Usefulness of 99mTc–pertechnetate SPECT-CT in thyroid tissue volumetry: phantom studies and a clinical case series

2022 ◽  
Vol 15 ◽  
Author(s):  
Enrico Calandri ◽  
Maria Teresa Giraudo ◽  
Roberta Sirovich ◽  
Antonella Ostan ◽  
Mirco Pultrone ◽  
...  
Keyword(s):  
Thyroid Tissue ◽  
Extraction Procedure ◽  
Case Series ◽  
Target Volume ◽  
Volume Measurement ◽  
Percentage Error ◽  
Planar Images ◽  
Lower Variability ◽  
Phantom Studies ◽  
Post Hoc

Background: An accurate measurement of the target volume is of primary importance in theragnostics of hyperthyroidism Objective: Our purpose was to evaluate the accuracy of a threshold–based isocontour extraction procedure for thyroid tissue volumetry from SPECT-CT. Methods: Cylindrical vials with a fixed volume of 99mTcO4 at different activities were inserted into a neck phantom in two different thickness settings. Images were acquired by orienting the phantom in different positions, i.e., 40 planar images and 40 SPECT-CT. The fixed values of the iso-contouring threshold for SPECT and SPECT-CT were calculated by means of linear and spline regression models. Mean, Median, Standard Deviation, Standard Error, Mean Absolute Percentage Error and Root Mean-Square Error were computed. Any difference between the planar method, SPECT and SPECT-CT and the effective volume was evaluated by means of ANOVA and post-hoc tests. Moreover, planar and SPECT-CT acquisitions were performed in 8 patients with hyperthyroidism, considering relevant percentage differences greater than > 20 % from CT gold standard. Results: Concerning phantom studies, the planar method shows higher values of each parameter than the other two methods. SPECT-CT shows lower variability. However, no significant differences were observed between SPECT and SPECT-CT measurements. In patients, relevant differences were found in 7 out of 9 lesions with the planar method, in 6 lesions with SPECT, but in only one with SPECT-CT. Conclution: Our study confirms the superiority of SPECT in volume measurement if compared with the planar method. A more accurate measurement can be obtained from SPECT-CT.

scholarly journals Ectopic thyroid tissue in the head and neck: a case series

2014 ◽  
Vol 7 (1) ◽  
Author(s):  
Croce Adelchi ◽  
Pugliese Mara ◽  
Laus Melissa ◽  
Alessandro De Stefano ◽  
Mantini Cesare
Keyword(s):  
Head And Neck ◽  
Thyroid Tissue ◽  
Case Series ◽  
Ectopic Thyroid ◽  
Ectopic Thyroid Tissue

scholarly journals An 8-Year Longitudinal Study of Overreaching in 114 Elite Female Chinese Wrestlers

2015 ◽  
Vol 50 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Ye Tian ◽  
Zihong He ◽  
Jiexiu Zhao ◽  
Dalang Tao ◽  
Kuiyuan Xu ◽  
...  
Keyword(s):  
Creatine Kinase ◽  
Sports Medicine ◽  
Case Series ◽  
Position Statement ◽  
Reference Intervals ◽  
Diagnostic Sensitivity ◽  
Hemoglobin F ◽  
Overtraining Syndrome ◽  
Mean Differences ◽  
Post Hoc

Context: Successful training involves structured overload but must avoid the combination of excessive overload and inadequate recovery. Objective: The aim of this study was to determine the incidence of functional overreaching (FOR), nonfunctional overreaching (NFOR), and overtraining syndrome in elite female wrestlers during their normal training and competition schedules and to explore the utility of blood markers for the early detection of overreaching. Classification of FOR, NFOR, and overtraining syndrome was based on the European Congress of Sports Medicine position statement. Design: Case series. Setting: China Institute of Sport Science. Patients or Other Participants: Over an 8-year period, 114 wrestlers from the women's Asian wrestling team were monitored to help identify if and when they experienced FOR, NFOR, or overtraining syndrome. Main Outcome Measure(s): Creatine kinase, hemoglobin, testosterone, and cortisol were measured throughout the period to identify whether wrestlers were outside the reference intervals (constructed from normal recovery data) during periods of overreaching and not overreaching. Results: Among the 114 athletes, there were 13 (3.6%) instances of FOR, 23 (6.4%) instances of NFOR, and 2 (0.6%) instances of overtraining syndrome. The diagnostic sensitivity for FOR was 38%, 15%, 45%, and 18% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. The diagnostic sensitivity for NFOR was 29%, 33%, 26%, and 35% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. Specificity was 79%, 88%, 90%, and 82% for creatine kinase, hemoglobin, testosterone, and cortisol, respectively. Post hoc analysis showed no mean differences in creatine kinase (F = 0.5, P = .47), hemoglobin (F = 3.8, P = .052), testosterone (F = 0.2, P = .62), or cortisol (F = 0.04, P = .85) between monitoring periods when wrestlers were and were not diagnosed with FOR and NFOR. Conclusions: Coaches and sports scientists should not use single blood variables as markers of overreaching in elite female wrestlers.

