This document discusses radiopharmaceutical imaging of neuroendocrine tumors. It begins by defining neuroendocrine tumors and their most common sites of origin. It then discusses the radiopharmaceuticals used in imaging NETs, including somatostatin analogues that target somatostatin receptors, catecholamine analogues that target sympathetic nervous system tumors, and FDG that targets glucose metabolism. The document provides examples of different radiopharmaceutical scans and their findings in common NETs like carcinoid tumors, pheochromocytomas, and paragangliomas. It also discusses the added value of SPECT/CT in image interpretation.
HIDA scan evaluates hepatobiliary function and anatomy. It involves injecting a radiotracer that is taken up by the liver and excreted in bile. Images track the radiotracer's flow from liver to gallbladder and small intestine. Findings are used to diagnose conditions like acute cholecystitis, bile duct obstruction, and leaks. A normal scan shows sequential activity in the liver, bile ducts, gallbladder, and small bowel within an hour, confirming a patent system.
Dual energy CT utilizes two different x-ray spectra to characterize tissues. It can help address challenges with single energy CT like lesion detection and image noise. Dual energy CT works by analyzing how materials attenuate x-rays differently at various energies, allowing differentiation of substances like iodine and calcium. There are several technical approaches to dual energy CT, including sequential acquisition with two scans, rapid voltage switching between two voltages, and dual-source CT with two tube-detector pairs. Post-processing involves material decomposition and differentiation using image-domain or projection-domain algorithms.
PET/CT is a medical imaging technique that combines a positron emission tomography (PET) scanner and an x-ray computed tomography (CT) scanner into a single gantry system. This allows it to obtain both functional metabolic information from PET and anatomic information from CT in a single imaging session. The PET data provides physiological functional imaging while the CT data provides accurate structural information. By combining the PET and CT images, diagnostic accuracy and localization of lesions is improved for conditions like cancer, infections, and inflammation. The PET/CT scan involves intravenous injection of FDG, a CT scan, a PET scan, and generation of thousands of fused PET/CT images which are reconstructed, reformatted and analyzed.
This document discusses advances in oncological PET imaging. It begins by outlining limitations of current PET/CT imaging related to false positives, false negatives, and radiation exposure. It then describes several advances in PET imaging including new radiotracers for tumor characterization, instrumentation improvements, software enhancements to reduce radiation dose, and hybrid PET/MRI imaging. The document provides examples of how various new radiotracers beyond FDG can provide clinical benefits for tumor imaging and characterization.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
Interventional radiology uses minimally invasive techniques guided by imaging to diagnose and treat medical conditions. Procedures use small incisions or catheters inserted through blood vessels to access internal organs. The Seldinger technique is commonly used, involving insertion of a guidewire and catheter through a needle into the femoral artery. A variety of catheters and guidewires are used depending on the target vessel. Angiography involves injecting contrast dye to visualize vessels. Interventional radiology suites contain specialized equipment like large X-ray tubes and digital image receptors to facilitate complex image-guided procedures.
This document discusses radiopharmaceutical imaging of neuroendocrine tumors. It begins by defining neuroendocrine tumors and their most common sites of origin. It then discusses the radiopharmaceuticals used in imaging NETs, including somatostatin analogues that target somatostatin receptors, catecholamine analogues that target sympathetic nervous system tumors, and FDG that targets glucose metabolism. The document provides examples of different radiopharmaceutical scans and their findings in common NETs like carcinoid tumors, pheochromocytomas, and paragangliomas. It also discusses the added value of SPECT/CT in image interpretation.
HIDA scan evaluates hepatobiliary function and anatomy. It involves injecting a radiotracer that is taken up by the liver and excreted in bile. Images track the radiotracer's flow from liver to gallbladder and small intestine. Findings are used to diagnose conditions like acute cholecystitis, bile duct obstruction, and leaks. A normal scan shows sequential activity in the liver, bile ducts, gallbladder, and small bowel within an hour, confirming a patent system.
Dual energy CT utilizes two different x-ray spectra to characterize tissues. It can help address challenges with single energy CT like lesion detection and image noise. Dual energy CT works by analyzing how materials attenuate x-rays differently at various energies, allowing differentiation of substances like iodine and calcium. There are several technical approaches to dual energy CT, including sequential acquisition with two scans, rapid voltage switching between two voltages, and dual-source CT with two tube-detector pairs. Post-processing involves material decomposition and differentiation using image-domain or projection-domain algorithms.
PET/CT is a medical imaging technique that combines a positron emission tomography (PET) scanner and an x-ray computed tomography (CT) scanner into a single gantry system. This allows it to obtain both functional metabolic information from PET and anatomic information from CT in a single imaging session. The PET data provides physiological functional imaging while the CT data provides accurate structural information. By combining the PET and CT images, diagnostic accuracy and localization of lesions is improved for conditions like cancer, infections, and inflammation. The PET/CT scan involves intravenous injection of FDG, a CT scan, a PET scan, and generation of thousands of fused PET/CT images which are reconstructed, reformatted and analyzed.
This document discusses advances in oncological PET imaging. It begins by outlining limitations of current PET/CT imaging related to false positives, false negatives, and radiation exposure. It then describes several advances in PET imaging including new radiotracers for tumor characterization, instrumentation improvements, software enhancements to reduce radiation dose, and hybrid PET/MRI imaging. The document provides examples of how various new radiotracers beyond FDG can provide clinical benefits for tumor imaging and characterization.
CT urography is an imaging technique used to examine the urinary tract. It involves non-contrast CT imaging followed by CT imaging after intravenous contrast administration, including excretory phase images 8-10 minutes later. CT urography can detect abnormalities of the kidneys, ureters and bladder such as tumors, stones, infections and congenital anomalies. It provides both anatomical and functional information about the urinary tract.
Interventional radiology uses minimally invasive techniques guided by imaging to diagnose and treat medical conditions. Procedures use small incisions or catheters inserted through blood vessels to access internal organs. The Seldinger technique is commonly used, involving insertion of a guidewire and catheter through a needle into the femoral artery. A variety of catheters and guidewires are used depending on the target vessel. Angiography involves injecting contrast dye to visualize vessels. Interventional radiology suites contain specialized equipment like large X-ray tubes and digital image receptors to facilitate complex image-guided procedures.
