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Validation of automated image co-registration integrated into in-house software for voxel-based internal dosimetry on single-photon emission computed tomography images
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Leitão, André Luiz Alberti

; Fonda, Uysha de Souza

; Buchpiguel, Carlos Alberto

; Willegaignon, José

; Sapienza, Marcelo Tatit

Radiologia Brasileira

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Jun 2023, Volume 56 Nº 3 Páginas 137 - 144

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Objective: To develop an automated co-registration system and test its performance, with and without a fiducial marker, on single-photon emission computed tomography (SPECT) images. Materials and Methods: Three SPECT/CT scans were acquired for each rotation of a Jaszczak phantom (to 0°, 5°, and 10° in relation to the bed axis), with and without a fiducial marker. Two rigid co-registration software packages-SPM12 and NMDose-coreg-were employed, and the percent root mean square error (%RMSE) was calculated in order to assess the quality of the co-registrations. Uniformity, contrast, and resolution were measured before and after co-registration. The NMDose-coreg software was employed to calculate the renal doses in 12 patients treated with 177Lu-DOTATATE, and we compared those with the values obtained with the Organ Level INternal Dose Assessment for EXponential Modeling (OLINDA/EXM) software. Results: The use of a fiducial marker had no significant effect on the quality of co-registration on SPECT images, as measured by %RMSE (p = 0.40). After co-registration, uniformity, contrast, and resolution did not differ between the images acquired with fiducial markers and those acquired without. Preliminary clinical application showed mean total processing times of 9 ± 3 min/patient for NMDose-coreg and 64 ± 10 min/patient for OLINDA/EXM, with a strong correlation between the two, despite the lower renal doses obtained with NMDose-coreg. Conclusion: The use of NMDose-coreg allows fast co-registration of SPECT images, with no loss of uniformity, contrast, or resolution. The use of a fiducial marker does not appear to increase the accuracy of co-registration on phantoms.

Resumo Objetivo: Desenvolver corregistro automático e testar seu desempenho com ou sem marcador fiducial em imagens de tomografia computadorizada de emissão de fóton único (SPECT). Materiais e Métodos: Três SPECT/CTs foram adquiridas para cada rotação de um simulador de Jaszczak em relação ao eixo da maca (0°, 5° e 10°), com e sem fiducial. Dois métodos de corregistro inelástico foram aplicados - SPM12 e NMDose-coreg -, e a porcentagem do erro quadrático médio (%RMSE) foi usada para analisar a qualidade do corregistro. Uniformidade, contraste e resolução foram medidos antes e após o corregistro. NMDose com corregistro automático foi usado para calcular a dose renal de 12 pacientes tratados com 177Lu-DOTATATE e comparado com OLINDA/EXM. Resultados: A marcação fiducial não modificou a qualidade do corregistro das imagens SPECT, medida pela %RMSE (p = 0,40). Não houve impacto na uniformidade, contraste e resolução após o corregistro de imagens adquiridas com ou sem fiduciais. Aplicação clínica preliminar mostrou tempo total de processamento de 9 ± 3 min/paciente para NMDose e 64 ± 10 min/paciente para OLINDA/EXM, com alta correlação entre ambos, apesar de menor dose renal em NMDose. Conclusão: NMDose-coreg permite o corregistro rápido de imagens SPECT, sem perda de uniformidade, contraste ou resolução. O uso da marcação fiducial não aumentou a precisão do corregistro em fantomas.

https://doi.org/10.1590/0100-3984.2022.0096

Radiation safety measures in diagnostic nuclear medicine, based on the potential radiation dose emitted by radioactive patients
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Willegaignon, José

; Fernandes, Samantha Cristina Pereira

; Pelissoni, Rogério Alexandre

; Coura-Filho, George Barbério

; Sapienza, Marcelo Tatit

; Buchpiguel, Carlos Alberto

Radiologia Brasileira

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Fev 2023, Volume 56 Nº 1 Páginas 13 - 20

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

Abstract Objective: To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. Materials and Methods: We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. Results: The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Conclusion: Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