scholarly journals Simultaneous PET/Mri in Stroke: A Case Series

2015 ◽  
Vol 35 (9) ◽  
pp. 1421-1425 ◽  
Author(s):  
Peter Werner ◽  
Dorothee Saur ◽  
Vilia Zeisig ◽  
Barbara Ettrich ◽  
Marianne Patt ◽  
...  
Keyword(s):  
Case Series ◽  
Patient Stratification ◽  
Resonance Imaging ◽  
Ovine Model ◽  
Stroke Patients ◽  
Complementary Information ◽  
Systemic Thrombolysis ◽  
Positron Emission ◽  
Magnetic Resonance Imaging Mri ◽  
Post Hoc

Prospective studies on magnetic resonance imaging (MRI)-guided systemic thrombolysis 44.5 hours after stroke onset did not reach their primary end points. It was discussed and observed in post hoc data re-assessment that this was partly because of limited MRI accuracy to measure critical hypoperfusion. We report the first cases of simultaneous [15O]H2O-positron emission tomography (PET)/MRI in stroke patients and an ovine model. Discrepancies between simultaneously obtained PET and MRI readouts were observed that might explain the above current limitations of stroke MRI. By offering highly complementary information, [15O]H2O-PET/MRI might help to identify critically hypoperfused tissue resulting in an improved patient stratification in thrombolysis trials.

scholarly journals A STUDY OF THE PHYSIOLOGICAL ACTIVITY OF ADENOMATA OF THE THYROID GLAND, IN RELATION TO THEIR IODINE CONTENT, AS EVIDENCED BY FEEDING EXPERIMENTS ON TADPOLES

1916 ◽  
Vol 24 (4) ◽  
pp. 345-359 ◽  
Author(s):  
Allen Graham
Keyword(s):  
Tumor Tissue ◽  
Physiological Function ◽  
Physiological Activity ◽  
Thyroid Tissue ◽  
Iodine Content ◽  
Percentage Error ◽  
Active Principle ◽  
Thyroid Cells ◽  
Specific Stimulus ◽  
Well Differentiated