Introduction to Bone Scan: Techniques and Diagnosis Waseem M.Nizamani
This document provides an overview of nuclear medicine imaging techniques like bone scans. It discusses how nuclear medicine shows physiological functioning rather than anatomy. Bone scans specifically involve injecting radioactive tracers that are absorbed by bone and then imaging their distribution to identify abnormalities. The document reviews normal scan findings, uses of bone scans to detect conditions like metastases and fractures, and presents several case examples to illustrate bone scan interpretations for conditions like osteomyelitis, bone metastases, and trauma.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
This document discusses fusion imaging, which combines images from different modalities to create a hybrid image. It describes fusion imaging techniques like PET-CT and SPECT-CT that merge functional imaging data with anatomical images. The primary advantage of fusion imaging is that it allows correlation of findings from two concurrent imaging modalities, providing both anatomical and functional/metabolic information in a single exam. Specifically, PET-CT fusion improves diagnostic accuracy and lesion localization by overcoming the limitations of each individual modality. In conclusion, combined PET-CT exams are more effective than PET alone for localizing lesions and differentiating normal variants from tumors.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
Chest x-ray, pelvis x-ray, and FAST scan are used in the primary survey of trauma patients to rapidly identify life-threatening injuries like hemothorax, pneumothorax, and free fluid. CT scan is the definitive imaging study for trauma as it can identify internal organ damage and injuries that are difficult to detect otherwise. Head CT is especially important for patients with head injuries to identify injuries like extradural and subdural hematomas. Whole body CT allows for rapid full-body assessment but has limitations of availability and high radiation dose.
Radioactivity is the spontaneous disintegration of unstable atomic nuclei. It was discovered in 1896 and results in the emission of radiation. The number of neutrons and protons in a nucleus determines its stability, with heavier elements above atomic number 82 generally being radioactive. Radioactive decay occurs through different types of emission and can be used for medical applications like radiation therapy or diagnostic imaging. Proper patient preparation and safety precautions are important when using radiopharmaceuticals like iodine-131 to optimize treatment and minimize radiation exposure.
This document discusses radionuclide thyroid imaging. It indicates the main indications for the procedure include assessing gland anatomy and function, detecting nodules, and identifying functioning metastatic tissues. The main radiopharmaceuticals used are 99mTc pertechnetate, 131I sodium iodide, and 123I sodium iodide. Patient preparation may involve stopping medications and iodine-rich foods. Views obtained include anterior, oblique, and whole body. Findings are interpreted as normal, enlarged, or showing diffuse/localized changes. I-131 is now mainly used for metastatic screening due to its high radiation dose.
Computerized tomography (CT) was pioneered by Godfrey Hounsfield and Allan Cormack in the 1970s. CT uses X-rays and computer processing to create cross-sectional images of the body. The first CT scanners used a translate-rotate design, while later generations used multiple detectors and spiral scanning for faster, more detailed imaging. Image reconstruction uses back projection to convert attenuation measurements into pixel values and display slices. CT provides excellent anatomical detail and is widely used for diagnosing conditions of the brain, blood vessels, lungs and other organs.
PET imaging is useful for cancer diagnosis and management. It provides functional information about glucose metabolism in tumors that can help establish prognosis, guide treatment decisions, and assess response. PET using 18F-FDG has high sensitivity and specificity for detecting cancer. It has applications in staging, restaging, and monitoring treatment response for many cancer types including lung cancer, lymphoma, and head and neck cancers. PET can identify tumor involvement that may be missed by anatomical imaging alone.
This presentation provides sufficient material for anyone who wants is interested in interventional radiology. Here we will discuss the available facilities, mechanisms and equipments.
In my opinion this presentation will prove a footstep in interventional radiology
Helical and multislice CT techniques provide advantages over traditional slice-by-slice CT scanning. Helical CT, also known as spiral CT, involves continuously transporting the patient through the gantry while acquiring data during multiple 360 degree scans, allowing for increased speed, improved image continuity and less motion artifact. Multislice CT uses multiple parallel detectors to scan a greater volume of the patient per rotation, providing shorter acquisition times, improved z-axis resolution, and more information for radiologists. Both techniques rely on technological advances like slip-ring devices and interpolation algorithms to efficiently process the continuously acquired data into diagnostic images.
Digital breast tomosynthesis (DBT) is an emerging 3D breast imaging technique that involves acquiring low-dose X-ray images of the stationary breast from multiple angles to create tomographic slices. The first DBT system was introduced in 2011. DBT provides improved visualization of lesions and reduced call back rates compared to 2D digital mammography. While DBT exposes patients to a higher radiation dose than 2D mammography alone, combining DBT with a synthesized 2D mammogram can achieve a radiation dose similar to standard mammography alone. DBT is being widely adopted for breast cancer screening due to its superior performance over conventional digital mammography.
Interventional radiology (IR) is a medical subspecialty that performs minimally invasive procedures using medical imaging guidance. IR can be used for both diagnostic and therapeutic procedures. Some common IR procedures include angioplasty to unblock arteries, stent placement to treat aneurysms, tumor ablation, drainage catheter placement, and pain management injections. IR treatments can avoid the need for open surgery and allow many patients to be treated as outpatients. IR utilizes imaging technologies like fluoroscopy, CT, MRI, and ultrasound to guide small catheters and wires to access the inside of the body for both diagnostic testing and treatments.
Fractionation in radiotherapy refers to dividing the total radiation dose into smaller doses given over multiple treatment sessions. This allows healthy cells to repair sublethal damage between fractions while maximizing cancer cell kill through mechanisms like redistribution and reoxygenation. The "5 R's" of radiobiology explain fractionation: repair of sublethal damage in normal cells; redistribution of tumor cells to sensitive phases; reoxygenation of hypoxic tumor cells; repopulation of tumor cells during prolonged treatment; and intrinsic radiosensitivity differences between cell types. Fractionation schedules are tailored based on these factors to improve the therapeutic ratio for different cancers and patients.