Resumo Objetivo: O objetivo deste trabalho foi levantar o potencial de dose de radiação emitida por pacientes em procedimentos diagnósticos, visando a estabelecer cuidados de radioproteção mais otimizados. Materiais e Métodos: Taxas de dose de radiação emitidas por 175 pacientes administrados com os radionuclídeos 99mTc, 131I e 18F para cintilografias óssea, renal, cardíaca, cerebral e corpo inteiro, foram mensuradas com um detector de radiação, servindo para avaliar o clareamento do radiofármaco no organismo e risco de exposição após administração dos radiofármacos. Resultados: O clareamento, representado pela meia-vida efetiva, variou de 1,18 ± 0,30 h até 11,41 ± 0,02 h e a dose de radiação máxima acumulada oferecida pelos pacientes a 1,0 m foi de 149,74 ± 56,72 µSv. Mesmo para distâncias de 0,5 m, as doses estimadas foram, respectivamente, duas e dez vezes inferiores ao nível de restrição para o público geral (1,0 mSv) e exposição médica (5,0 mSv/episódio). Conclusão: Doses de radiação oferecidas por pacientes em procedimentos diagnósticos são inferiores aos níveis de restrição recomendados pela International Commission on Radiological Protection e International Atomic Energy Agency, e assim, cuidados de radioproteção são geralmente desnecessários.

https://doi.org/10.1590/0100-3984.2022.0064

68Ga-PSMA PET/CT: effect of external cooling on salivary gland uptake
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Junqueira, Matheus Zanelatto

; Rocha, Nelisa Helena

; Sapienza, Marcelo Tatit

Radiologia Brasileira

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Jun 2021, Volume 54 Nº 3 Páginas 171 - 176

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Avaliar o impacto do resfriamento externo de glândulas salivares (REGS) na captação de 68Ga-PSMA como marcador indireto dessa intervenção para redução da dose local na terapia com 177Lu-PSMA. Materiais e Métodos: Dez pacientes com câncer de próstata foram submetidos a PET/CT com 68Ga-PSMA com REGS unilateral. O resfriamento se iniciou 30 minutos antes da injeção do radiofármaco até o fim da aquisição de imagem, 1 hora após a injeção. Cada glândula foi avaliada para os valores de captação padronizados máximo, médio e pico (SUVmáx, SUVmédio e SUVpico, respectivamente). O volume foi definido por um isocontorno usando 10% do SUVmáx. Os resultados foram comparados com o teste t de Student. Resultados: Não houve diferença estatisticamente significante entre os valores de SUV das glândulas resfriadas e seus controles. Houve 27% de redução volumétrica (p = 0,004) nas parótidas resfriadas em comparação ao controle. Conclusão: Não houve redução da captação de 68Ga-PSMA nas glândulas salivares ao REGS. Atualmente não há evidências que suportem essa prática clínica.

Abstract Objective: To evaluate the effect that external cooling of the salivary glands (ECSG) has on the uptake of gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as an indirect assessment of the capacity of ECSG to reduce the local dose in lutetium-177-PSMA-617 radioligand therapy. Materials and Methods: Ten patients with prostate cancer were submitted to 68Ga-PSMA positron emission tomography/computed tomography with unilateral ECSG. The ECSG was started at 30 min before the injection of the radiotracer and maintained until the end of image acquisition (1 h after injection). Each salivary gland was assessed by determining the maximum, mean, and peak standardized uptake values (SUVmax, SUVmean, and SUVpeak, respectively). The volume of each gland was determined in a volume of interest delineated by a threshold SUVmax of 10%. Paired Student’s t-tests were used in order to compare the results. Results: In terms of the SUV parameters, there were no statistically significant differences between the cooled and contralateral salivary glands. However, the mean volume was 27% lower in the cooled parotid glands than in the contralateral parotid glands (p = 0.004). Conclusion: The use of ECSG does not appear to reduce 68Ga-PSMA uptake by the salivary glands. In addition, there is yet no evidence that ECSG is effective in preventing salivary gland toxicity.

https://doi.org/10.1590/0100-3984.2020.0044 224 downloads

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
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Fink, Thais T.

; Marques, Heloisa H.S.

; Gualano, Bruno

; Lindoso, Livia

; Bain, Vera

; Astley, Camilla

; Martins, Fernanda

; Matheus, Denise

; Matsuo, Olivia M.

; Suguita, Priscila

; Trindade, Vitor

; Paula, Camila S.Y.

; Farhat, Sylvia C.L.

; Palmeira, Patricia

; Leal, Gabriela N.

; Suzuki, Lisa

; Odone Filho, Vicente

; Carneiro-Sampaio, Magda

; Duarte, Alberto José S.

; Antonangelo, Leila

; Batisttella, Linamara R.