It seems evident from the foregoing experiments that the so called tumors (adenomata) of the thyroid possess the property of taking up iodine and metabolizing it into the active combination in the same way that the non-tumorous thyroid tissue does, although not so readily nor to the same degree, and the action on tadpoles of feeding desiccated tumorous thyroid tissue does not differ qualitatively from feeding desiccated non-tumorous thyroid tissue. The action in either case depends upon the iodine (active iodine) content, and in the case of the adenomata bears no constant relation to the state of their growth or differentiation. Examination of Tables II and III shows that in the main this is true. There are, however, certain discrepancies as to time of death, appearance of first forelegs, degree of emaciation, and rate of growth in certain dishes of the series, the action being not quite parallel to the iodine content. Some of these discrepancies may be explained in part by accidents of feeding, slight differences in size, age) and susceptibility of the different tadpoles receiving the same thyroid, and also by the variations in the amount of thyroid consumed by the different individuals in the same dish. Lenhart has shown that the action of the same thyroid varies with the quantity fed. Another important factor which has to be considered is the condition of the iodine itself. It was suspected at the time of these experiments that the iodine might be present in an active and an inactive form, but no satisfactory proof of this assumption, at the beginning of these experiments, was at hand. Support of this point has been afforded by the work of Kendall on the isolation of the active principle of thyroid and the separation of the iodine into two fractions. Since the completion of our experiments Marine has demonstrated by means of perfusion experiments in vivo and in vitro that iodine is rapidly taken up by the thyroid cells, and though the iodine increase in the perfused lobe may be 1,000 per cent in 2 hours as compared with the control lobe, yet the action on tadpoles is no greater. It then becomes an important question to determine the time required by the thyroid to take up inorganic iodine and manufacture it into the active thyroid principle. It is known that iodine is rapidly taken up by the thyroid, and in man the iodine content of the thyroid is subject to greater variations than in animals on account of the prevalent therapeutic use of iodine and the iodides in goiter and other conditions; even the iodine used in preparing patients for operations would increase the iodine content of the thyroid in a short time, so that one might expect such variations in the action of a given thyroid preparation fed to tadpoles as appear in these experiments. In this connection it is interesting to note (Table II) that Thyroid 20 with 4.31 mg. of iodine was only slightly more active than No. 5 with 1.31 mg. of iodine. Two possibilities have to be considered here. First, No. 20 may have active iodine slightly greater than 1.31 mg. and the balance present as inactive iodine. Second, No. 5 with 1.31 mg. of iodine might represent the maximum possible effect under the conditions of the experiment and a larger quantity of active thyroid iodine could produce no greater effect. Of course with the lower iodine contents the variations in effects might well come within the limits of errors of observation. Also the percentage error would be greater in the iodine determinations, accidents of feeding, etc. Our conclusions as to the effect of feeding desiccated thyroid to tadpoles agree in general with those of Lenhart. The action of the thyroid depends not upon a specific stimulus to differentiation but upon a stimulation of metabolism in general in proportion to the active iodine and the quantity consumed. High iodine contents produce rapid emaciation, at the same time resulting in differentiation even in tadpoles dying in 8 to 12 days. Low iodine contents result in differentiation at an earlier period than the controls. Tadpoles fed on thyroid with practically no iodine grow better than the controls, in this instance the thyroid acting simply as a food. Finally, the interest that the results of these experiments may have in connection with the question of function in tumor tissue should be pointed out. To those who hold that tumor lacks the capacity for physiological function, the adenomata of the thyroid could not be consistently regarded as tumors. To those who hold physiological function as a possible property of tumor tissue, the adenomata might be regarded as tumors. Future studies might warrant a recognition of different grades or degrees of tumor. On this basis the fetal adenoma (very little differentiation) might represent a higher degree of tumor than the diffuse colloid or simple adenomatous thyroid in which the adenomatous nodules are present to a great extent throughout the whole gland and are well differentiated. It is certain that there are all grades and degrees of growth and differentiation in the life history of fetal adenomata of the thyroid, from the pure fetal, undifferentiated adenoma with little or no iodine to the simple or colloid adenoma, well differentiated and with varying amounts of iodine approaching that of normal thyroid.

scholarly journals Association between rotavirus gastroenteritis and intussusception: suggested evidence from a retrospective study in claims databases in the United States. Corresponding author: Corinne Willame, MPH, GSK, 20 Avenue Fleming, Wavre, Belgium

2019 ◽  
Author(s):  
Corinne Willame ◽  
Brigitte Cheuvart ◽  
Emmanuel Aris ◽  
Volker Vetter ◽  
Catherine Cohet
Keyword(s):  
United States ◽  
Sensitivity Analysis ◽  
Case Series ◽  
The United States ◽  
Temporal Association ◽  
Administrative Claims ◽  
Fracture Group ◽  
Rotavirus Gastroenteritis ◽  
Risk Period ◽  
Post Hoc

Abstract Background: The etiology of intussusception (IS), a serious medical condition of acute gastrointestinal obstruction, remains unclear. Limited evidence suggests a role for viral infections, including rotavirus infection. This study aimed to explore the risk of IS after rotavirus gastroenteritis (RV GE) in the first year of life, where the incidence of IS is highest. Methods: In this retrospective, self-controlled case series (SCCS), we assessed the risk of IS after RV GE in infants <1 year of age, using data extracted from administrative claims databases in the United States. Incidence rate ratios (IRR) of IS were calculated for the 7- and 21-day risk periods after RV GE (main analysis) or after fracture (sensitivity analysis using a control event) in subjects presenting with claims for these conditions. Post-hoc analyses were also performed. Results: Out of the 290,912,068 subjects screened, 42 subjects presented claims for RV GE and IS (RV GE group) and 66 presented claims for fracture and IS (fracture group). The IRR of IS after RV GE was 79.6 (95% confidence interval, CI: 38.6–164.4) in the 7-day risk period and 25.5 (95% CI: 13.2–49.2) in the 21-day risk period. The sensitivity analysis also showed an association between IS and fracture for the two risk periods: IRR was 6.1 (95% CI: 3.0–12.7) and 2.8 (95% CI: 1.5–5.4) in the 7- and 21-day risk periods, respectively, which suggested potential confounding such as by history of rotavirus vaccination, or a visit effect. Post-hoc analyses investigating these points did not confirm an association between fracture and IS, but still suggested a possible association between RV GE and IS. Conclusions: A temporal association between RV GE and IS was detected using the SCCS design in United States claims databases. However, due to some limitations identified through additional analyses, further studies are needed to confirm this association.

