTc-tetro- pendent (adenosine) coronary vasomotion in post-menopausal women fosmin SPECT in characterizing fixed defects and potentially improving (PM) with and without coronary risk factor (RF). test specificity. Methods: In 74 women (58 ± 8 years) with normal adenosine N-13-am- monia PET images, MBF during CPT and in response to adenosine was quantified by N-13 ammonia PET and a 2-compartment model. CPT was performed with a 2-min hand immersion in iced-water and adenosine stress testing with a standard 6-min infusion (0.14 mg·kg-1·min-1). RF included hypertension, hypercholesterolemia, diabetes, smoking and obesity. CPT response was defined “CPT+” when MBF increased from rest conditions (MBFCPT-MBFREST ≥0) and “CPT-“ when it decreased (MBFCPT- Nuklearmedizin 3/2003
  • 4. A146 Abstracts, Lucerne 2003 MBFREST <0). Comparisons used Kruskal-Wallis or Wilcoxon rank-sum O6 Decreased coronary flow reserve after caffeine ingestion in tests and were considered significant if (p <0.05). healthy volunteers during acute exposure to simulated altitude Results: “CPT-“ response was observed in 27(36%) women and “CPT+” in M Namdar, R Grathwohl, R Delaloye, P Köpfli, P A Kaufmann 47(64%) women. For groups with the same “CPT” response, MBFCPT was Nuklearkardiologie, Universitätspital Zürich similar in “RF-“ and “RF+” women. However, MBFREST was higher in PM Aim: Caffeine antagonizes adenosine-induced hyperemic myocardial women with risk factors and a negative response to CPT (“RF+/CPT-“) blood flow (MBF). Its impact on exercise-induced coronary flow reserve than in any other groups of women (p = 0.03). The “rate-pressure-pro- (CFR) remains unknown. Our aim was to determine the acute effect of duct” as an index of cardiac work did not differ between groups during caffeine on CFR during bicycle exercise at baseline and during exposure to rest, CPT or adenosine. MBFADENOSINE was similar in the four groups simulated altitude. (p = 0.8). Methods: 15O-labelled H2O and Positron Emission Tomography (PET) was used to measure CFR in 16 healthy volunteers (mean age 26 y ± 1 y) before and 50 minutes after oral ingestion of caffeine (200 mg). Supine bicycle exercise (mean workload 154 ± 27 Watts, 100 ± 5% of predic- ted) was used as stress. Measurements were performed at normoxia (n = 8) or during simulation of an altitude of 4500 m by inhalation of 12.5% oxygen in N2. Results: Caffeine levels were zero at baseline in all subjects and increased to 14.7 ± 2 µmo/l fifty minutes after caffeine intake. Rate pressure product (rest and exercise) was not affected by caffeine. Caffeine increased Conclusion: A negative MBF response to CPT, possibly indicative of coro- resting MBF significantly by 21 ± 18% (normoxia, p <0.01) and 35 ± nary endothelial dysfunction, was observed in 36% of PM women. This 15% (hypoxia, p <0.0005), whereas hyperemic MBF decreased signifi- MBF response was associated with an elevated MBF at rest. The reason(s) cantly by 17 ± 18% (normoxia, p <0.0005) and 25 ± 11% (hypoxia, p for the increase in MBF relative to cardiac work remains uncertain, but <0.0005), resulting in a decrease in CFR of 36% (normoxia, p <0.01) and raises the possibility of a “coronary inflammatory-like” hyperaemic state 47% (hypoxia, p <0.005). of coronary blood flow. Conclusions: Intake of a caffeine dose equivalent to two cups of coffee significantly reduces CFR during physical exercise. This effect is even O5 Validation of ECG-gated SPECT in the assessment of left more pronounced at exposure to simulated high altitude, suggesting that ventricular ejection fraction caffeine may antagonize intrinsic adenosine mediated hyperemic response C Jaeggi, M Namdar, P Koepfli, PA Kaufmann to exercise and hypoxia. Nuklearkaradiologie, UniversitätsSpital Zürich Background: The assessment of left ventricular ejection fraction (LVEF) O7 Ein Vergleich zwischen 111In-DOTATOC und 111In-DOTATATE: provides strong diagnostic as well as prognostic information in patients Biodistribution und Dosimetrie in Patienten mit neuroendokrinen Tumoren with documented or suspected coronary artery disease (CAD). Gated F Forrer, H Uusijärvi*, M Cremonesi**, C Waldherr, H Mäcke***, J Müller-Brand SPECT is a modern technique for measurement of LVEF. Our purpose was Institut für Nuklearmedizin Kantonsspital, Basel, Department of Radiation Physics*, to validate ECG-gated SPECT for the assessment of LVEF at our institute Göteborg, Divisione di Medicina Nucleare Istituto Europeo di Oncologia**, in comparison with echocardiography (ECHO) and left ventricular angio- Milano, Institut für Radiochemie Kantonsspital***, Basel graphy (ANGIO). Ziel: Es existieren noch keine Vergleiche über die Bioverteilung von Methods: 101 consecutive patients (26 men, 75 women, mean age 63 y ± DOTA-Tyr3-octreotid (DOTATOC) und DOTA-Tyr3-Thr8-octreotid 10 y) were included in the study. 58 of them had an ECHO, 44 an ANGIO (DOTATATE) im Menschen. Deshalb soll mit dieser Studie geprüft in addition to gated SPECT. 53 patients were examined with technetium- werden, ob es relevante Unterschiede gibt und ob für die Therapie neu- 99m-tetrofosmin and 48 with technetium-99m-labeled sestamibi. An roendokriner Tumore eines der Peptide Vorteile hat. Insbesondere interes- ROC-analysis was performed to assess the cut-off value of gated SPECT siert das Tumor-zu-Nieren-Verhältnis, da die Niere meist das dosislimitie- LVEF with best sensitivity and specificity for discriminating normal from rende Organ ist. pathologic LVEF. Bland-Altman correlation analysis was performed for all Methoden: Drei Patienten mit metastasierenden neuroendokrinen Tumoren patients. wurde im Abstand von zwei Wochen 222 MBq 111In-DOTATOC bzw. Results: ROC-analysis of gated SPECT vs. ECHO revealed a cut-off value 111 In-DOTATATE injiziert. Ganzkörperszintigraphien und Blutentnahmen for normal LVEF of >57% (sensitivity 100%, specificity 78.3%). SPECT in Serie wurden bis 48 h p.i. angefertigt. Urin wurde bis 48 h p.i. gesam- vs. ANGIO resulted in a cut-off of 45% (sensitivity 66.7%, specificity melt. Mittels ROI-Technik und MIRDOSE 3.0 wurden die zu erwartenden 76.3 %). The flat shape of ROC curve for ANGIO indicates that ANGIO absorbierten Dosen für Nieren, Leber und Milz sowie für insgesamt 7 Me- values are less reliable. There was no significant bias for the comparison of tastasen bestimmt (5 Leber- und 2 Knochenmetastasen). Wir benutzten gated-SPECT versus ECHO or ANGIO according to Bland and Altman. 