1
|
Noij DP, Boerhout EJ, Pieters-van den Bos IC, Comans EF, Oprea-Lager D, Reinhard R, Hoekstra OS, de Bree R, de Graaf P, Castelijns JA. Whole-body-MR imaging including DWIBS in the work-up of patients with head and neck squamous cell carcinoma: a feasibility study. Eur J Radiol 2014; 83:1144-1151. [PMID: 24768188 DOI: 10.1016/j.ejrad.2014.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the feasibility of whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted whole-body imaging with background-body-signal-suppression (DWIBS) for the evaluation of distant malignancies in head and neck squamous cell carcinoma (HNSCC); and to compare WB-MRI findings with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) and chest-CT. METHODS Thirty-three patients with high risk for metastatic spread (26 males; range 48-79 years, mean age 63 ± 7.9 years (mean ± standard deviation) years) were prospectively included with a follow-up of six months. WB-MRI protocol included short-TI inversion recovery and T1-weighted sequences in the coronal plane and half-fourier acquisition single-shot turbo spin-echo T2 and contrast-enhanced-T1-weighted sequences in the axial plane. Axial DWIBS was reformatted in the coronal plane. Interobserver variability was assessed using weighted kappa and the proportion specific agreement (PA). RESULTS Two second primary tumors and one metastasis were detected on WB-MRI. WB-MRI yielded seven clinically indeterminate lesions which did not progress at follow-up. The metastasis and one second primary tumor were found when combining (18)F-FDG-PET/CT and chest-CT findings. Interobserver variability for WB-MRI was κ=0.91 with PA ranging from 0.82 to 1.00. For (18)F-FDG-PET/CT κ could not be calculated due to a constant variable in the table and PA ranged from 0.40 to 0.99. CONCLUSIONS Our WB-MRI protocol with DWIBS is feasible in the work-up of HNSCC patients for detection and characterization of distant pathology. WB-MRI can be complementary to (18)F-FDG-PET/CT, especially in the detection of non (18)F-FDG avid second primary tumors.
Collapse
Affiliation(s)
- Daniel P Noij
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Els J Boerhout
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Indra C Pieters-van den Bos
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Emile F Comans
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Daniela Oprea-Lager
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Rinze Reinhard
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Remco de Bree
- Department Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(2).
| | - Pim de Graaf
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| | - Jonas A Castelijns
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, The Netherlands(1).
| |
Collapse
|
2
|
Schook RM, Koudstaal L, Comans EF, Postmus PE, Grünberg K, Paul MA, Smit EF, Sutedja TG. Benefit of a second opinion: From metastatic disease to resectable lung cancer with sarcoid-like reaction. Respir Med Case Rep 2014; 13:26-7. [PMID: 26029554 PMCID: PMC4246249 DOI: 10.1016/j.rmcr.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Mediastinal lymphadenopathy in combination with lung cancer is suggestive for lymph node metastases but can also have other origins. Case report We describe a patient diagnosed with stage IV lung cancer presenting with parenchymal lesions and enlarged mediastinal lymph nodes. A second opinion including FDG-PET scan review and a mediastinoscopy followed by surgery revealed tumor specimens originating from a single primary tumor with a sarcoid-like reaction in the mediastinal lymph nodes, changing the diagnosis from metastasized to resectable lung cancer. Discussion PET positive lesions are not always synonymous with metastatic disease in the presence of a malignant tumor. Conscientious review of FDG-PET scans and tissue sampling are therefore mandatory to determine definitive staging and subsequent interventions.
Collapse
Affiliation(s)
- Romane M Schook
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Lyan Koudstaal
- Department of Pathology, VU University Medical Center Amsterdam, The Netherlands
| | - Emile F Comans
- Department of Radiology and Nuclear Medicine, VU University Medical Center Amsterdam, The Netherlands
| | - Pieter E Postmus
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Katrien Grünberg
- Department of Pathology, VU University Medical Center Amsterdam, The Netherlands
| | - Marinus A Paul
- Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| | - Thomas G Sutedja
- Department of Pulmonary Diseases, VU University Medical Center Amsterdam, The Netherlands
| |
Collapse
|
3
|
Rizvi SN, Comans EF, Boellaard R, van Tinteren H, Hoekstra OS. Two decades at the cross-roads of biology, physics and epidemiology: Lessons learned in [18F-]FDG positron emission tomography in oncology. Eur J Cancer 2010; 46:2150-8. [DOI: 10.1016/j.ejca.2010.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/06/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
|
4
|
Meijerink MR, van Waesberghe JHT, van der Weide L, van den Tol P, Meijer S, Comans EF, Golding RP, van Kuijk C. Early detection of local RFA site recurrence using total liver volume perfusion CT initial experience. Acad Radiol 2009; 16:1215-22. [PMID: 19524457 DOI: 10.1016/j.acra.2009.03.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/28/2009] [Accepted: 03/30/2009] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to prospectively evaluate the feasibility of a novel total liver volume perfusion computed tomographic technique in demonstrating treatment-site recurrence of liver metastases after radiofrequency ablation (RFA). MATERIALS AND METHODS Eleven patients considered to be at increased risk for local RFA-site tumor recurrence underwent both positron emission tomography (PET) and perfusion computed tomography (CTP): a 12-phase scan of the entire liver acquired before and 11 times after contrast injection. After coregistration, blood flow maps were created using the maximum slope method. RESULTS In all cases, the CTP-derived blood flow maps fully paralleled the PET images in showing either the absence (nine of 13 lesions) or presence (four of 13 lesions) of local RFA-site recurrence. Marginal lesions with high hepatic arterial perfusion (>50 mL/min/100 g) and low portal venous perfusion (<10 mL/min/100 g) represented recurring vital tumor tissue (P < .05). CONCLUSION Total liver volume CTP seems feasible for the detection and localization of treatment-site recurrence after RFA.