scholarly journals Clinicopathological analysis of primary carcinoid tumour of the ovary arising in mature cystic teratomas

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110346
Author(s):  
Fengcai Yan ◽  
Quan Zhou ◽  
Yulin Lin ◽  
Chunkai Yu ◽  
Hong Chang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Carcinoid Tumour ◽  
Mature Teratoma ◽  
Thyroid Tissue ◽  
Case Series ◽  
Cytokeratin 19 ◽  
Histopathological Analysis ◽  
Retrospective Case ◽  
Carcinoid Tumours ◽  
Thyroid Transcription Factor 1

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Methods This retrospective case series analysed the data from patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Results The study enrolled four patients. Histopathological analysis of the tumours identified the following subtypes: insular ( n = 1), trabecular ( n = 1) and strumal ( n = 2). All four primary ovarian carcinoid tumours originated from a mature teratoma. The morphology of the primary ovarian carcinoids was similar to other neuroendocrine tumours. Strumal carcinoids were composed of different proportions of thyroid tissue intimately admixed with carcinoid tumour. Tumour tissue was arranged in insular and/or trabecular patterns. The nucleus of tumour cells displayed exquisite chromatin without obvious mitotic figures. Tumour tissues were positively stained for neuroendocrine markers chromogranin A, synaptophysin and CD56 to varying degrees. Strumal carcinoid tumours were cytokeratin 19 positive and thyroid transcription factor 1 negative. No recurrence or metastasis occurred during follow-up (12–71 months). Conclusion Primary ovarian carcinoid tumours arising in mature cystic teratomas are rare. Diagnosis and differential diagnosis should be confirmed by clinical features, histopathological characteristics and specific immunophenotyping.

Stereotactic body radiotherapy for hepatocellular carcinoma in the setting of poor liver function: A case series.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 493-493
Author(s):  
Vladimir Valakh ◽  
Graeme Williams
Keyword(s):  
Hepatocellular Carcinoma ◽  
Stereotactic Body Radiotherapy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Distant Metastases ◽  
Hepatic Function ◽  
Target Volume ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Therapy Targets

493 Background: Role of stereotactic body radiotherapy (SBRT) to the liver for patients with poor hepatic function after transcatheter arterial chemoembolization (TACE) has not been established. We reviewed results of SBRT for men with hepatocellular carcinoma (HCC) and Child-Pugh (CP) score ≥ 8 cirrhosis after TACE. Methods: Following a median of 3 TACE treatments, five males with severe cirrhosis received SBRT for persistent or progressive HCC in 2011-14. Clinico-pathologic characteristics and treatment details were retrospectively retrieved. Results: Median age at diagnosis was 55 years (range, 48 – 55). Median interval between cancer diagnosis and SBRT was 38 months (range, 3 – 60). All 5 patients experienced decline in CP score after TACE, for a median of drop of 1 point (range, 1 – 3) between the initiation of TACE and referral for radiotherapy. At time of SBRT, 4 had CP class B and 1 class C cirrhosis with median CP score of 9 (range, 8 – 11). There were no distant metastases and one patient had extrahepatic tumor extension. Three of 5 exhibited clinical symptoms of decompensated cirrhosis within 30 days before radiotherapy and one had portal vein thrombosis. Median MELD score at SBRT was 15 (range, 12 – 18). SBRT to a median total dose of 27.5 Gray (range, 27.5 – 30) was delivered in 5 once daily fractions. Median radiotherapy course duration was 9 days (range, 5 – 18). All patients had single radiation therapy targets with median largest tumor dimension of 3.6 cm (range, 2.4 – 6.2). Median planned target volume was 24 cm3(range, 17 – 197). Sorafenib was given prior to SBRT to one patient, concurrently to one, and sequentially after radiotherapy to another. There were no acute complications. Two patients died within 20 days from completion of SBRT. Median follow up for surviving > 20 days was 10 months (range, 5 – 13). None experienced radiographic tumor progression after radiotherapy. Estimated overall survival was 40% at 6 months (95% confidence intervals, 0 – 83.8%). Conclusions: For HCC patients with CP score ≥ 8 following TACE, prognosis after liver SBRT was poor.

scholarly journals Calibration of the EBT3 Gafchromic Film Using HNN Deep Learning