Bone scintigraphy uses radiolabeled phosphonates injected intravenously to evaluate bone formation. It produces whole body images of tracer distribution in the skeleton. Increased uptake indicates elevated osteoblastic activity such as might occur with fractures, tumors, or metastases. The scan has high sensitivity but low specificity for bone abnormalities, so findings must be interpreted in clinical context. It is useful for detecting skeletal involvement by cancer or other bone diseases.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
CT enteroclysis involves placing a nasojejunal tube and using it to instill contrast into the small bowel under fluoroscopy. CT enterography involves having the patient drink oral contrast. Both techniques use IV contrast to evaluate the bowel wall, enhancement, blood vessels, and for signs of bleeding. CT enteroclysis allows for more distal small bowel evaluation but enterography is more comfortable for patients. Indications include investigating Crohn's disease, small bowel obstruction, and unexplained GI bleeding. The procedure involves bowel preparation, premedication, and imaging the abdomen with thin slices during arterial and venous phases to fully evaluate the small bowel and other organs.
This document provides an overview of nuclear medicine and radiology concepts. It discusses atomic and nuclear structure, radioactive decay processes like alpha, beta, and gamma decay, and how radiation interacts with matter through processes like the photoelectric effect and Compton scattering. It also describes common radiation detectors like gas-filled detectors and scintillation detectors. Finally, it summarizes several nuclear medicine imaging systems like planar imaging with gamma cameras and emission computed tomography with SPECT and PET.
CT and MRI urography are radiological techniques used to evaluate the kidneys, ureters, and bladder. CT urography involves acquiring images in three phases after intravenous contrast administration, while MRI urography uses heavily T2-weighted sequences without contrast or excretory T1-weighted sequences after gadolinium contrast. Both techniques provide anatomical details and can detect conditions like renal calculi, tumors, and congenital anomalies. CT urography has advantages of better spatial resolution and ability to depict calcifications but exposes patients to radiation, while MRI urography avoids radiation but has longer scan times and lower spatial resolution.
Nuclear medicine techniques such as radioactive iodine scans and therapy are important in evaluating and treating thyroid diseases. Radioactive iodine is selectively taken up and concentrated in the thyroid gland, allowing functional imaging and selective internal radiotherapy for hyperthyroidism and thyroid cancer. Radioactive iodine therapy is the primary treatment for Graves' disease and toxic multinodular goiter. It is also used to ablate residual thyroid tissue after surgery and treat thyroid cancer metastases. Precautions must be taken after radioactive iodine therapy to limit radiation exposure to others.
JOURNAL CLUB CONFORMAL RT FOR PEDIATRIC LOW GRADE GLIOMAFaraz Badar
This study evaluated the results of conformal radiation therapy (CRT) with a reduced clinical target volume margin of 0.5 cm in pediatric patients with low-grade glioma enrolled in the Children's Oncology Group phase 2 study ACNS0221. The primary objective was to determine if the rate of early marginal failure was unacceptable. Secondary objectives included estimating progression-free survival, event-free survival, overall survival, and determining if a high MIB-1 labeling index correlated with worse outcomes. The study found acceptable rates of marginal failure and showed promising progression-free and overall survival with reduced margins, suggesting smaller margins may reduce long-term side effects.
Introduction to Bone Scan: Techniques and Diagnosis Waseem M.Nizamani
This document provides an overview of nuclear medicine imaging techniques like bone scans. It discusses how nuclear medicine shows physiological functioning rather than anatomy. Bone scans specifically involve injecting radioactive tracers that are absorbed by bone and then imaging their distribution to identify abnormalities. The document reviews normal scan findings, uses of bone scans to detect conditions like metastases and fractures, and presents several case examples to illustrate bone scan interpretations for conditions like osteomyelitis, bone metastases, and trauma.
1. Renal radionuclide imaging uses various radiotracers like DMSA, MAG3, and DTPA with technetium-99m or iodine-131 to evaluate renal perfusion and function, obstruction, renovascular hypertension, infection, and transplant and congenital kidney anomalies.
2. DMSA scintigraphy with technetium-99m is commonly used to assess renal morphology and detect infections, masses, and post-infection scarring by visualizing renal contours and detecting "cold" defects.
3. Diuretic renal scans with MAG3 or DTPA and Lasix are used to evaluate obstruction by assessing tracer washout from the renal pelvises,
This document discusses fusion imaging, which combines images from different modalities to create a hybrid image. It describes fusion imaging techniques like PET-CT and SPECT-CT that merge functional imaging data with anatomical images. The primary advantage of fusion imaging is that it allows correlation of findings from two concurrent imaging modalities, providing both anatomical and functional/metabolic information in a single exam. Specifically, PET-CT fusion improves diagnostic accuracy and lesion localization by overcoming the limitations of each individual modality. In conclusion, combined PET-CT exams are more effective than PET alone for localizing lesions and differentiating normal variants from tumors.
Transarterial chemoembolization (TACE) involves delivering chemotherapy drugs and embolic agents directly into liver cancers via catheters in the hepatic artery. TACE is generally used to treat hepatocellular carcinoma that cannot be surgically removed. During the procedure, a catheter is placed into the hepatic artery supplying the tumor and chemotherapy mixed with iodinated oil is injected, followed by embolization of the artery with gelatin sponges. TACE can reduce tumor size and symptoms but common side effects include abdominal pain and nausea. Response to treatment is evaluated after 3-4 weeks using imaging to assess the extent of tumor coverage by the oil and residual enhancement.
Chest x-ray, pelvis x-ray, and FAST scan are used in the primary survey of trauma patients to rapidly identify life-threatening injuries like hemothorax, pneumothorax, and free fluid. CT scan is the definitive imaging study for trauma as it can identify internal organ damage and injuries that are difficult to detect otherwise. Head CT is especially important for patients with head injuries to identify injuries like extradural and subdural hematomas. Whole body CT allows for rapid full-body assessment but has limitations of availability and high radiation dose.
Radioactivity is the spontaneous disintegration of unstable atomic nuclei. It was discovered in 1896 and results in the emission of radiation. The number of neutrons and protons in a nucleus determines its stability, with heavier elements above atomic number 82 generally being radioactive. Radioactive decay occurs through different types of emission and can be used for medical applications like radiation therapy or diagnostic imaging. Proper patient preparation and safety precautions are important when using radiopharmaceuticals like iodine-131 to optimize treatment and minimize radiation exposure.