Collapse
|
5
|
van der Veldt AA, Buist MR, van Baal MW, Comans EF, Hoekstra OS, Molthoff CF. Clarifying the Diagnosis of Clinically Suspected Recurrence of Cervical Cancer: Impact of 18F-FDG PET. J Nucl Med 2008; 49:1936-43. [DOI: 10.2967/jnumed.108.055046] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
|
6
|
Klumpers UMH, Veltman DJ, Boellaard R, Comans EF, Zuketto C, Yaqub M, Mourik JEM, Lubberink M, Hoogendijk WJG, Lammertsma AA. Comparison of plasma input and reference tissue models for analysing [(11)C]flumazenil studies. J Cereb Blood Flow Metab 2008; 28:579-87. [PMID: 17928801 DOI: 10.1038/sj.jcbfm.9600554] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A single-tissue compartment model with plasma input is the established method for analysing [(11)C]flumazenil ([(11)C]FMZ) studies. However, arterial cannulation and measurement of metabolites are time-consuming. Therefore, a reference tissue approach is appealing, but this approach has not been fully validated for [(11)C]FMZ. Dynamic [(11)C]FMZ positron emission tomography scans with arterial blood sampling were performed in nine drug-free depressive patients and eight healthy subjects. Regions of interest were defined on co-registered magnetic resonance imaging scans and projected onto dynamic [(11)C]FMZ images. Using a Hill-type metabolite function, single (1T) and reversible two-tissue (2T) compartmental models were compared. Simplified reference tissue model (SRTM) and full reference tissue model (FRTM) were investigated using both pons and (centrum semiovale) white matter as reference tissue. The 2T model provided the best fit in 59% of cases. Two-tissue V(T) values were on average 1.6% higher than 1T V(T) values. Owing to the higher rejection rate of 2T fits (7.3%), the 1T model was selected as plasma input method of choice. SRTM was superior to FRTM, irrespective whether pons or white matter was used as reference tissue. BP(ND) values obtained with SRTM correlated strongly with 1T V(T) (r=0.998 and 0.995 for pons and white matter, respectively). Use of white matter as reference tissue resulted in 5.5% rejected fits, primarily in areas with intermediate receptor density. No fits were rejected using pons as reference tissue. Pons produced 23% higher BP(ND) values than white matter. In conclusion, for most clinical studies, SRTM with pons as reference tissue can be used for quantifying [(11)C]FMZ binding.
Collapse
Affiliation(s)
- Ursula M H Klumpers
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
van Westreenen HL, Westerterp M, Sloof GW, Groen H, Bossuyt PMM, Jager PL, Comans EF, van Dullemen HM, Fockens P, Stoker J, van der Jagt EJ, van Lanschot JJB, Plukker JTM. Limited additional value of positron emission tomography in staging oesophageal cancer. Br J Surg 2007; 94:1515-20. [PMID: 17902092 DOI: 10.1002/bjs.5708] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The detection of distant metastases in patients with oesophageal cancer may be improved with [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), preventing unnecessary surgical explorations. The aim of this study was to assess the additional value of FDG-PET after a state-of-the-art preoperative staging protocol. METHODS All patients in this prospective cohort study were staged with multidetector computed tomography, endoscopic ultrasonography and external ultrasonography of the neck, both combined with selective fine-needle aspiration cytology. Patients considered eligible for curative surgery after these investigations underwent FDG-PET. RESULTS FDG-PET revealed suspicious hot spots in 30 (15.1 per cent) of 199 patients. Metastases were confirmed in eight (4.0 per cent). In six of these, distant metastases were confirmed before surgery, but exploratory surgery was necessary for histological confirmation in the other two. All eight upstaged patients had clinical stage III-IV disease before FDG-PET (6.6 per cent of 122 with stage III-IV disease). In seven patients (3.5 per cent) hot spots appeared to be synchronous neoplasms, mainly colonic polyps. However, those in the remaining 15 (7.5 per cent) were false positive, leading to unnecessary additional investigations. CONCLUSION FDG-PET improves the selection of patients with oesophageal cancer for potentially curative surgery, especially in stages III-IV. However, the diagnostic benefit is limited after state-of-the-art staging, and so broad implementation in daily clinical practice is questionable.
