Performances de la scintigraphie parathyroïdienne au 99mTc-Sestamibi dans l’hyperparathyroïdie secondaire (à propos de 20 cas)

Aim of the studyTo evaluate the performance of the ^99mTc-Sestamibi parathyroid scintigraphy and to compare it with the performance of cervical ultrasonography in patients with secondary hyperparathyroidism who are candidates for parathyroidectomy.Patients and methodsWe performed a retrospective study including 20 patients with severe secondary hyperparathyroidism who underwent parathyroid scintigraphy in the nuclear medicine department of Sfax, during the period between January 2009 and June 2012. Our two days protocol included dual-phase, MIBI/Tc subtraction and single photon emission photons (SPECT) techniques. We analyzed the results obtained from each technique alone, then from combinations thereof. For all patients, we have collected the surgical and histopathological data as well cervical ultrasound if available.ResultsThe subtraction technique was the best performing with a sensitivity of 47% and an accuracy of 55%. The combination of subtraction scintigraphy and SPECT has improved the sensitivity to 53%and accuracy to 57%. The combined lecture of ultrasound and scintigraphy has given the best performance with a sensitivity of 58%, a specificity of 83% and an accuracy of 66%.ConclusionParathyroid scintigraphy combining subtraction and SPECT showed better reliability. The coupling with ultrasound is essential to improve results. The poor performance of scintigraphy in secondary hyperparathyroidism implies that it should be required only to search for ectopic or supernumerary glands.     

Diagnostic d’une ectopie parathyroïdienne par scintigraphie double traceur

IntroductionA common cause of hyperparathyroidism is the presence of an ectopic parathyroid adenoma. Its diagnostic management remains a challenge and multiple imaging tests exist.Case reportA 39-year-old patient with hyperparathyroidism. At diagnosis, ultrasound and CT were not conclusive. MIBI scintigraphy has objectified a typical parathyroid ectopia in mediastinal position. Surgical resection confirmed parathyroid adenoma allowing standardization of laboratory patient.DiscussionMIBI scintigraphy is the most efficient technique for the diagnosis of hyperparathyroidism, especially in the case of an ectopic parathyroid.     

Apport de la scintigraphie au Tc99 m dans l’ectopique thyroïdienne. À propos d’un cas

Thyroid ectopia is a rare disease (1/4000 to 1/8000 patients with hypothyroidism) whose pathogenesis is poorly understood. It may be asymptomatic or present with clinical or biological hypothyroidism. We report the observation of ectopic thyroid diagnosed in a 42-year-old patient. On physical examination, there was no signs of hypothyroidism and thyroid was not palpable. In thyroid scintigraphy, this training is an ectopic thyroid tracheal pre-position. The SPECT/CT cervical examination confirmed the presence of lobed hyoid in training and examination of the thyroid empty lodge. We discuss in this article the clinical and radiological features of this pathology and we insist on the necessity to consider this diagnosis before any hypothyroidism associated with the absence of palpation of thyroid gland in normal position even in adults.     

Hyperparathyroïdie primaire : confrontation scintigraphie parathyroïdienne TEMP-TDM au MIBI-Tc99m aux données histologiques

BackgroundPrimary Hyperparathyroidism is a common endocrinopathie whose parathyroid scintigraphy is part of its preoperative assessment. Our aim was to compare our results of scintigraphy with single-photon emission tomography coupled with a scanner (SPECT-CT) with the operative data and in particular histological data.MethodsRetrospective study including 46 patients who underwent surgery for hyperparathyroidism and had a positive parathyroid scintigraphy and in whom the definitive operative and histological reports are available.ResultsThe mean age was 56.7 years with a sex ratio of 0.12. The median parathyroid hormone (PTH) was 246 pg./ml with mean serum calcium of 113.5 mg/ml. The sensitivities of cervical ultrasound, planar scintigraphy and SPECT-CT were respectively 50 %, 89.12 % and 95.65 %. A SPECT-CT had a better sensitivity in patients with a nodular thyroid or ectopic or infracentimetric adenoma. Surgical exploration was unilateral in 69.5 % of cases. Intraoperative PTH was reduced by more than 50 % in 95 % of patients. As for the histology, considered the gold standard diagnostic examination, it concluded that a parathyroid adenoma was found in 45 patients. The resected parathyroid parenchyma was normal in a single patient despite the hypertrophic appearance.ConclusionThe main contribution of SPECT-CT is the accurate localization of ectopic hyper functional glands, thus selecting patients for unilateral or minimally invasive cervical surgery and reducing the rate of therapeutic failure. It has also better results than planar scintigraphy in small parathyroid glands and in cases associated to nodular thyroids.     