This document discusses radionuclide thyroid imaging. It indicates the main indications for the procedure include assessing gland anatomy and function, detecting nodules, and identifying functioning metastatic tissues. The main radiopharmaceuticals used are 99mTc pertechnetate, 131I sodium iodide, and 123I sodium iodide. Patient preparation may involve stopping medications and iodine-rich foods. Views obtained include anterior, oblique, and whole body. Findings are interpreted as normal, enlarged, or showing diffuse/localized changes. I-131 is now mainly used for metastatic screening due to its high radiation dose.
Computerized tomography (CT) was pioneered by Godfrey Hounsfield and Allan Cormack in the 1970s. CT uses X-rays and computer processing to create cross-sectional images of the body. The first CT scanners used a translate-rotate design, while later generations used multiple detectors and spiral scanning for faster, more detailed imaging. Image reconstruction uses back projection to convert attenuation measurements into pixel values and display slices. CT provides excellent anatomical detail and is widely used for diagnosing conditions of the brain, blood vessels, lungs and other organs.
PET imaging is useful for cancer diagnosis and management. It provides functional information about glucose metabolism in tumors that can help establish prognosis, guide treatment decisions, and assess response. PET using 18F-FDG has high sensitivity and specificity for detecting cancer. It has applications in staging, restaging, and monitoring treatment response for many cancer types including lung cancer, lymphoma, and head and neck cancers. PET can identify tumor involvement that may be missed by anatomical imaging alone.
This presentation provides sufficient material for anyone who wants is interested in interventional radiology. Here we will discuss the available facilities, mechanisms and equipments.
In my opinion this presentation will prove a footstep in interventional radiology
Helical and multislice CT techniques provide advantages over traditional slice-by-slice CT scanning. Helical CT, also known as spiral CT, involves continuously transporting the patient through the gantry while acquiring data during multiple 360 degree scans, allowing for increased speed, improved image continuity and less motion artifact. Multislice CT uses multiple parallel detectors to scan a greater volume of the patient per rotation, providing shorter acquisition times, improved z-axis resolution, and more information for radiologists. Both techniques rely on technological advances like slip-ring devices and interpolation algorithms to efficiently process the continuously acquired data into diagnostic images.
Digital breast tomosynthesis (DBT) is an emerging 3D breast imaging technique that involves acquiring low-dose X-ray images of the stationary breast from multiple angles to create tomographic slices. The first DBT system was introduced in 2011. DBT provides improved visualization of lesions and reduced call back rates compared to 2D digital mammography. While DBT exposes patients to a higher radiation dose than 2D mammography alone, combining DBT with a synthesized 2D mammogram can achieve a radiation dose similar to standard mammography alone. DBT is being widely adopted for breast cancer screening due to its superior performance over conventional digital mammography.
Interventional radiology (IR) is a medical subspecialty that performs minimally invasive procedures using medical imaging guidance. IR can be used for both diagnostic and therapeutic procedures. Some common IR procedures include angioplasty to unblock arteries, stent placement to treat aneurysms, tumor ablation, drainage catheter placement, and pain management injections. IR treatments can avoid the need for open surgery and allow many patients to be treated as outpatients. IR utilizes imaging technologies like fluoroscopy, CT, MRI, and ultrasound to guide small catheters and wires to access the inside of the body for both diagnostic testing and treatments.
Fractionation in radiotherapy refers to dividing the total radiation dose into smaller doses given over multiple treatment sessions. This allows healthy cells to repair sublethal damage between fractions while maximizing cancer cell kill through mechanisms like redistribution and reoxygenation. The "5 R's" of radiobiology explain fractionation: repair of sublethal damage in normal cells; redistribution of tumor cells to sensitive phases; reoxygenation of hypoxic tumor cells; repopulation of tumor cells during prolonged treatment; and intrinsic radiosensitivity differences between cell types. Fractionation schedules are tailored based on these factors to improve the therapeutic ratio for different cancers and patients.
Bone scintigraphy uses radiolabeled phosphonates injected intravenously to evaluate bone formation. It produces whole body images of tracer distribution in the skeleton. Increased uptake indicates elevated osteoblastic activity such as might occur with fractures, tumors, or metastases. The scan has high sensitivity but low specificity for bone abnormalities, so findings must be interpreted in clinical context. It is useful for detecting skeletal involvement by cancer or other bone diseases.
A comprehensive study about new and upcoming modalities in imaging and screening of breast lesions with description about every new modalities with their advantages and pitfalls.
CT enteroclysis involves placing a nasojejunal tube and using it to instill contrast into the small bowel under fluoroscopy. CT enterography involves having the patient drink oral contrast. Both techniques use IV contrast to evaluate the bowel wall, enhancement, blood vessels, and for signs of bleeding. CT enteroclysis allows for more distal small bowel evaluation but enterography is more comfortable for patients. Indications include investigating Crohn's disease, small bowel obstruction, and unexplained GI bleeding. The procedure involves bowel preparation, premedication, and imaging the abdomen with thin slices during arterial and venous phases to fully evaluate the small bowel and other organs.
This document provides an overview of nuclear medicine and radiology concepts. It discusses atomic and nuclear structure, radioactive decay processes like alpha, beta, and gamma decay, and how radiation interacts with matter through processes like the photoelectric effect and Compton scattering. It also describes common radiation detectors like gas-filled detectors and scintillation detectors. Finally, it summarizes several nuclear medicine imaging systems like planar imaging with gamma cameras and emission computed tomography with SPECT and PET.
CT and MRI urography are radiological techniques used to evaluate the kidneys, ureters, and bladder. CT urography involves acquiring images in three phases after intravenous contrast administration, while MRI urography uses heavily T2-weighted sequences without contrast or excretory T1-weighted sequences after gadolinium contrast. Both techniques provide anatomical details and can detect conditions like renal calculi, tumors, and congenital anomalies. CT urography has advantages of better spatial resolution and ability to depict calcifications but exposes patients to radiation, while MRI urography avoids radiation but has longer scan times and lower spatial resolution.
Nuclear medicine techniques such as radioactive iodine scans and therapy are important in evaluating and treating thyroid diseases. Radioactive iodine is selectively taken up and concentrated in the thyroid gland, allowing functional imaging and selective internal radiotherapy for hyperthyroidism and thyroid cancer. Radioactive iodine therapy is the primary treatment for Graves' disease and toxic multinodular goiter. It is also used to ablate residual thyroid tissue after surgery and treat thyroid cancer metastases. Precautions must be taken after radioactive iodine therapy to limit radiation exposure to others.