; Polanczyk, Guilherme V.

; Pereira, Rosa Maria R.

; Carvalho, Carlos Roberto R.

; Buchpiguel, Carlos A.

; Latronico, Ana Claudia

; Seelaender, Marilia

; Silva, Clovis Artur

; Pereira, Maria Fernanda B.

; Sallum, Adriana M. E.

; Brentani, Alexandra V. M.

; Neto, Álvaro José S.

; Ihara, Amanda

; Santos, Andrea R.

; Canton, Ana Pinheiro M.

; Watanabe, Andreia

; Santos, Angélica C. dos

; Pastorino, Antonio C.

; Franco, Bernadette D. G. M.

; Caruzo, Bruna

; Ceneviva, Carina

; Martins, Carolina C. M. F.

; Prado, Danilo

; Abellan, Deipara M.

; Benatti, Fabiana B.

; Smaria, Fabiana

; Gonçalves, Fernanda T.

; Penteado, Fernando D.

; Castro, Gabriela S. F. de

; Gonçalves, Guilherme S.

; Roschel, Hamilton

; Disi, Ilana R.

; Marques, Isabela G.

; Castro, Inar A.

; Buscatti, Izabel M.

; Faiad, Jaline Z.

; Fiamoncini, Jarlei

; Rodrigues, Joaquim C.

; Carneiro, Jorge D. A.

; Paz, Jose A.

; Ferreira, Juliana C.

; Ferreira, Juliana C. O.

; Silva, Katia R.

; Bastos, Karina L. M.

; Kozu, Katia

; Cristofani, Lilian M.

; Souza, Lucas V. B.

; Campos, Lucia M. A.

; Silva Filho, Luiz Vicente R. F.

; Sapienza, Marcelo T.

; Lima, Marcos S.

; Garanito, Marlene P.

; Santos, Márcia F. A.

; Dorna, Mayra B.

; Aikawa, Nadia E.

; Litvinov, Nadia

; Sakita, Neusa K.

; Gaiolla, Paula V. V.

; Pasqualucci, Paula

; Toma, Ricardo K.

; Correa-Silva, Simone

; Sieczkowska, Sofia M.

; Imamura, Marta

; Forsait, Silvana

; Santos, Vera A.

; Zheng, Yingying

Clinics

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2021, Volume 76 elocation e3511

Resumo: En | Texto: En | PDF: En

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

https://doi.org/10.6061/clinics/2021/e3511

Ultrasonography Echotexture as a surrogate for Sialadenitis secondary to 131I Radioiodine Therapy for differentiated Thyroid Cancer: a review and metaanalysis
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Lima, Graziele Aparecida Simões

; López, Rossana Verónica Mendoza

; Ozório, Gislaine Aparecida

; de Freitas, Ricardo Miguel Costa

; Willegaignon, Jose

; Sapienza, Marcelo Tatit

; Chammas, Maria Christina

; Coura-Filho, George Barberio

Clinics

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2020, Volume 75 elocation e1843

Resumo: En | Texto: En | PDF: En

To systematically review and analyze the medical literature to assess ultrasonography echotexture changes in thyroid cancer patients for the detection of chronic sialadenitis caused by radioiodine therapy. Methods: Sources were retrieved from PubMed, Scopus, EMBASE and LILACS through November 2018. All studies that assessed ultrasonographic features before 131I administration and at 12 months after 131I administration were selected. After data extraction, statistical analysis was performed by using Stata software. Results: From a total of 435 studies, 4 studies involving 665 patients were considered eligible, and echotexture heterogeneity was found with a significant difference. Conclusions: Ultrasound echotexture may detect chronic sialadenitis secondary to salivary radioiodine therapy.

https://doi.org/10.6061/clinics/2020/e1843 148 downloads

Radionuclide therapy: current status and prospects for internal dosimetry in individualized therapeutic planning
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Sapienza, Marcelo Tatit

; Willegaignon, José

Clinics

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2019, Volume 74 elocation e835

