scholarly journals False-negative 123I-MIBG SPECT is most commonly found in SDHB-related pheochromocytoma or paraganglioma with high frequency to develop metastatic disease

2011 ◽  
Vol 19 (1) ◽  
pp. 83-93 ◽  
Author(s):  
Jay S Fonte ◽  
Jeremyjones F Robles ◽  
Clara C Chen ◽  
James Reynolds ◽  
Millie Whatley ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Single Photon ◽  
False Negative ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Tumor Diameter ◽  
Metastatic Tumors ◽  
Primary Tumors ◽  
Photon Emission Computed Tomography

The purpose of this study was to present the characteristics and outcome of patients with proven pheochromocytoma or paraganglioma who had false-negative iodine-123 metaiodobenzylguanidine single photon emission computed tomography (123I-MIBG SPECT). Twenty-one patients with false-negative 123I-MIBG SPECT (7 males, 14 females), aged 13–55 years (mean: 41.40 years), were included. We classified them as nonmetastatic or metastatic according to the stage of the disease at the time of false-negative 123I-MIBG SPECT study, the location and size of the tumor, plasma and urinary catecholamine and metanephrine levels, genetic mutations, and outcome in terms of occurrence and progression of metastases and death. Thirteen patients were evaluated for metastatic tumors, while the remaining eight were seen for nonmetastatic disease. All primary tumors and multiple metastatic foci did not show avid 123I-MIBG uptake regardless of the tumor diameter. The majority of patients had extraadrenal tumors with hypersecretion of normetanephrine or norepinephrine. SDHB mutations were present in 52% (n=11) of cases, RET mutation in 4% (n=1), and the rest were apparently sporadic. Twenty-four percent (n=5) had metastatic disease on initial presentation. Fourteen patients were followed for 3–7 years. Of them, 71% (n=10) had metastatic disease and the majority had SDHB mutations. Nine are still alive, while five (four with SDHB) died due to metastatic disease. We concluded that false-negative 123I-MIBG SPECT is frequently related to metastatic tumors and usually due to SDHB mutations with unfavorable prognosis. We therefore recommend that patients with false-negative 123I-MIBG SPECT be tested for SDHB mutations and undergo more regular and close follow-up.

scholarly journals NOGA-Guided Analysis of Regional Myocardial Perfusion Abnormalities Treated With Intramyocardial Injections of Plasmid Encoding Vascular Endothelial Growth Factor A-165 in Patients With Chronic Myocardial Ischemia

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Mariann Gyöngyösi ◽  
Aliasghar Khorsand ◽  
Sholeh Zamini ◽  
Wolfgang Sperker ◽  
Christoph Strehblow ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Perfusion Defect ◽  
Single Photon ◽  
Photon Emission ◽  
Tracer Uptake ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Background— The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A 165 using an elaborated transformation algorithm. Methods and Results— After randomization, 80 no-option patients received either active, phVEGF-A 165 (n=40), or placebo plasmid (n=40) percutaneously via NOGA-Myostar injections. The injected area (region of interest, ROI) was delineated as a best polygon by connecting of the injection points marked on NOGA polar maps. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI were similar in the VEGF and placebo groups (19.4±4.2% versus 21.5±5.4% of entire myocardium). No differences were found between VEGF and placebo groups at baseline with regard to the perfusion defect severity (rest: 69±11.7% versus 68.7±13.3%; stress: 63±13.3% versus 62.6±13.6%; and reversibility: 6.0±7.7% versus 6.7±9.0%). At follow-up, a trend toward improvement in perfusion defect severity at stress was observed in VEGF group as compared with placebo (68.5±11.9% versus 62.5±13.5%, P =0.072) without reaching normal values. The reversibility of the ROI decreased significantly at follow-up in VEGF group as compared with the placebo group (1.2±9.0% versus 7.1±9.0%, P =0.016). Twenty-one patients in VEGF and 8 patients in placebo group ( P <0.01) exhibited an improvement in tracer uptake during stress, defined as a ≥5% increase in the normalized tracer uptake of the ROI. Conclusions— Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A 165 plasmid improve, but do not normalize, the stress-induced perfusion abnormalities.

18FDG-SPECT Imaging of Brain Tumours

1998 ◽  
Vol 11 (2) ◽  
pp. 149-160
Author(s):  
W. Reiche ◽  
A. Schaefer ◽  
S. Schmidt ◽  
J. R. Moringlane ◽  
W Feiden ◽  
...  
Keyword(s):  
Brain Tumours ◽  
Brain Cortex ◽  
Single Photon ◽  
False Negative ◽  
Photon Emission ◽  
High Energy ◽  
Emission Computed Tomography ◽  
Fdg Uptake ◽  
Glioma Recurrence

The purpose of this prospective study was to examine, if it is possible in principal to obtain suitable information to grade brain tumours and detect recurrences in follow up with 18Fluoro-Deoxyglucose (18FDG) and Single Photon Emission Computed Tomography (SPECT) using ultra high energy collimators. Fifty two brain SPECT investigations were carried out in 41 patients. Forty patients had primary brain tumours and one an anaplastic meningioma. SPECT acquisition was started 30 min after application of 400 MBq 18FDG using special high energy 511 KeV collimators. After attenuation correction (coef.= 0.07 cm−1/) brain tumour FDG uptake was quantified as ratio to contralateral brain cortex (RUV: relative uptake value). SPECT data were compared with histopathological findings and CT/MR images. In grade 4 gliomas (glioblastomas), 18FDG uptake depended on the ratio viable tumour tissue, taking up contrast media in CT/MRI, to cystic tumour areas. Two cases showed increased uptake (RUV = 1.33 and 1.05) compared to the contralateral cortex and four with central necrosis a decreased uptake (RUV = 0.79 ± 0.14). Grade 2 gliomas (five cases) showed a decreased 18FDG uptake (RUV = 0.68 ± 0.02) compared with contralateral brain cortex. In grade 3 astrocytomas (two cases), 18FDG uptake was significantly lower than cortex uptake, but slightly increased when compared with white matter uptake (RUV = 0.79 and 0.82). In follow-up, eight patients with a grade 4 glioma recurrence and one patient with a medulloblastoma recurrence showed an increased 18FDG uptake (RUV = 1.2 ±0.09 and 1.2). In one grade 4 glioma recurrence, SPECT results were false negative showing decreased FDG-uptake due to the presence of necrotic areas induced by radiotherapy. Grade 2 glioma recurrences (eight cases) showed low 18FDG uptake values (RUV = 0.73 ± 0.11). Radionecrosis also showed a decreased 18FDG uptake (RUV = 0.64 ± 0.09) compared with unaffected cortex. These results demonstrate that grading and follow-up tests of brain tumours are possible with 18FDG-SPECT, although SPECT with high energy collimators provides a relatively poor spatial resolution which requires further technical improvements.

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