JOURNAL CLUB CONFORMAL RT FOR PEDIATRIC LOW GRADE GLIOMAFaraz Badar
This study evaluated the results of conformal radiation therapy (CRT) with a reduced clinical target volume margin of 0.5 cm in pediatric patients with low-grade glioma enrolled in the Children's Oncology Group phase 2 study ACNS0221. The primary objective was to determine if the rate of early marginal failure was unacceptable. Secondary objectives included estimating progression-free survival, event-free survival, overall survival, and determining if a high MIB-1 labeling index correlated with worse outcomes. The study found acceptable rates of marginal failure and showed promising progression-free and overall survival with reduced margins, suggesting smaller margins may reduce long-term side effects.
Learning Objectives: Explore and propose strategies that would support HBCUs as 5G Testbeds and Partners in deployment of 5G nationwide.
Description: Broadband and 5G technology have created the conditions for the Fourth Industrial Revolution (4IR), whether it is the potential of blockchain for enabling key 5G technologies; or the impact IoT devices will have on health care, artificial intelligence innovations, or meeting the demands of increasing data-intensive applications. 4IR will have disruptive implications for the organizational structures of HBCUs and the economies within which they operate. HBCUs, as an integral part of America’s 5G-deployment strategy, are keys to the nation’s growth, productivity and competitiveness strategy. HBCU preparedness for the Fourth Industrial Revolution might well be a solution to the problem of a digitally bifurcated society. It has been predicted that from 2020 to 2035, the total contribution of 5G to real global GDP will be equivalent to an economy the size of India—currently the seventh largest economy in the world. HBCUs have the potential to be force multipliers in the contribution of 5G to both national and global GDP.
At the end of this seminar, participants will be able to:
1. Offers suggestions that might lead to developing strategies for HBCUs to be key players in local, state and regional broadband/5G planning ecosystems;
2. Offer suggestions to ensure that HBCUs partner with federal government agencies and the telecommunications industry to be players in the 5G prototyping efforts for participation in 5G testbeds;
3. Develop some problem-solving heuristics for leadership to help re-position HBCUs as leaders in a global digital society and economy;
4. List strategies for how HBCUs can alter their organizational structures for 5G collective impact investing;
5. Suggest strategic steps to establish partnerships for Dynamic Spectrum Sharing;
6. Offer solutions for how HBCUs can participate in the Department of Defense and other federal agency 5G Strategies.
Evidence based management in High grade gliomasYamini Baviskar
This document discusses the evidence-based management of high grade gliomas. It begins with an introduction and epidemiology section, then covers the WHO classification system. It describes the diagnostic approach including imaging and molecular markers. Treatment strategies are outlined, including maximal safe resection surgery, adjuvant radiotherapy combined with chemotherapy, and adjuvant systemic therapy. Key points covered include extent of resection impacting survival, radiotherapy doses and techniques, and molecular markers aiding diagnosis and prognosis.
The document discusses neuroendocrine tumors of the gastrointestinal tract. It covers the histological classification of NETs based on mitotic count and Ki-67 index. Diagnosis involves clinical presentation, biochemical evaluation, radiological imaging including CT, MRI, somatostatin receptor scintigraphy, and Ga-68 dotatate PET/CT. Management depends on primary tumor site and includes endoscopic or surgical resection with or without lymphadenectomy. Advanced metastatic disease may be treated with molecularly targeted therapies like everolimus or antiangiogenic agents. Peptide receptor radionuclide therapy is also an option for somatostatin receptor positive tumors.
Planethospital, the world's first medical tourism company has helped a few patients obtain stem cell therapy for ALS (Lou Gehrig's disease). Author, Rudy Rupak
This document summarizes a study that investigated the impact of postoperative non-steroidal anti-inflammatory drugs (NSAIDs) on adverse events after gastrointestinal surgery. The study was a multi-center prospective cohort study involving over 1,500 patients across 109 centers. It found that early use of NSAIDs within the first 3 days after surgery was associated with a 28% reduction in overall complications and 36% reduction in patients receiving high doses, with no increase in anastomotic leaks. The results suggest NSAIDs may safely reduce complications after gastrointestinal surgery.
This study was performed to analyze the efficacy and safety of con-current radiotherapy and weekly paclitaxel in the treatment of carcinoma of uterine cervix. Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-Intracavitary brachytherapy, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg ∕m2 during entire course of external beam radiotherapy. Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. The results of this study suggest that concurrent chemo radiotherapy is feasible in treatment of carcinoma cervix with acceptable and manageable toxicity and paclitaxel act as radio sensitizer in locally advanced cervical cancer.
Factors affecting the biodistribution of radiopharmaceuticals@Saudi_nmc
This document discusses factors that can affect the biodistribution of radiopharmaceuticals used in nuclear medicine imaging and therapy. It describes 4 main categories of factors: 1) those related to radiopharmaceutical preparation and formulation such as radiochemical impurities, 2) factors caused by administration techniques like infiltrated injections or blood clots, 3) pathophysiological and biochemical changes in the patient, and 4) medical procedures previously received by the patient like radiation therapy. Understanding these factors is important to avoid misinterpretations from scans with altered biodistribution patterns.
Effectiveness of gefitinib as additional radiosensitizer to conventional chem...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to conventional chemoradiation for locally advanced head and neck squamous cell carcinoma. 104 patients were randomized to receive either gefitinib plus cisplatin-based chemoradiation (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found a statistically significant difference in overall response rates favoring the gefitinib arm, as well as improved disease-free survival. However, the gefitinib arm also resulted in higher rates of manageable toxicities like dermatitis, mucositis, and diarrhea.