111 In als Surrogat für 90Y. Conclusions: Assessment of LVEF by gated SPECT at our institution is Resultate: Bei allen Patienten zeigte sich in den Nieren, in der Leber und in accurate. The cut-off value for normal LVEF is >57%. der Milz sowie in insgesamt 4 der 7 Metatsatsen eine stärkere Akkumulati- on [%iA] von DOTATATE. In allen drei Patienten war die „residence time“ in den gesunden Organen bei DOTATATE länger. Folglich berechnet sich eine höhere Dosis in mGy/MBq für die gesunden Organe bei DOTATATE. Das Verhältnis zwischen den absorbierten Dosen von Tumor zu Normal- gewebe variierte stark zwischen den einzelnen Patienten und den verschie- denen Metastasen. Nuklearmedizin 3/2003
  • 5. A147 Abstracts, Lucerne 2003 Verhältnis der durchschnittlich absorbierten Dosen von Metastasen zu Nor- O9 Radioimmunotherapy with lutetium-177-DOTA-rituximab: malgewebe: a phase I/II-study in patients with follicular and mantelcell lymphoma: an interim analysis F Forrer, A Lohri*, J Chen, R Herrmann**, H Mäcke, J Müller-Brand Nuclear Medicine, University Hospital, Basel, Medical Oncology Kantonsspital*, Liestal, Medical Oncology University Hospital**, Basel Ziel: Radioimmunotherapy with 131I and 90Y labelled anti-CD20 antibodies showed convincing results mainly in treatment of indolent lymphomas. We analyzed the pharmacokinetics and dosimetry of 177Lu labelled, chimeric (human-mouse) anti-CD20-antibody rituximab. The antibody was modi- Schlussfolgerungen: Aufgrund der vorliegenden Studie scheinen die fied with up to 4 DOTA-chelators with retained immunoreactivity. 177Lu beiden Peptide gleichwertig für die Therapie neuroendokriner Tumore. was chosen because of its low β-energy (0.497 MeV) and its imageable Insbesondere das Verhältnis der Tumordosis zur Nierendosis, zeigt keinen γ-energies. These are favorable physical characteristics for the treatment signifikanten Unterschied. Durch die gleichzeitige Infusion einer Ami- of small tumors or tumors that diffusely infiltrate visceral structures. nosäurenlösung lässt sich die Nierendosis signifikant reduzieren. Ob in Methoden: 7 patients (2 women, 5 men) with relapsed lymphoma were dieser Beziehung ein entscheidender Unterschied zwischen den beiden included so far. After pretherapeutic staging (18F-FDG-PET, CT, bone Peptiden besteht, muss noch geklärt werden. marrow biopsy) patients received 250 mg/m2 rituximab on day 1. On day 8 patients received another course of Rituximab followed by the injection O8 Premiers résultats d’un analogue de la neurotensine, 99mTc-NT-XI, of 20 mCi/m2 177Lu-DOTA-rituximab (32-40 mCi). Scintigraphic images évalué chez des patients avec un adénocarcinome pancréatique were obtained up to 15 d p.i. to determine biodistribution and total dose. F Buchegger1, F Bonvin1, M Kosinski1, AO Schaffland1, J Prior1, JC Reubi3, Blood samples were collected up to 15 d p.i. Urine was collected by male P Bläuenstein4, E García Garayoa4, M Gillet2, PA Schubiger4, A Bischof Delaloye1 patients up to 72 h p.i. Calculations were done with dose-factors published Services de Médecine Nucléaire1 et de Chirurgie2, Centre Hospitalier Universitaire Vaudois, on „RADAR“ (Stabin M et al.; www.doseinfo-radar.com). Lausanne, Division de Biologie Cellulaire3, Institut de Pathologie, Université de Berne et Resultate: Early -camera images showed mainly blood pool activity. Over Centre des Sciences Radiopharmaceutiques4, Institut Paul Scherrer, Villigen time, in 6 of the 7 patients a clear specific uptake at tumor sites was seen. The effective half-life of the whole-body activity ranged from 95 to 136 h Objectif: La sûreté, la biodistribution et l’uptake tumoral de NT-XI, analo- (mean 117 h ± 15 h), leading to diffuse whole-body-doses of 1007 gue de la neurotensine, a été étudié chez 4 patients prévus pour être opérés mGy to 1459 mGy (mean 1150 ± 123 mGy). The dose to the red marrow d’un adénocarcinome pancréatique primaire. ranged from 393 to 539 mGy (mean 447 mGy ± 55 mGy). Excretion of Méthodes: L’hexapeptide NT-XI contenant la séquence carboxyterminale activity was found to be low in urine with a maximum of 10% of the injec- modifiée de la neurotensine a été radiomarqué au 99mTc via un histidine- ted activity excreted within 72 h by the kidneys. The application of 177Lu- Nα-acétate. Les patients ont été suivis par scintigraphie durant 4 heures et 177-DOTA-rituximab was well tolerated. Clinical results and toxicity will par des prélèvements sanguins durant ~20 heures jusqu’à l’opération. be presented at the meeting. La radioactivité tissulaire et l’expression tumorale du récepteur de la Schlussfolgerungen: 177Lu-177-DOTA-rituximab seems to be an inter- neurotensine ont été déterminées dans les prélèvements chirurgicaux. esting, well tolerated compound with clinical activity already in a low dose Résultats: L’injection du 99mTc-NT-XI n’a pas provoqué d’effet secondaire. range. Dose escalation is in progress. Les demi-vies α et β sanguines étaient de 35 (17 à 62) et 230 (107 à 383) minutes, respectivement. L’élimination, essentiellement rénale, était rapide (92 à 97% / 20 h). La scintigraphie montrait une captation