Collapse
Affiliation(s)
- H L van Westreenen
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Zijlstra JM, Comans EF, van Lingen A, Hoekstra OS, Gundy CM, Willem Coebergh J, Bongers V. FDG PET in lymphoma: the need for standardization of interpretation. An observer variation study. Nucl Med Commun 2007; 28:798-803. [PMID: 17728610 DOI: 10.1097/mnm.0b013e3282eff2d5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To measure and describe patterns of interobserver variation in visual interpretation of 18-FDG PET in malignant lymphoma. METHODS Eleven nuclear medicine physicians with different levels of PET experience independently reviewed 37 18F-FDG PET scans of lymphoma patients (10 obtained at presentation, 27 during or after therapy). They were requested to identify and localize suspicious lymphoma sites and to assign a stage to the baseline scans, and to interpret the remaining scans for the presence of viable lymphoma. Individual (extra-)nodal regions were assessed for the likelihood of malignancy as positive, negative or equivocal. These results were compared to expert readings after dichotomization in conservative and sensitive reading classifications. RESULTS Sixty-one percent and 56% (using sensitive and conservative reading, respectively) of the baseline scans were scored in accordance with the experts. Fourteen of the 27 scans obtained for therapy evaluation with viable tumour sites were scored in accordance with the experts in 82% and 94% of the patients, using conservative and sensitive reading, respectively. The 13 negative scans were scored in agreement with the experts in only 45% of the cases. False positivity pertained especially to the neck, periclavicular, axilla, mediastinum, lung and bone marrow. More experienced observers tended to have fewer false negative scores. CONCLUSION There are substantial disparities among nuclear medicine physicians' interpretations of FDG PET scans of lymphoma patients, which may affect patient care and results of multi-institutional clinical trials. A well-defined set of criteria is urgently needed to improve consistency.
Collapse
Affiliation(s)
- Josée M Zijlstra
- Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
9
|
Smulders SA, Gundy CM, van Lingen A, Comans EF, Smeenk FWJM, Hoekstra OS. Observer variation of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography in mediastinal staging of non-small cell lung cancer as a function of experience, and its potential clinical impact. Mol Imaging Biol 2007; 9:318-22. [PMID: 17610119 PMCID: PMC2039839 DOI: 10.1007/s11307-007-0108-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Purpose To test the extent of variation among nuclear medicine physicians with respect to staging non-small cell lung cancer with positron emission tomography (PET). Procedures Two groups of nuclear medicine physicians with different levels of PET experience reviewed 30 PET scans. They were requested to identify and localize suspicious mediastinal lymph nodes (MLN) using standardized algorithms. Results were compared between the two groups, between individuals, and with expert reading. Results Overall we found good interobserver agreement (kappa 0.65). Experience with PET translated into a better ability to localize MLN stations (68% vs. 51%, respectively), and experienced readers appeared to be more familiar with translating PET readings into clinically useful statements. Conclusions Although our results suggest that clinical experience with PET increases observers’ ability to read and interpret results from PET adequately, there is room for improvement. Experience with PET does not necessarily improve the accuracy of image interpretation.
Collapse
Affiliation(s)
- Sietske A. Smulders
- Department of Pulmonary Diseases, Catharina Hospital Eindhoven, Amsterdam, The Netherlands
| | - Chad M. Gundy
- Department of Pulmonary Diseases, Catharina Hospital Eindhoven, Amsterdam, The Netherlands
| | - Arthur van Lingen
- Departments of Clinical Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
| | - Emile F. Comans
- Nuclear Medicine and PET research, VU University Medical Centre Amsterdam, VU University, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Frank W J M Smeenk
- Nuclear Medicine and PET research, VU University Medical Centre Amsterdam, VU University, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Otto S. Hoekstra
- Department of Pulmonary Diseases, Catharina Hospital Eindhoven, Amsterdam, The Netherlands
| | | |
Collapse
|
10
|
Herder GJM, Kramer H, Hoekstra OS, Smit EF, Pruim J, van Tinteren H, Comans EF, Verboom P, Uyl-de Groot CA, Welling A, Paul MA, Boers M, Postmus PE, Teule GJ, Groen HJM. Traditional versus up-front [18F] fluorodeoxyglucose-positron emission tomography staging of non-small-cell lung cancer: a Dutch cooperative randomized study. J Clin Oncol 2006; 24:1800-6. [PMID: 16567772 DOI: 10.1200/jco.2005.02.4695] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE We investigated whether application of positron emission tomography (PET) immediately after first presentation might simplify staging while maintaining accuracy, as compared with traditional strategy in routine clinical setting. METHODS At first presentation, patients with a provisional diagnosis of lung cancer without overt dissemination were randomly assigned to traditional work-up (TWU) according to international guidelines or early PET followed by histologic/cytologic verification of lesions, or imaging and follow-up. Patients with [18F] fluorodeoxyglucose (18FDG) -avid, noncentral tumors without suspicion of mediastinal or distant metastases on PET proceeded directly to thoracotomy. Follow-up in presumed benign lesions was at least 12 months. In patients treated with surgery or neoadjuvant therapy, the quality of staging was measured by comparing the clinical stage to the final stage (combination of peroperative staging and 6 months of follow-up). To investigate test substitution, we analyzed the number of (non)invasive tests to achieve clinical TNM staging, and its associated costs. RESULTS Between 1999 and 2001, 465 patients (233 TWU, 232 PET) were enrolled at 22 hospitals. The mean (standard deviation) number of procedures to finalize staging was equal in the TWU arm and the PET arm: 7.9 (2.0) v 7.9 (1.9), P = .90, respectively. Mediastinoscopies occurred significantly less often in the PET arm. Agreement between clinical and final stage was good in both arms (kappa = .85 v .78; P = .07). Costs did not differ significantly. CONCLUSION Up-front 18FDG-PET in patients with (suspected) lung cancer does not reduce the overall number of diagnostic test, but it maintains quality of TNM staging with the use of less invasive surgery.