11.[42 53]effectiveness of gefitinib as additional radiosensitizer to convent...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The study found that the experimental arm had a statistically significant higher overall response rate compared to the control arm. Disease-free survival also favored the experimental arm. However, the experimental arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chemoradiation improved outcomes
11.effectiveness of gefitinib as additional radiosensitizer to conventional c...Alexander Decker
This randomized controlled study evaluated the effectiveness of adding the tyrosine kinase inhibitor gefitinib to concurrent chemoradiation for locally advanced head and neck squamous cell carcinoma. Between 2008-2011, 104 patients were randomized to receive either cisplatin-based chemoradiation plus daily gefitinib (experimental arm) or cisplatin-based chemoradiation alone (control arm). The overall response rate was significantly higher in the gefitinib arm compared to the control arm. Disease-free survival also favored the gefitinib arm. However, the gefitinib arm resulted in more grade 2-3 dermatitis, mucositis and diarrhea. Adding gefitinib to chem
This document provides an overview of tuberculosis of the spine. Some key points:
- Spinal tuberculosis accounts for 50% of osteoarticular tuberculosis cases and commonly presents with back pain.
- Diagnosis relies on clinical exam, imaging, and molecular/histological tests since culture has low yield from bone. MRI is often diagnostic.
- Treatment involves antitubercular drug therapy for 9-12 months. Surgery is indicated for debridement of active lesions, neurological deficits, or deformity/instability in healed cases.
- Surgical approaches include anterior, posterior, and combined. Posterior-only approaches using instrumentation are now preferred for deformity correction and stabilization.
Dr. Thomas Chen, UCI grand rounds 7-28-2010 anushara
The document discusses new treatments being developed for malignant gliomas. It describes research into targeting the endoplasmic reticulum stress response pathway to induce apoptosis in glioma cells. Several new drug candidates and delivery methods are discussed, including an implantable pump being developed to provide continuous metronomic chemotherapy delivery directly to the brain tumor. Gene therapy using replication-competent retroviruses and improved immunotherapy approaches are also mentioned as promising new treatment strategies.
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Benign breast conditions can mimic breast cancer on PET/CT imaging. The most common cause of benign FDG uptake in the breast is inflammatory lesions. PET/CT is used along with other imaging like mammography and MRI to make a diagnosis. Common benign causes of FDG uptake include dense breast tissue, fat necrosis, lactation, silicone implants or granulomas, infection, trauma, and benign breast tumors. While normal breast tissue FDG uptake depends on density and menopausal status, benign conditions like fat necrosis, lactation, silicone rupture, infection, and benign tumors can have increased FDG uptake. Poorly FDG-avid cancers, lobular carcinoma, DCIS, and small tumors are also important considerations in
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
MIBG scan presentation
1. I-123 and I-131 mIBG Adrenergic
Tumor
Imaging and Therapy
Dr. Mustafa Al-Thabhawee
Tehran university of medical sciences
Research center for Nuclear medicine
National center of excellence
Shariati hospital
2020
Depending on nuclear medicine requisites 2021and MIBG
Guideline
2. Radiolabeled meta-iodo-benzyl-guanidine (MIBG) adrenal medullary scintigraphy has
been used clinically since the 1980s for diagnosis and staging of neural crest tumors
(e.g., pheochromocytomas, neuroblastomas and paragangliomas).
I-131-labeled MIBG was the original diagnostic agent; however, I-123-labeled MIBG is
now widely available and preferable because of its superior image quality with an
optimal 159-keV gamma-ray energy and lower patient radiation given a lack of β–
emissions and shorter half-life of 13 hours as opposed to I-131 with a 364-keV
gamma-ray energy, β– emissions, and 8-day half life. I-131 mIBG is reserved for
therapy.
Introduction
3. In numerous drugs interfere with mIBG uptake. The most commoninclude
tricyclic antidepressants, reserpine, cocaine, and the alpha-and beta-blocker
labetalol (Table 13.3):
Drugs interfere
Mechanism of interfere:
1: Inhibition of sodium-dependent uptake system (i.e. uptake-one inhibition)
2: Transport interference: inhibition of uptake by active transport into vesicles,
i.e. inhibition of granular uptake, and competition for transport into
vesicles, i.e. competition for granular uptake
3: Depletion of content from storage vesicles/granules
4: Calcium-mediated
5: Other, possible, unknown mechanisms
Methodology
4. In numerous drugs interfere with mIBG
uptake.
The most commoninclude tricyclic
antidepressants, reserpine, cocaine, and
the alpha-and beta-blocker labetalol
(Table 13.3):
Drugs interfere :
Methodology
5. Pretreatment with saturated potassium iodide (SSKI) or Lugol’s solution is recommended in the
package insert and in procedural guidelines to block thyroid uptake (Table 13.4)
BLock thyroid uptake
6. Before examination
The technologist, nurse or physician should give the patient (or parents if the patient is a child) a thorough explanation of
the preparation procedure and of the scintigraphic study.
Before examination
Patient History:
The patient should be clinically evaluated by the nuclear medicine physician who should consider any information that could be useful for
the interpretation of scintigraphic images:
1.Relevant history of suspected or known primary tumour
2.Intake of possibly interfering drugs
3.Absence or presence of symptoms
4.Laboratory test results (plasma and urinary catecholamine dosage, carcinoembryonic antigen, 5-hydroxyindoleacetic acid, neuron-specific
enolase, chromogranin A, calcitonin, etc.)
5.Results of any other imaging studies (CT, MRI, ultrasonography, plain radiographic imaging).
6.History of recent biopsy, surgery, chemotherapy, hor- mone therapy, radiation therapy.
7. After injection
Patients should be encouraged to drink large volumes of fluids following mIBG injection and
should void immediately prior to the study.
Side effects
1. Adverse effects of mIBG (tachycardia, pallor, vomiting, abdominal pain), that are not
related to allergy but to the pharmacological effects of the molecule, are very rare when
slow injection is used.
2.Injection via a central venous catheter must be avoided if possible (imaging artefacts,
potential adverse effects).
After injection
and
side effects of injection
9. I-123 MIBG avidly localizes in organs with high
adrenergic innervation, including the heart,
salivary glands, kidneys, and liver.
Variable activity is seen in the lungs, gallbladder,
salivary glands, and nasal mucosa.
Mild to moderate adrenal uptake often occurs with
planar I-123 MIBG imaging and is nearly always
seen with SPECT.
No uptake occurs in the normal skeleton.
It is cleared through the colon and kidneys.
Uptake and Distribution
10. The uptake of radiolabelled mIBG in different organs depends on catecholamine excretion and/or adrenergic innervation.
After intravenous injection approximately 50% of the administered radioactivity appears in the urine by 24 h, and 70–
90% of the residual activity is recovered within 48 h.