rénale, O10 Synthesis and biological activity of a new and highly potent ligand hépatique, splénique et de la moelle osseuse chez tous les patients ainsi for somatostatin receptors 2, 3, and 5 qu’une hyperactivité importante digestive chez 2 patients. La tumeur n’a M Ginj1, D Wild1, JS Schmitt1, JC Reubi2, B Waser2, M de Jong3, HF Bernard3, EP Krenning3, pas été visualisée chez 3 patients, alors qu’elle était localisée par SPECT HR Mäcke1 au niveau de la tête du pancréas chez le 4ème. L’uptake tumoral du 99mTc- 1 University Hospital Basel, Department of Nuclear Medicine, Radiological Chemistry, NT-XI mesuré ex-vivo était le plus élevé chez le 4ème patient, en relation 2 University of Bern, Institute of Pathology, 3 avec l’observation d’une forte expression du récepteur. Deux autres University Hospital Dijkzigt, Department of Nuclear Medicine, Netherlands tumeurs ne montraient pas d’expression du récepteur et une autre était Aim: The prototypes for tumor targeting with radiolabelled peptides are positive mais que sur de rares cellules tumorales dispersées. derivatives of somatostatin (SRIF) like DTPA-octreotide or DOTA-TOC Conclusion: L’injection du 99mTc-NT-XI a bien été tolérée et a permis de with high affinity mainly for sstr2 and moderate affinity to sstr5. We aimed visualiser la seule tumeur présentant une haute densité de récepteurs de la at developing new SRIF-analogs for internal radiotherapy, which recog- neurotensine tandis que 2 tumeurs n’exprimant pas le récepteur et une ne nize different receptor subtypes, to expand the present range of accessible l’exprimant que sur quelques cellules éparses ne pouvaient pas être mises tumors. en évidence. Ces résultats sont similaires aux observations pré-cliniques et Methods: Using parallel solid phase synthesis, we synthesized new octa- parlent en faveur d’une poursuite de l’évaluation clinique des analogues peptides based on octreotide, by replacing Phe3 mainly with unnatural radiomarqués de la neurotensine. amino acids. The affinity profile was determined using transfected cell lines with sstr1-5. Internalization was determined using AR4-2J cell lines and bio-distribution was studied in a rat tumor model. Results: Parallel solid phase synthesis allowed quickly to synthesize a range of new SRIF-based radiopeptides. One of them, DOTA-NOC, showed high affinity to sstr 2,3 and 5, if complexed with Y(III) or In(III). The rate of internalization in this series was the highest for 111In-DOTA- NOC. Bio-distribution in tumour bearing rats again showed very promising Nuklearmedizin 3/2003
  • 6. A148 Abstracts, Lucerne 2003 results. The uptake in sstr expressing tissues including the CA 20948 the stability in the human blood serum, the rate of internalization into AR4- tumour was significantly higher for 111In-DOTA-NOC compared with 2J cells, and biodistribution in male Lewis rats bearing the rat pancreatic 111In-DOTA-TOC and the tumour-to-kidney ratio was improved by a factor tumor AR4-2J. of 2. Results: The bombesin derivatives were synthesized with an overall yield Conclusion: Parallel solid phase synthesis along with the suitable bioas- of 23-32%. Compared to bombesin (IC50, 2.4 ± 0.6 nmol/l), all IC50 says is a powerful tool to select new radiopeptides with improved targeting values of our analogs are similar with low nM range. It is interesting to find properties. 111In and 90Y-DOTA-NOC are very promising radiopeptides for different linkers have a distinct effect on the stability and lead to a different the diagnosis and peptide receptor mediated radiotherapy of a larger range rate of internalization. The uptake of the radiolabeled analogs in the GRP of sstr expressing tumours like thyroid, colon or lung adenocarcinomas positive organs and the AR4-2J tumors was specific as shown by blocking which were shown to overexpress SRIF receptor subtypes other than sstr2. experiments. The tumor uptake of 111In-DTPA-GABA-HZ in the rat was 1.71 ± 0.51% ID/g at 4 h p.i., and in the pancreas was 3.92 ± 0.86% O11 New stabilised bombesin analogues as potential tumour imaging ID/g; the tumor/blood, tumor/muscle, tumor/liver, tumor/kidney ratios were 107, 171, 33, and 1.5 respectively. agents Conclusion: The results indicate that DOTA/DTPA-linker-HZ have high D Rüegg1, C Leonardi1, A Blanc1, M Lutz1, E García Garayoa1, P Bläuenstein1, binding affinities to the GRP receptor, and have a fast rate of internaliza- A Beck-Sickinger2, D Tourwé3, PA Schubiger1 tion into AR4-2J cells. The biodistributions showed high specific uptake in 1 Paul Scherrer Institut, Villigen, Switzerland, 2University of Leipzig, Germany and AR4-2J tumor and GRP positive organs, indicating that it is promising in 3Free University, Brussels, Belgium. diagnosis or therapy of GRP receptor positive tumors. Aim: Neuropeptides such as bombesin (BBS) bind cell-surface receptors overexpressed in several human tumours and show interesting properties O13 Management of small cell lung cancer: The role of whole-body for cancer diagnosis and therapy. However, their potential clinical utility is 18 limited by their rapid degradation. New BBS(7-14) analogues have been F-fluorodeoxyglucose positron emission tomography synthesised and characterised. The different analogues were designed EM Kamel, D Zwahlen*, MT Wyss , KD Stumpe, GK von Schulthess, HC Steinert based on the results obtained in the stability experiments with an unmodi- Department of Nuclear Medicine, and Department of Radiation Oncology*, fied BBS(7-14) analogue and enzyme inhibitors. University Hospital of Zurich, Switzerland Methods: The metabolic stability was tested in vitro in human plasma by Aim: To evaluate the role of whole-body 18F-fluorodeoxyglucose positron means of HPLC. Enzyme inhibitors were used to identify the enzymes emission tomography (FDG PET) in the management of patients with cleaving BBS. Binding assays were performed in PC-3 cells for analysing small cell lung cancer (SCLC). the affinity for GRP receptors. Materials and methods: Forty two consecutive patients with small cell lung Results: The positions 9 (Ala), 13 (Leu) and 14 (Met) are important for the cancer were evaluated by FDG PET for initial staging (n = 24), and post- stability. The replacement of Ala9 by a DAla, Leu13 by a CHx-Ala or Met14 therapy restaging (n = 18). PET findings were correlated with clinical and by a Nle increased the stability. The analogue with CHx-Ala showed the radiological work-up which included CT of the chest and upper abdomen, longer half-life (16 h). Differences were found in the affinity for GRP re- bone scan, and CT or MRI of the brain. ceptors. The substitutions with CHx-Ala and Nle did not affect much the Results: Compared with the conventional initial staging tools PET equally affinity whereas the introduction of DAla led to an important decrease in identified 20 patients with limited disease (n = 14), and extensive disease affinity. (n = 6). Additionally, PET up-staged 3 patients, and down-staged 1 pa- Conclusion: Modifications of the molecule BBS(7-14) can increase the tient. For post therapy restaging, discordant findings were observed in 6 plasma stability. However, BBS(7-14) seems to be more sensitive to struc- (33%) patients, PET successfully differentiated post therapy changes from tural changes since they might decrease the affinity for GRP receptors. residual disease (n = 3), unmasked soft tissue metastases (n = 1), and With longer plasma half-lives we ensure that enough intact peptide reaches excluded bone metastases (n = 1) when the other tools showed false re- the tumour area. Besides, a high affinity is also necessary to bind to the sults. In one patient PET missed the presence of minimal disease residue. overexpressed GRP receptors and be uptaken by the tumour cells. PET had a remarkable impact on the management of 9 (37%) patients of the initial staging and 3 (17%) patients of the restaging groups respective- O12 Synthesis and evaluation of bombesin analogs modified with ly. PET revealed low yield for the detection of cerebral metastases. Conclusion: FDG PET is a valuable tool in the management of patients different linkers with SCLC. H Zhang, K Hinni, J Chen, JC Reubi*, HR Maecke Institute of Nuclear Medicine, University Hospital Basel, Basel, *Institute of Pathology, University of Berne, Berne O14 Hilar staging of non small cell lung cancer using 3D-PET/CT image Aim: Bombesin receptors are over-expressed on a variety of human fusion tumors, and [D-Tyr6, -Ala11, Phe13, Nle14]Bombesin(6-14) has been EM Kamel, C Burger, D Lardinois*, W Weder*, GK von Schulthess, HC Steinert shown to bind to all bombesin receptor subtypes with high affinity. In pa- Department of Nuclear Medicine, and Department of Thoracic Surgery*, University Hospital tients studies, a 99mTc labeled bombesin analog showed high uptake in of Zurich, Switzerland breast(4/6) and prostate(1/4) carcinomas. We report here on DOTA/DTPA Aim: In non-small-cell lung cancer (NSCLC) accurate preoperative tumor conjugated bombesin analogs based on the sequence [D-Tyr6, -Ala11, staging is essential for choosing the appropriate treatment. PET/CT image Thi13, Nle14]Bombesin(6-14) (HZ), and focus on the influence of different fusion combines the metabolic and anatomic information of both methods. linkers on their characters. However, the exact localization of lymph node metastases in the hilus is a Method: Parallel solid peptide synthesis was used to synthesize the above challenge. Lymph nodes distal to the mediastinal pleural reflection and mentioned bombesin derivatives. They were analyzed with mass spectros- within the visceral pleura are classified as N1 nodes. Lymph nodes within copy and analytical HPLC. DOTA/DTPA-linker-HZ was complexed with the mediastinal pleural envelope are classified as N2 nodes. Because the YIII or InIII and their affinity were studied using cryostat sections of human pleura is not visible neither in CT nor in PET, the exact classification of a prostate cancer tissue. 111In/177Lu/90Y labeled analogs were used to study hilar node as N1 node or N2 node remains difficult. Therefore, we under- Nuklearmedizin 3/2003
  • 7. A149 Abstracts, Lucerne 2003 took a prospective blinded study to evaluate the additional incremental va- O16 Comparison of 18F-FDG-PET and bone scintigraphy for monitoring lue of 3D reconstruction of fused PET/CT images in the hilar nodal staging disease activity in patients with rheumatoid arthritis receiving treatment of patients with NSCLC with a monoclonal chimeric anti-TNF antibody: a pilot study Materials and Methods: 21 patients (age 47-76 years, 14 men, 7 women) GW Goerres, A Forster*, V Treyer, D Uebelhart*, B Michel*, B Seifert**, GK von Schulthess, with proven NSCLC were enrolled in the study. Integrated PET/CT AH Kaim*** imaging was performed (Discovery LS; GEMS). In all patients lymph node Division of Nuclear Medicine, Department of Rheumatology and *Institute of Physical metastases in the hilar region were detected. 