Collapse
Affiliation(s)
- Gerarda J M Herder
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Herder GJ, van Tinteren H, Golding RP, Kostense PJ, Comans EF, Smit EF, Hoekstra OS. Clinical prediction model to characterize pulmonary nodules: validation and added value of 18F-fluorodeoxyglucose positron emission tomography. Chest 2005; 128:2490-6. [PMID: 16236914 DOI: 10.1378/chest.128.4.2490] [Citation(s) in RCA: 273] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The added value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning as a function of pretest risk assessment in indeterminate pulmonary nodules is still unclear. OBJECTIVE To obtain an external validation of the prediction model according to Swensen and colleagues, and to quantify the potential added value of FDG-PET scanning as a function of its operating characteristics in relation to this prediction model, in a population of patients with radiologically indeterminate pulmonary nodules. DESIGN, SETTING, AND PATIENTS Between August 1997 and March 2001, all patients with an indeterminate solitary pulmonary nodule who had been referred for FDG-PET scanning were retrospectively identified from the database of the PET center at the VU University Medical Center. RESULTS One hundred six patients were eligible for the study, and 61 patients (57%) proved to have malignant nodules. The goodness-of-fit statistic for the model (according to Swensen) indicated that the observed proportion of malignancies did not differ from the predicted proportion (p = 0.46). PET scan results, which were classified using the 4-point intensity scale reading, yielded an area under the evaluated receiver operating characteristic curve of 0.88 (95% confidence interval [CI], 0.77 to 0.91). The estimated difference of 0.095 (95% CI, -0.003 to 0.193) between the PET scan results classified using the 4-point intensity scale reading and the area under the curve (AUC) from the Swensen prediction was not significant (p = 0.058). The PET scan results, when added to the predicted probability calculated by the Swensen model, improves the AUC by 13.6% (95% CI, 6 to 21; p = 0.0003). CONCLUSION The clinical prediction model of Swensen et al was proven to have external validity. However, especially in the lower range of its estimates, the model may underestimate the actual probability of malignancy. The combination of visually read FDG-PET scans and pretest factors appears to yield the best accuracy.
Collapse
Affiliation(s)
- Gerarda J Herder
- Department of Pulmonary Medicine, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
12
|
Pasic A, Brokx HA, Comans EF, Herder GJ, Risse EK, Hoekstra OS, Postmus PE, Sutedja TG. Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with 18F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study. Clin Cancer Res 2005; 11:6186-9. [PMID: 16144919 DOI: 10.1158/1078-0432.ccr-04-2480] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the role of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in radiologically occult preinvasive lesions and lung cancer in the central airways. EXPERIMENTAL DESIGN Twenty-two patients with 24 preinvasive lesions and early squamous cell cancer (SCC) being occult on high-resolution computed tomography were studied. All lesions were diagnosed based on histology sampled using autofluorescence bronchoscopy. FDG-PET findings were correlated with WHO histologic classification. FDG-PET was considered true-positive when the final diagnosis was SCC and true-negative when the lesions were classified as severe dysplasia or less. RESULTS FDG-PET was true-positive in 8 of 11 and true-negative in 11 of 13 cases corresponding with a sensitivity of 73% [95% confidence interval (CI), 0.43-0.91] and specificity of 85% (95% CI, 0.57-0.97). Positive and negative predictive values were 80% (95% CI, 0.48-0.96) and 79% (95% CI, 0.52-0.93), respectively. CONCLUSIONS Our very preliminary data suggest that FDG-PET might be useful for the evaluation of early central airway lesions, being positive in most SCC and negative in cases of severe dysplasia. Validation in a larger multicenter study is needed.