Since mIBG is excreted in the urine, the bladder and urinary tract show intense activity. mIBG is normally taken up mainly
by the liver; lower uptake levels are seen in the spleen, lungs, salivary glands, skeletal muscles and myocardium.
Normal adrenal glands are usually not seen, but faint uptake may be visible 48–72 h after injection in up to 15% of
patients when using 131I-mIBG.
However, normal adrenal glands can be visualized in up to 75% of patients using 123I-mIBG.
mIBG may accumulate to variable degrees in the nasal mucosa, lungs, gallbladder, colon and uterus.
Free iodine in the bloodstream may cause some uptake in the digestive system and in the thyroid (if not properly
blocked). No skeletal uptake should be seen.
Extremities show only slight muscular activity.
In children, uptake in brown fat is usually quite symmetrical along the edge of the trapezius muscles.
However, it is also seen over the top of each lung, and along either side of the spine to the level of the diaphragm in
children and in adults
Physiological distribution of mIBG
11. MIBG soft-tissue uptake is observed in primary
tumour and in metastatic sites including lymph
nodes, liver, bone and bone marrow.
Increased uptake in the skeleton (focal or
diffuse) is indicative of bone marrow
involvement and/or skeletal metastases.
Pathological uptake
13. 1. Detection, localization, staging and follow-up of neuroendocrine tumours and their metastases, in
particular:
A. phaeochromocytomas
B. neuroblastomas
C. ganglioneuroblastomas
D. ganglioneuromas
E. paragangliomas
F. carcinoid tumours
G. medullary thyroid carcinomas
H. Merkel cell tumours
I. MEN2 syndromes
2. Study of tumour uptake and residence time in order to decide and plan a treatment with high activities of
radiolabelled mIBG.
3. Evaluation of tumour response to therapy by measuring the intensity of mIBG uptake and the number of
focal mIBG uptake sites.
4. Confirmation of suspected tumours derived from neuroendocrine tissue.
Oncological indications
14. Functional studies of the adrenal medulla (hyperplasia),
sympathetic innervation of the myocardium, salivary glands
and lungs and movement disorders.
(Non-Oncological) indications
15. 1.Clinical and biochemical findings that are unknown or have not been considered.
2. Insufficient knowledge of physiological mIBG biodisribution and kinetics.
3. Small lesions, below the resolution of scintigraphy.
4.Incorrect patient preparation (e.g. pelvic views cannot be correctly interpreted if the patient has not
voided before the acquisition).
5. Lesions close to the areas of high physiological or pathological uptake.
6. Tumour lesions that do not take up mIBG (e.g. Changes in differentiation, necrosis, interfering drugs,
etc.).
7.Patient motion (mainly in children).
8.Increased diffuse physiological uptake (hyperplastic adrenal gland after contralateral adrenalectomy).
9.Increased focal physiological uptakes (mainly in the urinary tract or bowel).
10. Thyroid activity (if thyroid blockade is not adequate).
11. Urine contamination or any other external contamination (salivary secretion).
Sources of error
16. To evaluate mIBG scintigraphy images the following should be taken into account:
1.Clinical issue raised in the request for mIBG scintigraphy.
2. Clinical history of the patient.
3. Presence of symptoms or syndromes.
4.Topographical localization of the uptake according to other imaging data.
5.Uptake in nonphysiological areas (this is suspicious for a neuroendocrine tumour or metastasis).
6.Intensity and features of the tracer uptake (mIBG uptake may be observed both in benign and
malignant tumours).
7.Clinical correlation with any other data from previous clinical, biochemical and morphological
examinations.
8. Causes of false-negative results (lesion size, tumour biology, physiological uptake masking cancer
lesions, pharmaceutical interference, etc.).
9.Causes of false-positive results (artifacts, uptake due to physiological processes, benign uptake, etc.)
Interpretation
17. The nuclear medicine physician should record all information regarding the patient, type of examination, date,
radiopharmaceutical (administered activity and route), concise patient history, all correlated data from previous
diagnostic studies, and the clinical question.
The report to the referring physician should describe:
1.Whether the distribution of mIBG is physiological or not.
2. All abnormal areas of uptake (intensity, number and site; if necessary, retention of mIBG over time).
3. Comparative analysis: the findings should be related to any previous information or results from other clinical or
instrumental examinations.
4.Interpretation: a clear diagnosis of malignant lesions should be made if possible, accompanied by a differential
diagnosis when appropriate.
5. Comments on factors that may limit the accuracy of scintigraphy are sometimes important (lesion size, artefacts,
interfering drugs, etc.).
6.If an additional diagnostic examination or adequate follow-up are required to obtain a definitive diagnosis, this must
be recommended.
Reporting
20. This catecholamine-secreting tumor is derived from chromaffin cells. It can precipitate life-
threatening hypertension or cardiac arrhythmias secondary to its excessive catecholamine
secretion.
When these tumors arise outside of the adrenal gland, they are called paragangliomas and
can be found anywhere from the bladder up to the base of the skull.
Ten percent of pheochromocytomas are bilateral, 10% are extraadrenal, and 10% are
malignant.
They may be associated with multiple endocrine neoplasia (MEN) types IIA and IIB, von Hippel–
Lindau disease, neurofibromatosis, tuberous sclerosis, and Carney syndrome.
Adrenomedullary hyperplasia occurs in patients with MEN type IIA.
21. Pheochromocytomas often present with elevated blood or urinary
catecholamines and metanephrines, usually three times or greater
than normal.
If an adrenal mass is demonstrated with morphological imaging in
patients with evidence for the disease, the diagnosis is often inferred,
and further workup before surgery is not always necessary.
However, I-123 mIBG can confirm the adrenergic etiology of a detected
adrenal mass on anatomical imaging, detect extraadrenal
paragangliomas, and diagnose medullary hyperplasia and metastatic
pheochromocytoma.
Clinical manifestation
22. The characteristic I-123 mIBG scintigraphic appearance of a
pheochromocytoma, extraadrenal paraganglioma, or metastatic
disease is intense focal uptake with a high tumor-to-background
ratio(Fig. 13.12).
The sensitivity and specificity for detection are 90% and The sensitivity
and specificity for detection are 90% and 95%, respectively.