3D reconstruction of the hilar Medicine, University Hospital Zurich; **Department of Biostatistics, University of Zurich, region was performed using an in house software (www.pmod.com). ***Department of Radiology, University of Basel, Switzerland Through using a negative CT threshold (-150HU), air passages and lung Aim: The aim of this study was to compare 18F-fluorodeoxyglucose (FDG) were identified. By means of VOI, lymph nodes with increased FDG positron emission tomography (PET) with conventional bone scintigraphy uptake in PET were selected. The 3D-objects were displayed in a virtual for the assessment of disease activity in patients with rheumatoid arthritis room. The 3D-images were analyzed by two nuclear physicians and the N and to assess feasibility of PET scanning for monitoring treatment. stage was defined. The findings were correlated with intraoperative and Methods: Seven patients with active rheumatoid arthritis underwent FDG histopathologic staging results. PET and bone scintigraphy before and after treatment with infliximab. Results: Discrimination between N1 (node distal to mediastinal pleural A visual scoring system was used to evaluate disease activity in large joints reflection) and N2 (node proximal to mediastinal pleural reflection) was of the body, the wrists and finger joints. Spearman rank correlation was performed accurately using the 3D mode in 19 out of 21 patients. More used to compare the decrease in inflammatory activity as measured with accurate mediastinoscopy results were obtained in light of the 3D data. FDG PET and early and late bone scans with the decrease in clinical Identification of microscopic invasion of the pleura was not amenable by disease activity. the 3D mode. Results: FDG PET showed high scoring values before treatment onset and Conclusion: 3D PET/CT image fusion is a promising method for accurate a significant decrease in FDG uptake in patients who responded to inflixi- localization of hilar metastatic lymph nodes. The proposed algorithm may mab therapy. In all patients the disease activity assessed with FDG PET offer additional information about the nodal stations which are beyond the was clearly correlated to clinical outcome (p = 0.04). In contrast, early reach of mediastinoscopy. and late bone images were less reliable for the assessment of treatment response and the changes were smaller. O15 Impact of whole body positron emission tomography on initial Conclusion: In this pilot study, FDG PET was better than conventional staging and therapy in patients with squamous cell carcinoma of the oral bone scintigraphy for assessing disease activity. Our preliminary results cavity suggest that FDG PET has the potential to replace bone scintigraphy for DT Schmid, GK Eyrich*, KW Grätz*, GK von Schulthess, GW Goerres monitoring disease activity and treatment effects in future studies. Division of Nuclear Medicine and Department of Cranio-Maxillo-Facial Surgery*, University Hospital Zurich, Zurich, Switzerland O17 Does fluorodeoxyglucose positron emission tomographie Aim: The purpose of this study is to evaluate the additional clinical infor- (FDG-PET) of Echinococcus multilocularis (EM) liver lesions reflect parasite mation provided by whole body positron emission tomography (PET) with vitality? fluorodeoxyglucose (FDG) for initial staging of patients with squamous KDM Stumpe, EC Renner-Schneiter*, F Grimm**, Z Kadry***, P Deplazes**, cell carcinoma (SCC) of the oral cavity. PA Clavien***, RW Ammann*, EL Renner*, GK von Schulthess Methods: PET scans from the head to the pelvic floor of 34 consecutive Dept. Nuclear Medicine, *Div. Gastroenterology and Hepatology, **Dept. Parasitology, patients (22 men, 12 women; mean age 71 years) with histologically con- ***Dept. Visceral and Transplantation Surgery, University Hospital, Zurich, Switzerland firmed SCC of the oral cavity were retrospectively evaluated. Clinical Aim: To evaluate whether FDG-PET reflects vitality of Echinococcus mul- information including CT of the head and neck and chest X-ray or chest CT tilocularis (EM) lesions. was compared with information on nodal involvement and distant Methods: In an ongoing study, all EM cases newly diagnosed at our metastases or secondary tumors obtained with PET. institution are subjected to FDG-PET. Diagnosis of EM is based on typical Results: The primary tumor was identified with PET in 33 of 34 patients imaging (CT, MRI) and serology. Whenever technically feasible, radical (97%). In 27 patients (81%) the clinical N-stage was confirmed with PET. surgery is attempted, inoperable/not radically operated cases being treated In 2 Patients (6%) additional pathologic loco-regional lymph nodes were with benzimidazoles. At surgery, EM material is collected and subjected to found. In 5 patients more lymph nodes were identified with CT. Distant vitality testing using a mouse model. lesions were seen with PET imaging in bone, lung, mediastinum, liver and Results: 20 patients (15 women, 5 men; median age 61 yrs. [range 40-73]) colon. In 3 patients (6%) distant metastases were correctly identified. In have been studied so far. 16 of the 20 patients showed increased FDG another 4 patients (12%) a secondary cancer was detected. One false uptake of liver lesions in PET, in 4 patients FDG-PET was negative. At positive finding was described with PET. In 5 of 34 patients (15%) the diagnosis, all of the latter showed extensively calcified lesions and in 2 additional findings as revealed with PET lead to a change of treatment. serology was only weakly positive, suggesting inactive disease; one was Conclusion: Whole body PET provides relevant additional information to a nevertheless started on albendazole, but developed drug-induced hepatitis standard clinical staging procedure in patients with oral cavity SCC. The 14 weeks into treatment which rapidly resolved after discontinuation; in detection of distant metastases and secondary primary tumors can have a this patient FDG-PET was performed 14 weeks after stop of treatment; the great impact on patient management. patient was then successfully operated; in vivo vitality tests of the resected parasite material in mice remained negative. Conclusions: FDG-PET of liver lesions was positive in 16/20 untreated, and negative in 4/4 extensively calcified, presumably inactive human EM cases, one of the latter being proven to be avital. These preliminary data support that FDG-PET may reflect parasite vitality. Wether negativation of FDG-PET during benzimidazole treatment may be used as indicator for safely stopping therapy remains to be seen. Nuklearmedizin 3/2003