Collapse
Affiliation(s)
- Arifa Pasic
- Department of Pulmonology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Moll AC, Hoekstra OS, Imhof SM, Comans EF, Schouten-van Meeteren AYN, van der Valk P, Boers M. Fluorine-18 fluorodeoxyglucose positron emission tomography (PET) to detect vital retinoblastoma in the eye: preliminary experience. Ophthalmic Genet 2004; 25:31-5. [PMID: 15255112 DOI: 10.1076/opge.25.1.31.29001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To report our first experience with FDG-PET in the detection of vital retinoblastoma. METHODS Four newly diagnosed retinoblastoma patients, two treated retinoblastoma patients, and four control patients were enrolled in this pilot study. F18-FDG uptake was assessed in the light of clinical and histopathological features. RESULTS PET discriminated between new patients and controls, although tumor uptake varied widely. PET added no useful information with regard to possible vital tissue in tumor scars in the eye of the two treated retinoblastoma patients. Moreover, PET findings did not correlate with clinical or histopathological features. CONCLUSION Based on this small pilot study, F18-PET shows little promise in the detection of retinoblastoma. More research on other radiofarmacons is recommended.
Collapse
Affiliation(s)
- A C Moll
- Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
14
|
Herder GJ, Golding RP, Hoekstra OS, Comans EF, Teule GJ, Postmus PE, Smit EF. The performance of( 18)F-fluorodeoxyglucose positron emission tomography in small solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 2004; 31:1231-6. [PMID: 15175835 DOI: 10.1007/s00259-004-1552-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Accepted: 03/18/2004] [Indexed: 12/25/2022]
Abstract
Solitary pulmonary nodule (SPN, intraparenchymal lung mass <3 cm) is often a diagnostic challenge. This study was performed to evaluate the diagnostic accuracy of( 18)F-fluorodeoxyglucose positron emission tomography (FDG PET) in radiologically indeterminate SPN < or =10 mm on spiral CT. Between August 1997 and March 2001, we identified all patients with radiologically indeterminate SPNs < or =10 mm who were referred for FDG PET imaging at the VU University Medical Centre. All PET scans were retrospectively reviewed by an experienced nuclear medicine physician. PET was considered positive in cases with at least moderately enhanced focal uptake, and otherwise as negative. Lesions were considered benign on the basis of histology, no growth during 1.5 years or disappearance within at least 6 months. Thirty-five patients with 36 SPNs < or =10 mm in diameter at clinical presentation were identified (one patient had two metachronous lesions). In 13 of 14 malignant nodules and in two of 22 benign nodules, diagnosis was confirmed by histology. Prevalence of malignancy was 39%. PET imaging correctly identified 30 of 36 small lesions. One lesion proved to be false negative on PET (CT: 10 mm), and in five lesions, PET scans proved to be false positive. Specificity was 77% (17/22; 95% CI: 0.55-0.92), sensitivity 93% (13/14; 95% CI: 0.66-1.0), positive predictive value 72% (13/18; 95% CI: 0.46-0.90) and negative predictive value 94% (17/18; 95% CI: 0.73-1.0). This retrospective study suggests that FDG PET imaging could be a useful tool in differentiating benign from malignant SPNs < or =10 mm in diameter at clinical presentation. Such results may help in the design of larger prospective trials with structured clinical work-up.
Collapse
Affiliation(s)
- Gerarda J Herder
- Department of Pulmonary Diseases, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
15
|
Comans EF. Staging of non-small-cell lung cancer with integrated PET and CT. N Engl J Med 2003; 349:1188-90; author reply 1188-90. [PMID: 14503541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
16
|
Herder GJ, Van Tinteren H, Comans EF, Hoekstra OS, Teule GJ, Postmus PE, Joshi U, Smit EF. Prospective use of serial questionnaires to evaluate the therapeutic efficacy of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected lung cancer. Thorax 2003; 58:47-51. [PMID: 12511720 PMCID: PMC1746467 DOI: 10.1136/thorax.58.1.47] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A study was undertaken to study the effect of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the diagnosis and management of clinically problematic patients with suspected non-small cell lung cancer (NSCLC). METHODS A prospective before-after study was performed in a cohort of all 164 patients (university/community settings) referred for PET between August 1997 and July 1999. PET was restricted to cases where non-invasive tests had failed to solve clinical problems. The impact on diagnostic understanding and management was assessed using questionnaires (intended treatment without PET, actual treatment choice after PET, post hoc clinical assessment). RESULTS Diagnostic problems especially pertained to unclear radiological findings (n=112; 63%), mediastinal staging (n=36; 20%), and distant staging issues (n=16; 9%). PET findings were validated by reviewing medical records. PET had a positive influence on diagnostic understanding in 84%. Improved diagnostic understanding solely based on PET was reported in 26%. According to referring physicians, PET resulted in beneficial change of treatment in 50%. Cancelled surgery was the most frequent change in treatment after PET (35%). CONCLUSION FDG PET applied as "add on" technology in patients with these clinical problems appears to be a clinically useful tool, directly improving treatment choice in 25% of patients. The value of increased confidence induced by PET scanning requires further evaluation.