Resumo: En | Texto: En | PDF: En

The efficacy and toxicity of radionuclide therapy are believed to be directly related to the radiation doses received by target tissues; however, nuclear medicine therapy continues to be based primarily on the administration of empirical activities to patients and less frequently on the use of internal dosimetry for individual therapeutic planning. This review aimed to critically describe the techniques and clinical evidence of dosimetry as a tool for therapeutic planning and the main limitations to its implementation in clinical practice. The present article is a nonsystematic review of voxel-based dosimetry. Clinical evidence pointing to a correlation between the radiation dose and therapeutic response in various diseases, such as thyroid carcinoma, neuroendocrine tumors and prostate cancer, is reviewed. Its limitations include technical aspects related to image acquisition and processing and the lack of randomized clinical trials demonstrating the impact of dosimetry on patient therapy. A more widespread use of dosimetry in therapeutic planning involves the development of user-friendly dosimetric protocols and confirmation that dose estimation implies good efficacy and low treatment-related toxicity.

https://doi.org/10.6061/clinics/2019/e835 1586 downloads

Comparison of different quantification methods for 18F-fluorodeoxyglucose-positron emission tomography studies in rat brains
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Prando, Silvana

; Carneiro, Camila de Godoi

; Robilotta, Cecil Chow

; Sapienza, Marcelo Tatit

Clinics

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2019, Volume 74 elocation e1273

Resumo: En | Texto: En | PDF: En

OBJECTIVES: This study aimed to evaluate several methods to estimate glucose consumption in the male Wister rat brain as measured by PET. METHODS: Fourteen male Wistar normoglycemic rats were studied. The input function consisted of seventeen blood samples drawn manually from the femoral artery. Glucose uptake values were calculated using the input function resulting from the arterial blood samples and the tissue time-activity curve derived from the PET images. The estimated glucose consumption rate (Ki) based on the 2-tissue compartment model (2TCM) served as the standard for comparisons with the values calculated by the Patlak analysis and with the fractional uptake rate (FUR), standardized uptake value (SUV) and glucose corrected SUV (SUVglu). RESULTS: No significant difference between the standard Ki and the Patlak Ki was observed. The standard Ki was also found to have strong correlations and concordance with the Ki value estimated by the Patlak analysis. The FUR method presented an excellent correlation with the Ki value obtained by the 2TCM/Patlak analyses, in contrast to the SUV or SUVglu. CONCLUSIONS: From a methodological point of view, the present findings confirm the theoretical limitations of the cerebral SUV and SUVglu as a substitute for Ki in the estimation of glucose consumption in the brain. Our data suggest that the FUR is the surrogate to Ki.

https://doi.org/10.6061/clinics/2019/e1273 708 downloads

Radioguided localization of recurrent lymph nodes in differentiated thyroid cancer - Where are we now?
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Sapienza, Marcelo Tatit

Archives of Endocrinology and Metabolism

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Out 2018, Volume 62 Nº 5 Páginas 491 - 492

Resumo: En | Texto: En | PDF: En

https://doi.org/10.20945/2359-3997000000079 986 downloads

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group
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Cerci, Juliano Júlio

; Bogoni, Mateos

; Buccheri, Valeria

; Etchebehere, Elba Cristina Sá de Camargo

; Silveira, Talita Maira Bueno da

; Baiocchi, Otavio

; Pereira Neto, Carlos de Araujo Cunha

; Sapienza, Marcelo Tatit

; Marin, Jose Flavio Gomes

; Meneghetti, José Cláudio

; Novis, Yana

; Souza, Carmino Antonio de

; Chiattone, Carlos

; Torresan, Marcia

; Ramos, Celso Dario

Hematology, Transfusion and Cell Therapy

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Set 2018, Volume 40 Nº 3 Páginas 245 - 249

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective: To investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country. Methods: Patients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-D-glucose marrow uptake that resolved following chemotherapy. Results: A total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively. Conclusion: We conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.

https://doi.org/10.1016/j.htct.2018.03.002 603 downloads

10.

Methods for quantification of cerebral glycolytic metabolism using 2-deoxy-2-[18 F]fluoroglucose in small animals
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Prando, Silvana

; Ono, Carla Rachel

; Robilotta, Cecil Chow

; Sapienza, Marcelo Tatit

Research on Biomedical Engineering

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Set 2018, Volume 34 Nº 3 Páginas 254 - 272