  • 8. A150 Abstracts, Lucerne 2003 O18 Apport de la tomographie scintigraphique (SPECT) dans la pratique P1 Einfluss der Reduktion der Emissionszeit auf die Bildqualität einer quotidienne de la scintigraphie osseuse Ganzkörper FDG-PET/CT A Keller1, M Zwimpfer2, A Chouiter1, T de Perrot1, L Terraneo2 T Berthold, D Schmid, C Britt, A Buck, TF Hany 1Division de radiodiagnostic et de radiologie interventionnelle, Klinik und Poliklinik für Nuklearmedizin, Universitätsspital Zürich, Zürich 2Division de médecine nucléaire, Hôpital cantonal universitaire de Genève Ziel: Einfluss der Reduktion der Emissionszeit von 4 auf 2 Minuten von Objectif: Evaluer l’apport de la tomographie (SPECT) par rapport à CT-schwächungskorrigierten PET Datensätzen auf die Bildqualität. l’imagerie planaire (PLANE) dans la pratique de la scintigraphie osseuse Methoden: In 10 Patienten (Durchschnittsalter 57,3 Jahre; 28-77 Jahre; (SCos). 5 Männer, 5 Frauen) mit einem durchschnittlichen Body-mass-Index Matériel et méthode: En 2000-2001, 115 patients (66 F,49 H) âgés de (BMI) von 32,2 (25,4-38,0) wurde eine Ganzkörper FDG-PET/CT (Stan- 46.6 ± 24.2 ans, ont bénéficié d’une SCos avec des acquisitions PLANE darddosis 370 MBq) auf einem kombinierten PET/CT Gerät (Discovery et SPECT pour les indications suivantes: 1) Tumeur (n = 51), 2) Trauma- LS, GEMS, USA) durchgeführt. Dabei wurden für jedes axiale Gesichts- tisme (n = 31), 3) Infection (n = 16), 4) Nécrose aseptique (n = 4), feld Emissionsdaten während 4 und anschließend während 2 Minuten im 5) Divers (n = 13). L’acquisition PLANE a été pratiquée 3 heures après 2D-Modus aufgenommen. Für die Schwächungskorrektur wurde eine injection de 10.8 MBq/kg de poids corporel de Tc99m HDP (Mal- Niedrig-Dosis-CT (80 mA, 140 kV, 0,5 s Rotationszeit, Schichtdicke linckrodt®) avec les paramètres techniques suivants: collimateur LEHR 4,25 mm, totale Aufnahmezeit 22,4 s) verwendet. Für die quantitative Be- parallèle, matrice 128*128, vitesse de balayage de 8 cm/minute et des wertung der resultierenden Bilddaten wurde das Rauschen (Standardab- incidences statiques complémentaires de 7 minutes sur la (les) localisa- weichung der Impulsrate/ mittlere Impulsrate) eines Volumendatensatzes tion(s) pathologique(s). L’acquisition SPECT complémentaire a été in der Leber bestimmt. Die qualitative Bewertung wurde blind bezüglich réalisée sur une caméra « 3 têtes » (Toshiba® GCA 9300A), avec 30 der Emissionszeiten durchgeführt, wobei auf die Beurteilbarkeit des patho- paliers de 60 secondes sur 120º et une matrice de 256*1024. Les recons- logischen Befunds eingegangen wurde. Zusätzlich wurde die Bildqualität tructions ont été pratiquées dans les plans coronal, sagittal et axial avec subjektiv auf einer Skala (von sehr gut – gut – genügend – nicht diag- réalisation de coupes jointives en utilisant une méthode « filtered back nostisch) eingeteilt. projection ». Les SCos ont été analysées qualitativement par 2 lecteurs et Resultate: Das Bildrauschen war durchschnittlich 12% (3-19%) stärker considérées comme pathologique lorsqu’elles présentaient un (ou des) mit 2 Minuten Aufnahmezeit. Es zeigte sich keine direkte Korrelation foyer(s) hyper ou hypofixant(s). Les résultats de la SCos ont été systéma- zwischen Bildrauschen und BMI. Es konnte kein Unterschied in den tiquement confrontés à l’évolution clinique (100%) et à d’autres techni- pathologischen Befunden der beiden Gruppen gefunden werden. In 14 von ques d’imagerie (34%) lorsque nécessaire. 20 Datensätzen wurde die Bildqualität als sehr gut, in 6 als gut beurteilt, Résultats: Le SPECT a été réalisé sur le rachis (n = 78) [cervical (n = 7), ohne Unterschied zwischen 2 und 4 Minuten Aufnahmezeit dorsal (n = 21), lombaire (n = 50)], le bassin (n = 18), le crâne (n = Schlussfolgerungen: In unserem Patientenkollektiv mit erhöhtem BMI 12) et autres (n = 7). Le résultat PLANE - SPECT était identique dans führte die Reduktion der Emissionszeit von 4 auf 2 Minuten im 2D-Modus 61 cas / 115 (53%). Dans les 54 cas restants (47%), le SPECT a démontré erwartungsgemäß zu erhöhtem Bildrauschen ohne aber die diagnostische un plus grand nombre de foyers dans et/ou précisé leur topographie dans Sicherheit einzuschränken. 25 et 38 cas respectivement : tumeur (n = 32), traumatisme (n = 11), infection (n = 7), nécrose aseptique (n = 1), divers (n = 3). L’évolution P2 Characterizing adrenal lesions with 18F-FDG-PET clinique et la confrontation aux autres techniques d’imagerie (IRM = 24; CT =8; RX = 6; PET-FDG = 1) ont confirmé l’apport du SPECT S Merk, M Hentschel, I Brink, T Kelly, M Reincke*, E Moser comme un élément utile dans la prise en charge de 46 cas / 115 (40%). Department of Nuclear Medicine, *Department of Internal Medicine II, University Clinic Dans les 8 cas restants, le résultat positif du SPECT par rapport à la Freiburg PLANE n’a été corrélé à aucune autre anomalie clinique et/ou radiologique Ziel: Compared with adrenal metastases primary adrenal tumours are very (« faux positif ») dans 5 cas, et dans 3 cas, l’interprêtation du SPECT a seldom. Purpose of this study was to evaluate FDG whole-body PET évoqué une autre pathologie que le diagnostic final. during staging and restaging of primary adrenal carcinomas and to answer Conclusions: La réalisation d’un SPECT additionnel à la PLANE est un the question whether PET provides information on the dignity of adrenal complément très utile dans le bilan de multiples pathologies osseuses du masses. squelette axial, puisqu’il bénéficie d’une meilleure sensibilité de détection Methoden: Within the framework