Receptor-Mediated Tumor Targeting with Radiopeptides. Part 1. General Concepts and Methods: Applications to Somatostatin Receptor-Expressing Tumors

Radiolabeled peptides have become important tools in nuclear oncology, both as diagnostics and more recently also as therapeutics. They represent a distinct sector of the molecular targeting approach, which in many areas of therapy will implement the old “magic bullet” concept by specifically directing the therapeutic agent to the site of action. In this three-part review, we present a comprehensive overview of the literature on receptor-mediated tumor targeting with the different radiopeptides currently studied. Part I summarizes the general concepts and methods of targeting, the selection of radioisotopes, chelators, and the criteria of peptide ligand development. Then, the >400 studies on the application to somatostatin/somatostatin-release inhibiting factor receptor-mediated tumor localization and treatment will be reviewed, demonstrating that peptide radiopharmaceuticals have gained an important position in clinical medicine.     

Evaluation of rat and rabbit sera lipoproteins in experimentally induced hyperlipidemia by analytical ultracentrifugation

Animals of various species are widely used as models with which to study atherosclerosis and the lipoprotein metabolism. The objective of this study was to investigate the lipoprotein profiles in Wistar rats and New Zealand white rabbits with experimentally induced hyperlipidemia by means of ultracentrifugation. The Schlieren curves were utilized to compare suckling and adult rat sera to determine whether aging causes alterations in lipoprotein profiles. A striking feature of the data is the high concentration of low-density lipoproteins (LDL), (>5.2 mmol/l cholesterol) in the 2-week old rat serum pool which was greatly decreased in the 3-weeks rat serum pool (<1.3 mmol/l cholesterol). Additional experiments were performed to permit a direct comparison of the amounts of lipoprotein present in rat sera in experimental hyperlipidemia post-Triton WR 1339 administration. Rapid changes in concentrations in very low-density lipoproteins (VLDL), LDL and high-density lipoproteins (HDL) were observed after Triton injection. The administration of Triton WR 1339 to fasted rats resulted in an elevation of serum cholesterol levels. Triton physically alters VLDL, rendering them refractive to the action of lipolytic enzymes in the blood and tissues, preventing or delaying their removal from the blood. Whereas the VLDL concentration was increased markedly, those of LDL and HDL were decreased at 20 h after Triton treatment. Rabbits were fed a diet containing 2% cholesterol for 60 days to develop hyperlipidemia and atheromatous aortic plaques. A combination of preparative and analytical ultracentrifugation was used to investigate of LDL aliquots, to prepare radioactive-labeled lipoproteins and to study induced hyperlipidemia in rabbits. Analytical ultracentrifugation was applied to investigate the LDL flotation peaks before and after cholesterol feeding of rabbits. Modified forms of LDL were detected in the plasma of rabbits with experimentally induced atherosclerosis. ApoB-containing particles, migrating as LDL, intermediate density lipoproteins and VLDL were the most abundant lipoproteins. Gamma camera in vivo scintigraphy on rabbits with radiolabeled lipoproteins revealed visible signals corresponding to atherosclerotic plaques of the aorta and carotid arteries.     

Intérêt de la scintigraphie rénale au DMSA dans les pyélonéphrites aiguës de l’enfant

IntroductionAcute pyelonephritis is responsible for significant morbidity during the acute phase and distant irreversible kidney damage. However, diagnosis is often difficult in children. The aim of our study was to evaluate in children hospitalized for suspected acute pyelonephritis prevalence of acute lesions revealed by scintigraphy with ^99mTc labeled dimercaptosuccinic acid (DMSA) and the relationship between renal parenchymal lesions and different clinical factors and biological risks.MethodsThis is a prospective study collecting 40 children admitted with suspected infection of the high urinary tract. All have benefited from DMSA renal scintigraphy.ResultsThe average age of our patients was 3.25 years. The DMSA scan showed signs of acute pyelonephritis in 32.5% of cases. Taking this examination as a reference, fever was the most sensitive clinical signs (76.9%), but the specificity was only 48.1%. CRP (≥ 20 mg/mL) was the most sensitive (92.3%) but with a specificity of 40.7% organic signs. A high CRP was associated with acute pyelonephritis significantly (P = 0.0033). Sixty-three percent of refluxing kidneys were associated with acute pyelonephritis versus 20.8% of non-refluxing kidneys, with a significant difference (P = 0.007).ConclusionIn case of urinary tract infection in children, a complete clinical and laboratory table may be sufficient to retain the diagnosis of acute pyelonephritis. However, this possibility is rare. In the opposite case, a DMSA scan should be performed to confirm the diagnosis.     