Collapse
Affiliation(s)
- G J Herder
- Department of Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Herder GJ, Breuer RH, Comans EF, Risse EK, van Mourik JC, Postmus PE, Sutedja TG. Positron emission tomography scans can detect radiographically occult lung cancer in the central airways. J Clin Oncol 2001; 19:4271-2. [PMID: 11709574 DOI: 10.1200/jco.2001.19.22.4271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
18
|
Abstract
A positron emission tomography (PET) scan with 2-[fluorine-18]fluoro-2-deoxy-D-glucose ((18)FDG) was performed on a patient with clinical and laboratory signs of infection after a removed hip prosthesis but with indistinct signs on the bone scan and radiographs. The PET scan confirmed the clinical and laboratory signs and revealed an unidentified focus of infection in the distal area of the right femur.
Collapse
Affiliation(s)
- O P Temmerman
- Department of Orthopaedic Surgery, PET Centre, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
19
|
van den Bosch J, Netelenbos JC, bij de Vaate EA, Comans EF, Giaccone G. [Clinical thinking and decision making in practice. A patient with anal cancer and hypercalcemia]. Ned Tijdschr Geneeskd 2000; 144:2251-6. [PMID: 11109469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A 57-year-old male patient, recently known with an anal carcinoma with inguinal lymph node involvement, was admitted because of anorexia, nausea, vomiting and constipation. On physical examination the patient was dehydrated, and a systolic murmur, grade III/VI, punctum maximum apex cordis, was heard. Serum calcium was raised (4.50 mmol/l), as was the serum creatinine (328 mumol/l). Both values had been normal 14 days before admission. Serum parathormone was suppressed. A bone scan did not reveal evident lesions in the skeleton. FDG-PET scan showed uptake of the tracer into the bone marrow. A bone biopsy showed metastasis of a squamous cell carcinoma. Shortly after that the patient died. Hypercalcaemia is associated with cancer. Colorectal/anal carcinomas have a low incidence of hypercalcaemia. The prognosis of patients with cancer associated with hypercalcaemia is poor.
Collapse
Affiliation(s)
- J van den Bosch
- Afd. Geneeskundige Oncologie, Academisch Ziekenhuis Vrije Universiteit, Amsterdam
| | | | | | | | | |
Collapse
|
20
|
Lips P, Comans EF, Hoekstra OS, van der Poest Clement E, van Mourik JC, Teule GJ. Positron emission tomography for the detection of metastases of differentiated thyroid carcinoma. Neth J Med 2000; 57:150-6. [PMID: 11006491 DOI: 10.1016/s0300-2977(00)00067-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To show the value of positron emission tomography (PET) with 18-F-fluorodeoxyglucose (18-FDG) for the detection of metastases of differentiated thyroid carcinoma in selected patients. PATIENT HISTORIES There were four patients, who had undergone total thyroidectomy for papillary (two) or follicular thyroid carcinoma (two). All patients had subsequent treatment with (131)iodine. Three patients had an increasing serum concentration of thyroglobulin, one patient had antibodies against thyroglobulin. A diagnostic (131)iodine scintigraphy was negative in two patients, and uncertain in two patients. Positron emission tomography was performed about 45 min after administration of 10 mCi 18-F-fluorodeoxyglucose. In three patients PET showed uptake in the cervical region, caused by lymph node metastases in two (confirmed by neck dissection) and recurrent tumor on the trachea in one patient (confirmed by surgery). In the fourth patient uptake of 18-FDG was seen in the neck and in both lungs. This led to discontinuation of treatment with (131)iodine because the lung metastases did not accumulate (131)iodine. DISCUSSION In selected patients with differentiated thyroid carcinoma with an increasing serum concentration of thyroglobulin, PET is an important diagnostic option when scintigraphy with (131)iodine is negative or uncertain. In the four presented case histories, the results of PET led to a therapeutic decision: surgery in three patients and discontinuation of (131)iodine in one patient. The development of guidelines for the use of PET in the diagnosis of recurrent thyroid cancer is discussed.
Collapse
Affiliation(s)
- P Lips
- Department of Endocrinology, Academic Hospital Vrije Universiteit, P. O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
21
|
Comans EF, Hoekstra OS, Hoekman K, van der Hoeven JJ, Golding RP, Teule GJ. [Added value of positron emission tomography with fluoro-18-deoxyglucose as the tracer (FDG-PET) in clinical problem cases in oncology]. Ned Tijdschr Geneeskd 2000; 144:1520-8. [PMID: 10949634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Positron emission tomography with fluoro-18-deoxyglucose as tracer molecule (FDG-PET) is a relatively new imaging technique used in oncology to study tumour metabolism in vivo. Both qualitative and quantitative data obtained by PET provide unique information to the clinician and may guide the therapeutic approach in selected patients, where conventional diagnostic tests like CT or MRI yield equivocal results. According to the experience obtained in the Vrije Universiteit Medical Centre in Amsterdam, the additional value of FDG-PET can be explained by the sensitivity and the specificity of the technique, combined with the visualization of the whole body. FDG-PET may reveal metastases and tumour tissue may be differentiated from scar tissue and necrosis. PET is expensive and its effects on patient outcome has yet to be established.