of primary staging and post-surgical et localise avec plus de précision les anomalies scintigraphiques, élément restaging 35 patients were examined with FDG-PET, 9 with primary séméiologique important dans la caractérisation des différentes patho- adrenal carcinomas, 6 adrenal incidentalomas and 20 with adrenal meta- logies. stases of lung tumours (14 SCLC and 6 NSCLC). The examination was performed according to a standard protocol. The results were compared with morphological imaging and/or post-surgical histology. The images were evaluated visually and semi-quantitatively by SUV calculation. Therefore maximum values from circular ROIs were used. 3 independent investigators evaluated 3 representative tumour layers. Resultate: In comparison with morphological imaging (Sono, X-ray, CT, MRI) the PET detected all adrenal tumours as well as all distant metastases in patients with primary adrenal carcinomas. Moreover, the PET identified previously undetected metastases in 2 persons (1x trunk wall, 1x lung). The uptake of adrenal carcinomas (3.6 ± 0.8 (min/max 2.6/6.3)) is in the lower range of values showing adrenal metastases (SUV 6.2 ± 2.5; min/max 2.6/16.5). In case of the incidentalomas divergent uptake behaviour was observed. 3 metabolically active adrenal adenomas showed slightly increased glu- Nuklearmedizin 3/2003
  • 9. A151 Abstracts, Lucerne 2003 cose metabolism (SUV 2.5, 1.3, and 1.2). In the other 3 incidentalomas with PE compared to planar imaging. In addition, it permits routine (1 Conn-syndrome, 2 metabolically inactive adenomas) the FDG-uptake tomography, which makes it competitive to other tomographic modalities could not be visually differentiated from the background. performed for diagnosis of PE. Schlussfolgerungen: 18F-FDG-PET is a highly sensitive method for detction and staging of adrenal carcinomas. It seems to allow differentia- P5 Monitoring de pompes à diffusion intrathécale de médicaments: tion between malignant and benign adrenal lesions. à propos de 3 cas A Boubaker1, D Chedel2, E Buchser2, A Bischof Delaloye1 P3 PET as an aid to diagnose and monitor giant cell arteritis: 1 Service de Médecine Nucléaire, CHUV, 1011-Lausanne, 2Service d’anesthésiologie, d’antalgie et de neuromodulation, feasibility and first clinical results EU Nitzsche, MA Walter, U Schirp, F Forrer, S Wickli, A Tyndall, J Müller Ensemble Hospitalier de la Côte, Hôpital de Morges, 1110 Morges Divisions of Nuclear Medicine & PET Center, and Rheumatology, University of Basel Medical Objectif: Dans les douleurs chroniques, ou certains cas de maladies neuro- Center logiques avec spasticité, la neuromodulation par implantation de pompes à Aim: Polymyalgia rheumatica (PR) and arteritis temporalis (AT) may diffusion intrathécale de médicaments, contrôlées par télémétrie est overlap clinically in about 50%. Since involvement of AT is usually très utile. En cas d’échappement au traitement, les causes peuvent être segmental, the diagnosis may be missed on routine biopsy. PM does not multiples. Il est primordial de détecter un éventuel dysfonctionnement have a histo-pathological correlate. Therefore, we tested the hypophesis, d’une pompe sans side port et/ou une fuite du système pompe-cathéter. that FDG PET may aid diagnosis and monitoring of giant cell arteritis. Nous rapportons notre expérience chez 3 patients porteurs de pompes Methods: 18 patients (pts.), age: 58 ± 20 years, underwent whole body Medtronic, Synchromed®, sans side port. FDG PET imaging after overnight fasting. According to results of kinetic Méthodes: Après injection de 37 MBq d’In-111-DTPA dans le réservoir, imaging of inflammation by PET, acquisition was initiated after 45 min- une acquisition dynamique était réalisée suivie de vues supplémentaires utes uptake time. All images were interpreted by 3 investigators blinded to jusqu’à 4 heures pi. Le débit appliqué au système était de 0.9 ml/h pour un the clinical information of all patients. The PET results were correlated volume total de 5 ml. Le premier patient souffrait de douleurs sur lésion with the results obtained by biopsy, lab tests and clinical course. séquellaire du nerf sciatique droit avec une brusque recrudescence des Results: 3 of 18 pts. showed intense uptake of the wall of the whole aorta douleurs 14 mois après implantation du système. Le second souffrait and supraaortal branches. These pts. were not on any antiinflammative d’une diplégie spastique douloureuse sur syndrome de Little, bien con- medication. Scans of the other 15 pts. were read unremarkable. Of these, trôlée par Baclofène intra-thécal durant 10 ans, puis échappement malgré all but 2 were on glucocorticoid therapy. The latter 2 achieved complete augmentation des doses. Le dernier patient présentait des douleurs sur remission, which was maintained after withdrawal of medication. adénocarcinome pancréatique métastatique, bien contrôlées durant 3 mois Conclusion: FDG PET appears to be suitable to determine the extent of et en augmentation 3 semaines avant la scintigraphie. inflammation of large vessels in suspected giant cell arteritis. Moreover, it Résultats: Chez le premier patient, la scintigraphie a révélé un dysfonc- may represent a sensitive tool to diagnose and monitor giant cell arteritis. tionnement mécanique de la pompe, qui a été changée avec évolution cli- nique favorable. Chez le second, la scintigraphie a permis de localiser une P4 SPECT is superior compared to planar imaging for diagnosis of fuite du cathéter sous-cutané à son entrée dans l’espace intra-thécal: après révision du système l’évolution a été favorable. Le dernier patient présen- pulmonary embolism tait une progression de la maladie métastatique: la scintigraphie était nor- U Schirp, MA Walter, J Müller, EU Nitzsche male, le patient est