Resumo: En | Texto: En | PDF: En

Abstract Introduction The use of the same imaging and quantification techniques in small animals and clinical studies presents the opportunity for direct translational research in drug discovery and development, in neuropharmacological basis of neurological and psychiatric diseases, and in optimization of drug therapy. Thus, positron emission tomography (PET) studies in rodents can bridge the gap between pre-clinical and clinical research. The aim should be to find a method with capability to measure, without compromising accuracy, glucose distribution in the structures of the brain, which can also be used in pathological situations and with applicability for other substances than glucose analogue. Methods This is a systematic review of several assessment techniques available, including visual and quantitative methods that enable the investigation of the transport mechanisms and enzymes involved in glucose metabolism in the brain. In addition to the ex vivo methods, PET with glucose analogues allows in vivo analyses using qualitative, semiquantitative and quantitative methods. Results These techniques provide different results, and the applicability of a specific method is related to the purpose of the study and the multiple factors that may interfere in the process. Conclusion This review provides a solid background of tools and quantification methods for medical physicists and other professionals interested in cerebral glycolytic metabolism quantification in experimental animals. It also addresses the main factors related to animals, equipment and techniques that are used, as well as how these factors should be understood to better interpret the results obtained from experiments.

https://doi.org/10.1590/2446-4740.04517 1240 downloads

11.

Bone marrow uptake of 18F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms
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Vale, Rômulo Hermeto Bueno do

; Ferraro, Daniela Andrade

; Duarte, Paulo Schiavom

; Carvalho, Giovana

; Lima, Marcos Santos

; Coura Filho, George Barbério

; Sapienza, Marcelo Tatit

; Buchpiguel, Carlos Alberto

Radiologia Brasileira

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Abr 2018, Volume 51 Nº 2 Páginas 78 - 80

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Comparar o grau de absorção benigna de 18F-fluordesoxiglicose (18F-FDG) na medula óssea de pacientes com linfoma de Hodgkin com e sem sintomas B. Materiais e Métodos: Analisamos os prontuários de 74 pacientes com linfoma de Hodgkin submetidos a tomografia por emissão de pósitrons/tomografia computadorizada (PET/CT) com 18F-FDG antes do início da terapia entre outubro de 2010 e setembro de 2013. Em todos os pacientes, a biópsia da medula óssea foi negativa e as imagens de 18F-FDG PET/CT não sugeriram envolvimento da medula óssea. Dos 74 pacientes avaliados, 54 apresentaram sintomas inflamatórios (B) e 20 não. As regiões de interesse (ROIs) foram desenhadas no esterno, nos terços proximais dos úmeros, nos terços proximais dos fêmures e nas duas asas ilíacas (totalizando sete ROIs por paciente). Para comparar os pacientes com e sem sintomas B, em termos dos standardized uptake values (SUVs) para as sete ROIs, utilizamos o teste U de Mann-Whitney. Resultados: Para seis das ROIs, os SUVs foram maiores nos pacientes com sintomas B do que nos pacientes sem, e a diferença foi estatisticamente significante (p < 0,05). Houve também tendência para uma diferença estatisticamente significante entre os dois grupos em termos do SUV para a ROI da asa ilíaca direita (p = 0,06). Conclusão: Na nossa amostra, a presença de sintomas B foi associada ao aumento da captação de 18F-FDG na medula óssea.

Abstract Objective: To compare the degree of benign bone marrow uptake of 18F-fluorodeoxyglucose (18F-FDG) between Hodgkin lymphoma patients with and without B symptoms. Materials and Methods: We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) prior to the initiation of therapy between October 2010 and September 2013. In all of the patients, the bone marrow biopsy was negative and the 18F-FDG PET/CT images did not suggest bone marrow involvement. Of the 74 patients evaluated, 54 presented inflammatory (B) symptoms and 20 did not. Regions of interest (ROIs) were drawn on the sternum, the proximal thirds of the humeri, the proximal thirds of the femora, and both iliac wings (totaling seven ROIs per patient). To compare the patients with and without B symptoms, in terms of standardized uptake values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. Results: For six of the ROIs, the SUVs were higher in the patients with B symptoms than in those without, and the difference was statistically significant (p < 0.05). There was also a tendency toward a statistically significant difference between the two groups in terms of the SUV for the right iliac wing ROI (p = 0.06). Conclusion: In our sample, the presence of B symptoms was associated with increased 18F-FDG uptake in bone marrow.

https://doi.org/10.1590/0100-3984.2016.0201 960 downloads

12.

Complementary findings on 18F-FDG PET/CT and 18F-NaF PET/CT in a patient with Erdheim-Chester disease
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Sabino, Daniela

; Vale, Romulo Hermeto Bueno do

; Duarte, Paulo Schiavom

; Sapienza, Marcelo Tatit

; Buchpiguel, Carlos Alberto

Radiologia Brasileira

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Jun 2017, Volume 50 Nº 3 Páginas 202 - 203

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/0100-3984.2015.0172 1230 downloads

13.