Collapse
Affiliation(s)
- E F Comans
- Afd. Nucleaire Geneeskunde, Academisch Ziekenhuis Vrije Universiteit, Amsterdam.
| | | | | | | | | | | |
Collapse
|
22
|
Dragoiescu C, Comans EF, Van Riel A, Hoekstra OS. F-18 fluorodeoxyglucose positron emission tomographic imaging: in search of an unknown primary tumor. Clin Nucl Med 2000; 25:308-9. [PMID: 10750982 DOI: 10.1097/00003072-200004000-00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Dragoiescu
- Department of Nuclear Medicine, Free University Hospital, Amsterdam, The Netherlands.
| | | | | | | |
Collapse
|
23
|
Sloof GW, Visser FC, Comans EF, Bax JJ, Teerlink T, van der Vusse GJ, Knapp FF. Metabolism of radioiodinated fatty acid analogs in ischemic and hypoxic canine myocardium. J Nucl Med 1999; 40:1204-15. [PMID: 10405143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
UNLABELLED Myocardial metabolism of 17-[123I]-iodoheptadecanoic acid (IHDA), 15-(p-[131I]-iodophenyl)pentadecanoic acid (pIPPA) and 15-(p-[125I]-iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPP) was assessed during ischemia and hypoxia. The simultaneous investigation allowed us to evaluate differences in metabolic handling of these three fatty acids. METHODS In 17 open-chest dogs, the left ascending coronary artery was cannulated and extracorporeal bypass (ECB) perfused. In 3 dogs, ECB flow was kept normal, and these control experiments showed that kinetics of the radioiodinated fatty acids were not affected by the ECB technique itself. In 9 dogs, ECB flow was reduced to one third (ischemia), and in 5 dogs, the ECB area was perfused with venous blood and was kept at control values (hypoxia). After simultaneous intravenous injection of IHDA, pIPPA and DMIPP, seven paired biopsy specimens from the native and ECB-perfused myocardium were taken over an assay period of 35 min. Total activity and the distribution in the aqueous phase and lipid fractions were determined, and time-activity curves were constructed. RESULTS In ischemic (Is) but not in hypoxic (Hy) myocardium, peak total activity of IHDA, pIPPA and DMIPP decreased significantly versus normal (N) myocardium (IHDA: N = 700 +/- 267 versus Is = 335 +/- 158 dpm/mg/mCi; pIPPA: N = 988 +/- 318 versus Is = 438 +/- 180 dpm/mg/mCi; DMIPP: N = 352 +/- 146 versus Is = 179 +/- 82 dpm/mg/mCi; all P values < 0.001). The relative decrease was similar for IHDA, pIPPA or DMIPP. Half-time values of total activity were prolonged for IHDA and pIPPA but were shortened for DMIPP in ischemic and hypoxic myocardium (IHDA: N = 22, Is = 44 and Hy = 50 min; pIPPA: N = 24, Is = 95 and Hy = 169 min; DMIPP: N = 528, Is = 409 and Hy = 115 min). The aqueous phase activity for IHDA, pIPPA and DMIPP decreased significantly versus normal myocardium in both ischemic (IHDA: N = 71% +/- 9% versus Is = 36% +/- 9%, P < 0.001; pIPPA: N = 62% +/- 10% versus Is = 25% +/- 8%, P < 0.001; DMIPP: N = 26% +/- 11% versus Is = 18% +/- 3%, P < 0.05) and hypoxic (IHDA: N = 76% +/- 8% versus Hy = 62% +/- 8%, P < 0.05; pIPPA: N = 66% +/- 8% versus Hy = 46% +/- 10%, P < 0.05; DMIPP: N = 32% +/- 6% versus Hy = 24% +/- 4%, P < 0.05) myocardium. The relative decrease was significantly highest for pIPPA and lowest for DMIPP. Incorporation into triacylglycerols increased significantly for IHDA, pIPPA and DMIPP in both ischemic and hypoxic myocardium. In normal myocardium, DMIPP was already mainly incorporated into triacylglycerols. Activity of IHDA and pIPPA in acylcarnitine increased significantly in ischemic and hypoxic myocardium. CONCLUSION Kinetics of the radioiodinated fatty acid analogs in myocardium are altered during oxygen deprivation in a similar fashion as documented in literature for natural fatty acids. However, the changes were different between IHDA, pIPPA and DMIPP, suggesting different metabolic handling and thus reflecting different aspects of myocardial fatty acid metabolism.