Intramedullary implants coated with cubic boron nitride enhance bone fracture healing in a rat model

BackgroundBoron nitride is a biocompatible and an osteo-inductive material for orthopedic applications. The aim of this study was to evaluate the effects of two different allotrope boron nitride coated implants, cubic boron nitride and hexagonal boron nitride, on fracture healing.MethodsIn this experimental study, a total of 24 rats were divided into three groups. Group A was the control group with Kirschner wire without coating, while the wires were coated dominantly by cubic boron nitride in Group B and hexagonal boron nitride in Group C. Then a mid-third femoral fracture was created. The fracture healing was examined in terms of new bone formation with micro-CT analysis and histopathological examination, quantitative measurement of bone turnover metabolites and scintigraphic examination of osteoblastic activity on 28th day post fracture.ResultsMicro-CT measurement results revealed a statistically significant increase in bone volume/tissue volume ratio and bone surface values in group B compared to group A. Cortex diameter and osteoblast counts were statistically higher in group B compared to group A. Inflammatory response was increased in group C compared to groups A and B. Biochemical test results showed significantly increased alkaline phosphatase levels and decreased osteocalcin levels in group B compared to group A. The increase in serum phosphorus and decrease in serum calcium levels was statistically significant in group C compared to Group A.ConclusionBoth types of boron nitride coating had superior fracture healing features compared to control group. Therefore, c-BN coating can accelerate the fracture healing and could lead to shorten of union time.     

Various routes of administration of (99m)Tc-labeled synthetic lactoferrin antimicrobial peptide hLF 1-11 enables monitoring and effective killing of multidrug-resistant Staphylococcus aureus infections in mice

The synthetic antimicrobial peptide representative of the first 11 N-terminal amino acids of human lactoferrin (hLF 1-11) kills multidrug-resistant Staphylococcus aureus (MRSA). This study displays antimicrobial activity of hLF 1-11, via various routes of administration, against MRSA infections in mice. Radiolabeling hLF 1-11 with technetium-99m ((99m)Tc-hLF 1-11) enables scintigraphic monitoring directly after administration. (99m)Tc-hLF 1-11 was taken up by the gall bladder, intestines, and kidneys. Most of the radioactivity was captured in the urinary bladder and about 1% of the injected dose accumulated into infected thigh muscles. At 2 or 24h after either intravenously, subcutaneously, intraperitoneally, or orally injected a single dose of 0.04 mg/kg hLF 1-11 in mice significantly reduced (20-60 times) the number of viable MRSA. In a dose-response setting in immunocompetent mice maximum bactericidal effects (10,000 times reduction) of intravenously injected (99m)Tc-hLF 1-11 was seen with 40 mg/kg whereas the same dose of orally administered (99m)Tc-hLF 1-11 induced about approximately 100 times reduction. In conclusion, intravenously and orally administrated (99m)Tc-hLF 1-11 accumulates in infected tissues and is highly effective against experimental infections with MRSA. Moreover, scintigraphy is an excellent tool to study the pharmacology of experimental compounds and to determine the uptake in infected tissues.     

Value of 111In-Pentetreotide scintigraphy and 18F-FDG PET for clinical prognosis of patients with neuroendocrine neoplasms

Despite the existence of biological markers of aggressiveness, the clinical course of gastro-entero-pancreatic (GEP) neuroendocrine neoplasms (NEN) remains difficult to predict. Discrepancies between imaging data generated with ¹¹¹In-pentetreotide scintigraphy and ¹⁸F-FDG-PET could reflect the degree of cellular de-differentiation. NEN patients with both types of studies were identified retrospectively from the SwissNET database, which is collecting information on Swiss NEN patients since 2008. Progression free survival (PFS) and overall survival (OS) were assessed depending on functional imaging results. Correlation between histological grading (according to the WHO 2010 classification) and functional imaging status was also assessed. We identified 31 patients with both imaging studies, either on the primary tumor site (21/31) or for metastases (21/31), with 12/31 on both sites. Mean follow-up was 36 months (95% CI 27–45). 21 patients had a metastatic disease at diagnosis and 11 died at follow-up. 7/31 (22%) were NET G1, 16/31 (52%) were NET G2 and 8/31 (26%) were NEC G3. Only ¹⁸F-FDG PET status almost reached statistical significance (P = 0.054) with histological grading. Progression free-survival was significantly poorer in the ¹⁸F-FDG positive group (n = 21), with a median time for progression of 8 months, compared to 51 months in the negative group (n = 10) with a HR of 3.2 (97.5% CI 1.1–9.5, P = 0.04). Overall survival tended to be worse with a positive PET and a negative ¹¹¹In-pentetreotide scintigraphy status with a HR 1.63 (97.5%CI 0.11–21, P = 0.08). ¹¹¹In-pentetreotide scintigraphy status was not found to be predictive of survival nor progression.ConclusionThese data demonstrate the poorer prognostic value of a positive ¹⁸F-FDG-PET imaging in this cohort of patients.