décédé peu après. Division of Nuclear Medicine & PET Center, University of Basel Medical Center Conclusions : Chez nos 3 patients, la vérification des pompes à diffusion Aim: In the past, comparison of diagnostic imaging for diagnosis of intra-thécale par scintigraphie à l’In-111-DTPA s’est révélée efficace, per- pulmonary embolism (PE) was based on spiral computed X-ray tomog- mettant de localiser l’origine du dysfonctionnement dans 2 cas et de dé- raphy (CT) and planar scintigraphy based on PIOPED criteria. The latter montrer la perméabilité du système chez le dernier. resulted in a high percentage of inconclusive results. Because of this, we tested the hypophysis, that SPECT imaging may enable more accurate P6 The influence of antithyroid drugs on iodine kinetics and on the diagnosis of PE compared to planar imaging. Methods: 350 patients (pts.), age: 73 ± 46 years, underwent SPECT im- outcome of radioiodine treatment aging for suspected PE under clinical routine conditions. Transaxial, coro- MA Walter, B Eckard, M Christ-Crain*, B Müller*, E Nitzsche, J Müller-Brand nal and sagittal images, and 8 standard planar images were reconstructed Div. of Nuclear Medicine, *Div. of Endocrinology, University Hospital Basel from the SPECT data set for comparison of tomographic and planar im- Aim: The aim of this study was to analyze the influence of simultaneous aging. Images were read by two investigators blinded to the patient data. antithyroid drug (ATD) treatment on pretherapeutic iodine uptake kinetics Read out was based on three categories: PE positive, PE negative, nondiag- of the thyroid gland and its relation to the outcome after radioiodine (RAI) nostic for PE. therapy. Results: Positive diagnosis of PE was established in 31% (110 pts.), exclud- Methods: We included 229 patients suffering from toxic adenoma, multi- ed in 64% (224 pts.) and nonconclusive in 5%. Diagnostic performance for nodular goiter or Graves’ disease who were admitted for RAI therapy. A SPECT was significantly higher compared to planar imaging simultaneous ATD treatment was administered to high risk patients suf- (p <0.01). Regarding anatomic localization and extent of perfusion fering from cardiovascular or cerebrovascular diseases. The maximum defects, SPECT was again superior to planar imaging (p <0.01). Read iodine uptake prior to therapy was compared to the outcome after out time for SPECT was not significantly different from that for planar radioiodine treatment imaging (p = n.s.). Observer agreement was 0.95. Overall procedure time Results: Overall, an euthyroid state was achieved in 137 patients (60%), a amounted to 40 minutes for ventilation/perfusion imaging. hypothyroid state was achieved in 46 patients (20%) and 46 patients (20%) Conclusion: SPECT imaging in pts. with suspected PE is the procedure of remained hyperthyroid. Patients receiving simultaneous ATD medication choice, because it offers better diagnostic performance in detecting the showed a reduction of uptake and a decrease in the effective half life of ra- number, anatomic localization and extent of perfusion defects associated dioiodine in the thyroid. Simultaneous antithyroid medication negatively Nuklearmedizin 3/2003
  • 10. A152 Abstracts, Lucerne 2003 influenced the outcome of radioiodine therapy in patients suffering from P7 Méthode isotopique de contrôle de l’étanchéité du système de Graves’ disease as well as in patients suffering from toxic nodular goiter. In réduction du volume gastrique chez les patients obèses addition, patients presenting with a low iodine uptake prior to therapy had C Antonescu, E Chevalier, A Bischof Delaloye a better success rate after radioiodine treatment. Success rate decreased Service de Médecine Nucléaire, CHUV, Lausanne with higher uptake levels. This effect was found in patients suffering from Objectif: Contrôler l’étanchéité d’un système de réduction de volume multi-nodular goiter as well as in patients suffering from Graves’ disease gastrique chez les patients obèses. (Fig. 1). Méthodes: Le système de réduction du volume gastrique est formé d’une bande de silicone avec un anneau intérieur gonflable relié par un tube à un port d’accès extra-abdominal. La mise en place du système est réalisée par laparoscopie et le diamètre intérieur réglé par l’injection de ser physiologi- que. La bande est placée à environ 1 cm de la jonction oeso-gastrique. Deux patients obèses, 1F et 1H, BMI = 34 et 32 kg/m2, ont bénéficié d’un contrôle isotopique de leur système de limitation gastrique. Un vo- lume de 5ml de sulfures marqués au 99mTc a été injecté dans le port d’accès du système. Les activités injectées étaient de 187 MBq et respectivement 221 MBq. Pendant et après l’administration plusieurs séries d’acquisitions dynamiques (5’’/image) centrées sur l’abdomen ont été réalisées. L’examen a été complété par des vues statiques tardives antérieures de l’abdomen (2’/vue). Résultats: Chez une patiente l’examen a montré une fuite à la jonction tube/port d’accès externe qui a été corrigé par une intervention chirurgi- cale simple. Chez l’autre patient il n’y avait pas de mise en évidence de fuite du système et aucune révision chirurgicale n’a été entreprise. Les deux patients ont bien supporté l’examen. Conclusions: La méthode isotopique de contrôle de l’étanchéité du système de réduction de volume gastrique chez les patients obèses est Conclusion: In contrast to the present dogma, our results provide evidence relativement simple, fiable et permet d’éviter une révision chirurgicale that pretherapeutic height of iodine uptake level and posttherapeutic out- inutile. Son coût est très accessible. come are inversely correlated. Moreover, the negative effect of ATD on the outcome is not due to the reduced iodine uptake. Nuklearmedizin 3/2003