Estimating 131I biokinetics and radiation doses to the red marrow and whole body in thyroid cancer patients: probe detection versus image quantification
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Willegaignon, José

; Pelissoni, Rogério Alexandre

; Lima, Beatriz Christine de Godoy Diniz

; Sapienza, Marcelo Tatit

; Coura-Filho, George Barberio

; Queiroz, Marcelo Araújo

; Buchpiguel, Carlos Alberto

Radiologia Brasileira

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Jun 2016, Volume 49 Nº 3 Páginas 150 - 157

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Comparar o desempenho dos métodos de detecção de sonda e quantificação de imagens na estimativa da biocinética do radioisótopo 131I e das doses de radiação na medula óssea vermelha e no corpo inteiro durante a radioiodoterapia em pacientes com câncer de tireoide. Materiais e Métodos: Catorze pacientes portadores de câncer metastático de tireoide, sem acometimento ósseo, foram submetidos ao planejamento terapêutico visando estabelecer a melhor atividade de 131I a ser empregada na radioiodoterapia. Imagens cintilográficas e captações de corpo inteiro foram adquiridas 4, 24, 48, 72 e 96 h após a administração de atividades traçadoras de 131I, visando estimar a meia-vida efetiva (T1/2ef) e o tempo de residência do 131I no organismo dos pacientes. Resultados: Os valores médios de T1/2ef e tempo de residência foram, respectivamente, 19 ± 9 h e 28 ± 12 h pelo método de detecção de sonda e 20 ± 13 h e 29 ± 18 h pela quantificação de imagens. As doses médias na medula óssea vermelha e no corpo inteiro foram, respectivamente, 0,061 ± 0,041 mGy/MBq e 0,073 ± 0,040 mGy/MBq pelo método de detecção de sonda e 0,066 ± 0,055 mGy/MBq e 0,078 ± 0,056 mGy/MBq pela quantificação de imagens. A análise estatística demonstrou que os dois métodos apresentam desempenho semelhante no tocante à estimativa de T1/2ef (p = 0,801), tempo de residência (p = 0,801) e doses, tanto na medula óssea vermelha (p = 0,708) como no corpo inteiro (p = 0,811), mesmo com métodos otimizados de dosimetria que levam em consideração somente dois pontos de medida (4 h e 96 h) após a administração de 131I (p > 0,914). Conclusão: Existe excelente concordância entre o método de detecção de sonda e a quantificação de imagens quanto à estimativa da biocinética do 131I e das doses absorvidas de radiação. Contudo, o método de detecção de sonda deve ser usado com cuidado por ser incapaz de identificar regiões metastáticas e órgãos críticos durante a terapia com radionuclídeos, podendo distorcer ajustes da atividade de 131I a ser administrada durante a radioiodoterapia.

Abstract Objective: To compare the probe detection method with the image quantification method when estimating 131I biokinetics and radiation doses to the red marrow and whole body in the treatment of thyroid cancer patients. Materials and Methods: Fourteen patients with metastatic thyroid cancer, without metastatic bone involvement, were submitted to therapy planning in order to tailor the therapeutic amount of 131I to each individual. Whole-body scans and probe measurements were performed at 4, 24, 48, 72, and 96 h after 131I administration in order to estimate the effective half-life (Teff) and residence time of 131I in the body. Results: The mean values for Teff and residence time, respectively, were 19 ± 9 h and 28 ± 12 h for probe detection, compared with 20 ± 13 h and 29 ± 18 h for image quantification. The average dose to the red marrow and whole body, respectively, was 0.061 ± 0.041 mGy/MBq and 0.073 ± 0.040 mGy/MBq for probe detection, compared with 0.066 ± 0.055 mGy/MBq and 0.078 ± 0.056 mGy/MBq for image quantification. Statistical analysis proved that there were no significant differences between the two methods for estimating the Teff (p = 0.801), residence time (p = 0.801), dose to the red marrow (p = 0.708), and dose to the whole body (p = 0.811), even when we considered an optimized approach for calculating doses only at 4 h and 96 h after 131I administration (p > 0.914). Conclusion: There is full agreement as to the feasibility of using probe detection and image quantification when estimating 131I biokinetics and red-marrow/whole-body doses. However, because the probe detection method is inefficacious in identifying tumor sites and critical organs during radionuclide therapy and therefore liable to skew adjustment of the amount of 131I to be administered to patients under such therapy, it should be used with caution.

https://doi.org/10.1590/0100-3984.2015.0079 1677 downloads

14.