Planar imaging is often diagnostic, although SPECT/CT can be helpful
(Figs. 13.13 and 13.14). F-18 FDG has only a limited role but can be
useful with high-grade adrenal cancers or malignant
pheochromocytoma.
Characteristic I-123 mIBG Scintigraphic
appearance
23.
24.
25. The comparison between octreotide and MIBG scans shows a higher sensitivity of both diagnostic and
post-therapeutic MIBG scans regarding the number of up take foci.
The contrast and intensity of uptake were also higher with MIBG. These differences were particularly
visible in bone metastases and in hepatic or abdominal lesions, which occurred frequent in our patients.
27. This embryonal malignancy of the sympathetic nervous system most commonly
occurs in children younger than 4 years of age.
Over 70% of tumors originate in the retroperitoneal region, either from the adrenal
or the abdominal sympathetic chain, whereas approximately 20% occur in the
chest, derived from the thoracic sympathetic chain.
Patients with localized tumors can have a good prognosis andoutcome; those with
metastatic disease fare poorly. At the time of diagnosis, more than 50% of patients
present with metastatic disease, 25% have localized disease, and 15% have regional
extension.
Metastatic disease involves the lymph nodes, liver, bone marrow, and bone.
Introduction
28.
29. I-123 mIBG is valuable for staging, detecting metastatic disease,
restaging, and determining patient response to therapy.
The sensitivity for detection of neuroblastoma is reported to be >90%,
and the specificity is about 95%. Whole-body scanning is routine (Figs.
13.15 and 13.16).
SPECT and SPECT/CT aid in detection and localization (Fig. 13.17 ).
NETs and medullary carcinoma of the thyroid also take up MIBG,
however, with lower sensitivity than for neuroblastoma or
pheochromocytoma.
The role of I-123 MIBG in Neuroblastoma
30.
31.
32. 9-year-old girl with posterior mediastinal
mass.
(A) Planar anterior and posterior whole-
body images. The posterior planar image
shows focal uptake in the chest just above
the liver.
(B) Single-photon emission computed
tomography with computed tomography
(SPECT/CT) clearly localizes the paraspinal
mass. mass.
33. Bone scans have long been used to detect
osseous metastases in neuroblastoma. A
common location for metastases is in the
bilateral metaphyses of long bones. This could be
overlooked because of their symmetrical
appearance and high normal growth-plate
uptake in children. However, I-123 mIBG has
superior sensitivity for the detection of
metastases compared with bone scans because
the tumors initially involve the bone marrow.
The role of Bone scans in Neuroblastoma
34. Figure 1: 99mTc-methylene
diphosphonate bone scintigraphy
(BS) in a 12-year-old case of
mediastinal neuroblastoma (NB).
(a, anterior; b, posterior) and
4-year-old case of abdominal NB
(c, anterior; d, posterior) shows
heterogeneously increased
radiotracer uptake in the entire axial
and appendicular skeleton
suggesting widespread skeletal
metastases with cortical involvement
giving the appearance of a
metastatic superscan
36. 12 months female presented with irritability and
constipation.
Case 1
Anterior x-ray shows:
Large lower midline and left
flank soft tissue mass in the
pelvis and abdomen
displacing bowel superiorly
and laterally
Axial CT:
There is large, lobulated,
heterogeneous, mixed density,
retroperitoneal mass. It
demonstrates heterogeneous
enhancement and patchy
Case Discussion
Biopsy proven
retroperitoneal neuroblastoma with
classical imaging findings.
37. Case 2: 10 months female presented with history
of Wheezing and obstructive airway symptoms
when lying flat
Large right posterior
mediastinal mass with a well
defined inferior margin. The
mass is predominantly soft
tissue density with calcific foci
inferiorly.
CT confirms the chest x-ray
findings of a right posterior
mediastinal mass with soft
tissue density and internal
calcifications
MIBG shows intense tracer uptake in the
posterior mediastinal mass with no evidence
of MIBG-avid disease elsewhere.
This case shows typical imaging features of a thoracic
neuroblastoma. The presence of calcifications (seen in 80-
90% of neuroblastoma cases), and remodeling of the ribs
and neural exit foramina suggest the neurogenic origin,
arising from the sympathetic chain.
38. The scintigraphic findings with markedly
increased tracer seen in both adrenal masses.
Large bilateral upper abdominal
masses of heterogeneous density at
the superior aspect of the kidneys
MEN2 consists of medullary thyroid cancer (always
present) and pheochromocytoma (commonly
present). It can be further divided into MEN2a with
the addition parathyroid hyperplasia and MEN2b
with the presence of mucosal neuromas
Case 3: 35yrs female HX of medullary thyroid cancer presented with hypertension And
elevated calcitonin level.
44. Conventional therapies for metastatic pheochromocytoma and neuroblastoma
include surgery, chemotherapy, and tyrosine kinase inhibitors.
The 5-year survival rate has been <50%.
The high uptake of mIBG in neuroectodermal tumors has led to therapy with high-
dose I- 131 mIBG in patients who have failed conventional therapies and have
progressive or symptomatic disease, utilizing its 606-keV I-131 beta emissions.
The 5-year survival rate has been reported to be increased; however, complete
response rates are not high.
This therapy, although performed for many years at selected centers in the United
States and Europe, has been considered investigational.
Introduction
45. (Azedra)
in 2018 the FDA approved iobenguane I-131 (Azedra) for adult and
pediatric patients aged ≥12 years with a positive I-123 MIBG scan and
unresectable, locally advanced, or metastatic pheochromocytoma or
paraganglioma.
46. 1. patients must be pretreated with potassium iodide or other thyroid-blocking
medications beginning 24 to 48 hours before injection to minimize uptake of free
radioiodine by the thyroid (Table 13.4). It should be continued for 10 to 15 days
posttreatment.
In spite of doing this, hypothyroidism occurs in 11% to 20% of patients.
2. Before initiating therapy, excess catecholamines should be managed with alpha
blockade and atenolol.
3.Drugs that interfere with mIBG uptake must be discontinued, including labetalol,
reserpine, tricyclic antidepressants, sympathomimetics, and cocaine (Table 13.3).
The most significant toxicity is hematologic.
Patient preparation for the therapy with
I-131 mIBG