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Liyun Chang ◽  
Shyh-An Yeh ◽  
Sheng-Yow Ho ◽  
Hueisch-Jy Ding ◽  
Pang-Yu Chen ◽  
...  
Keyword(s):  
Neural Network ◽  
Deep Learning ◽  
Conventional Method ◽  
Aging Effect ◽  
Target Volume ◽  
Training Data ◽  
Percentage Error ◽  
Calibration Data ◽  
Gafchromic Film ◽  
Normal Tissues

To achieve a dose distribution conformal to the target volume while sparing normal tissues, intensity modulation with steep dose gradient is used for treatment planning. To successfully deliver such treatment, high spatial and dosimetric accuracy are crucial and need to be verified. With high 2D dosimetry resolution and a self-development property, the Ashland Inc. product EBT3 Gafchromic film is a widely used quality assurance tool designed especially for this. However, the film should be recalibrated each quarter due to the “aging effect,” and calibration uncertainties always exist between individual films even in the same lot. Recently, artificial neural networks (ANN) are applied to many fields. If a physicist can collect the calibration data, it could be accumulated to be a substantial ANN data input used for film calibration. We therefore use the Keras functional Application Program Interface to build a hierarchical neural network (HNN), with the inputs of net optical densities, pixel values, and inverse transmittances to reveal the delivered dose and train the neural network with deep learning. For comparison, the film dose calculated using red-channel net optical density with power function fitting was performed and taken as a conventional method. The results show that the percentage error of the film dose using the HNN method is less than 4% for the aging effect verification test and less than 4.5% for the intralot variation test; in contrast, the conventional method could yield errors higher than 10% and 7%, respectively. This HNN method to calibrate the EBT film could be further improved by adding training data or adjusting the HNN structure. The model could help physicists spend less calibration time and reduce film usage.

scholarly journals Field-based radiotherapy using volumetric modulated arc therapy (VMAT) for skin field cancerisation (SFC)–outcomes from 100 consecutive fields

2021 ◽  
Vol 8 (1) ◽  
pp. 13-24
Author(s):  
Gerald B. Fogarty ◽  
Susan Young ◽  
Serigne Lo ◽  
James O’ Toole ◽  
Mark Wanklyn ◽  
...  
Keyword(s):  
Volumetric Modulated Arc Therapy ◽  
Case Series ◽  
Sun Exposure ◽  
Treatment Completion ◽  
Target Volume ◽  
Poor Quality ◽  
Arc Therapy ◽  
Field Control ◽  
Field Cancerisation ◽  
Over Time

Introduction: Skin field cancerisation (SFC) arises from prolonged sun exposure and increases with age, especially in fair skinned individuals. Multiple areas of the skin can be involved, resulting in poor quality of life and cosmesis. Invasive skin cancer can arise causing morbidity and even death. The long-term efficacy of traditional treatments is disappointing. Volumetric modulated arc therapy (VMAT) allows efficient definitive radiotherapy treatment of large convex skin fields. This retrospective, single-institution study presents a case series of 100 consecutive SFC fields in 74 patients. Methods: The first 100 fields treated with VMAT for SFC by the same clinician (GBF) were identified through departmental medical records. Patient, field, treatment, and outcome factors were collected for analysis. The date of the first consultation was collected to calculate the rate of referrals over time. Results: The first patient completed treatment in October 2013 and the last patient in May 2020. Seventy-four mostly male (84%) patients with a median age of 76 years were identified. At least 75% had previously undergone treatment for SFC and 11% were immunosuppressed. Twenty percent of patients had more than one field treated with VMAT. Ninety-three fields of keratinocytic lineage were found with most involving the legs (27), scalp (23) or nose (20). Average planning target volume (PTV) size was 175 (range 5 - 1282) cm3. Average prescribed dose was 50 (range 15 - 72) Gy, average delivered dose was 45 (range 4 - 72) Gy. Sixty-four (69%) of fields completed the prescribed course. There were 15 (16%) in-field recurrences. In-field control on an intention-to-treat basis was 89% at 12 months. For those who completed the prescribed treatment, in-field control at 12 months was 98% as compared with 71% for those who did not (p <.0001). PTV size did not impact treatment completion. In those who completed the prescribed treatment, recurrence was not associated with PTV size nor dose. The rate of referrals increased over time. Conclusion: VMAT for SFC is feasible and effective if the whole course is completed. These findings support our national protocol. More research is warranted to predict radiosensitivity so that treatment can be better tailored. Research to identify patients at risk of lower leg lymphoedema before they become symptomatic is also needed to ensure treatment completion thereby reducing the risk of recurrence.

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