Incidental diagnosis of struma ovarii through radioiodine whole-body scanning: incremental role of SPECT/CT
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Vale, Rômulo Hermeto Bueno do

; Sado, Heitor Naoki

; Danilovic, Débora Lucia Seguro

; Duarte, Pulo Schiavom

; Sapienza, Marcelo Tatit

Radiologia Brasileira

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Abr 2016, Volume 49 Nº 2 Páginas 82 - 127

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/0100-3984.2015.0027 1072 downloads

15.

Receiver operating characteristic (ROC) curve for classification of18F-NaF uptake on PET/CT
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Valadares, Agnes Araujo

; Duarte, Paulo Schiavom

; Carvalho, Giovanna

; Ono, Carla Rachel

; Coura-Filho, George Barberio

; Sado, Heitor Naoki

; Sapienza, Marcelo Tatit

; Buchpiguel, Carlos Alberto

Radiologia Brasileira

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Fev 2016, Volume 49 Nº 1 Páginas 12 - 16

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Acessar valores de corte estabelecidos pela curva ROC para classificar a captação de 18F-NaF como normal ou maligna. Materiais e Métodos: Imagens de PET/CT foram realizadas 1 hora após a administração de 185 MBq de18F-NaF e volumes de interesse (VOIs) foram desenhados em três regiões do esqueleto: diáfise umeral proximal direita (UD), diáfise femoral proximal direita (FD) e corpo da primeira vértebra lombar (VB1), em 254 pacientes, totalizando 762 VOIs. A captação nos VOIs foi classificada como normal ou maligna baseada no padrão de distribuição do radiofármaco e nas imagens de CT. Um total de 675 volumes foi classificado como normais e 52 como malignos. Trinta e cinco VOIs classificados como indeterminados ou lesões não malignas foram excluídos da análise. Os valores de captação (SUVs) medidos nos VOIs foram plotados em uma curva ROC para cada uma das três regiões. Foi calculada a área sob a curva (AUC), bem como os valores de SUV mais adequados para a classificação dos VOIs (maior resultado da soma da sensibilidade e especificidade). Resultados: As AUCs foram 0,933, 0,889 e 0,975 para UD, FD e VB1, respectivamente. Os valores de corte mais adequados de SUV foram 9,0 (sensibilidade: 73%; especificidade: 99%), 8,4 (sensibilidade: 79%; especificidade: 94%) e 21,0 (sensibilidade: 93%; especificidade: 95%)para UD, FD e VB1, respectivamente. Conclusão: O valor de corte de SUV mais adequado varia de acordo com a região óssea em análise e não é possível estabelecer um valor adequado para todo o esqueleto.

Abstract Objective: To assess the cutoff values established by ROC curves to classify18F-NaF uptake as normal or malignant. Materials and Methods: PET/CT images were acquired 1 hour after administration of 185 MBq of18F-NaF. Volumes of interest (VOIs) were drawn on three regions of the skeleton as follows: proximal right humerus diaphysis (HD), proximal right femoral diaphysis (FD) and first vertebral body (VB1), in a total of 254 patients, totalling 762 VOIs. The uptake in the VOIs was classified as normal or malignant on the basis of the radiopharmaceutical distribution pattern and of the CT images. A total of 675 volumes were classified as normal and 52 were classified as malignant. Thirty-five VOIs classified as indeterminate or nonmalignant lesions were excluded from analysis. The standardized uptake value (SUV) measured on the VOIs were plotted on an ROC curve for each one of the three regions. The area under the ROC (AUC) as well as the best cutoff SUVs to classify the VOIs were calculated. The best cutoff values were established as the ones with higher result of the sum of sensitivity and specificity. Results: The AUCs were 0.933, 0.889 and 0.975 for UD, FD and VB1, respectively. The best SUV cutoffs were 9.0 (sensitivity: 73%; specificity: 99%), 8.4 (sensitivity: 79%; specificity: 94%) and 21.0 (sensitivity: 93%; specificity: 95%) for UD, FD and VB1, respectively. Conclusion: The best cutoff value varies according to bone region of analysis and it is not possible to establish one value for the whole body.

https://doi.org/10.1590/0100-3984.2014.0119 1829 downloads

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