Collapse
Affiliation(s)
- G W Sloof
- Department of Nuclear Medicine, Free University Hospital, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
24
|
Borgstein PJ, Pijpers R, Comans EF, van Diest PJ, Boom RP, Meijer S. Sentinel lymph node biopsy in breast cancer: guidelines and pitfalls of lymphoscintigraphy and gamma probe detection. J Am Coll Surg 1998; 186:275-83. [PMID: 9510258 DOI: 10.1016/s1072-7515(98)00011-8] [Citation(s) in RCA: 493] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sentinel node (SN) biopsy appears to offer an alternative to routine axillary lymph node dissection (ALND) for staging patients with breast cancer. Various techniques have been studied for identifying the SN, using vital blue dye or radioactive colloid, and initial reports are promising. The inherent limitations and pitfalls must be clearly understood before SN biopsy can be implemented in dinical practice. STUDY DESIGN In a prospective trial, the feasibility of using lymphoscintigraphy and gamma probe detection for performing SN biopsy was studied. In 130 consecutive patients with T1-T2, N0 breast cancer, preoperative lymphoscintigraphy was performed with technetium 99m-colloidal albumin. During ALND, the radioactive axillary SNs were localized by the gamma probe. Histopathologic examination of the harvested SNs was compared with the status of the axillary lymph nodes. RESULTS Axillary focal accumulations were clearly identified on lymphoscintigraphy in 116 patients (89%). The failure rate was significantly higher in patients who had a previous excision biopsy (36%) than in those with a palpable tumor in situ (4%). Using the gamma probe, radiolabeled axillary SNs were successfully biopsied in 122 patients (94%). Because 18 of these patients did not undergo formal lymphadenectomy, the predictive accuracy of SN biopsy was analyzed in 104 patients. Radioactive nodes revealed metastases in 44 of 104 patients (42%); in 26 of them (59%), these were the only involved axillary nodes. The SN was negative in 60 patients (58%); in one patient the ALND was found to contain metastatic disease (1.7% false negatives). Biopsy of the SN was 98% accurate in predicting the absence of nodal metastases. CONCLUSIONS There are certain guidelines for performing SN biopsy by lymphoscintigraphy and gamma probe detection. Success depends primarily on an adequate functional capacity of the SN, necessary for sufficient nodal uptake to ensure accurate identification. Lymphoscintigraphy defines the pattern of lymph flow and may prevent failure or false-negative biopsies. Biopsy of the SN is a highly accurate, minimally invasive method of staging patients with breast cancer and can substantially reduce the morbidity and costs of surgical treatment by avoiding unnecessary ALND in the majority of patients.
Collapse
Affiliation(s)
- P J Borgstein
- Department of Surgical Oncology, Academic Hospital, Free University, Amsterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
25
|
Lambert J, Pijpers R, van Ittersum FJ, Comans EF, Aarsen M, Pieper EJ, Donker AJ, Stehouwer CD. Sodium, blood pressure, and arterial distensibility in insulin-dependent diabetes mellitus. Hypertension 1997; 30:1162-8. [PMID: 9369271 DOI: 10.1161/01.hyp.30.5.1162] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We investigated 24-hour ambulatory blood pressure and arterial distensibility, a marker of biophysical vessel wall properties, in 32 normoalbuminuric type I diabetic patients and 32 healthy control subjects on diets containing 50 mmol and 200 mmol sodium per day. The increase in daytime diastolic blood pressure from 50 to 200 mmol sodium was significantly higher in the diabetic patients than in the control subjects (2.3+/-4.9 versus 0.2+/-3.7 mm Hg, P<.05). On a high sodium regimen, femoral artery distensibility was decreased in the diabetic patients compared with the control subjects (19.2+/-7.6 versus 24.1+/-9.3 10[-3]/kPa, P<.05). Angiotensin-converting enzyme inhibition in the diabetic patients on a high sodium diet decreased daytime diastolic blood pressure and increased femoral artery distensibility. The blood pressure decrease in response to angiotensin-converting enzyme inhibition correlated significantly with the blood pressure increase to sodium (for 24-hour systolic and diastolic blood pressure, r=.72, P<.001 and r=.76, P<.001). In addition, we found that in the diabetic patients on a high sodium diet, the renal blood flow response to exogenous angiotensin II was not bimodally distributed, as is the case in essential hypertension, in which a subgroup of the patients are characterized by sodium sensitivity of the blood pressure and an abnormal renal blood flow response to exogenous angiotensin II ("nonmodulator phenotype"). These results show that blood pressure in insulindependent diabetes mellitus is sodium sensitive, but that this is not related to the nonmodulator phenotype, and suggest that in IDDM a relatively high sodium intake may be a factor that predisposes to the development of diabetic vascular disease.
Collapse
Affiliation(s)
- J Lambert
- Department of Internal Medicine, Academisch Ziekenhuis Vrije Universiteit, Armsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Sloof GW, Visser FC, Comans EF, Groeneveld AB, Bax JJ, van Eenige MJ, van der Vusse GJ, Knapp FF. Heterogeneity of DMIPP uptake and its relationship with heterogeneous myocardial blood flow. J Nucl Med 1997; 38:1424-30. [PMID: 9293802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED To assess its potential role as a new metabolic probe, the relationship between regional uptake of the 15-(p-[125I]-iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPP) fatty acid analog and myocardial blood flow was studied. METHODS In 14 open-chest dogs, the left anterior descending coronary artery was cannulated and extracorporal bypass-perfused at normal (control group; n = 4) and reduced flow (intervention group; n = 10). Myocardial blood flow (MBF) was assessed with 46Sc-labeled microspheres. Forty minutes after intravenous injection of DMIPP, the heart was excised and cut into 120 samples. In each sample, MBF ml x g(-1) x min(-1) and DMIPP uptake (percentage of the injected dose per gram, %ID/g) were assessed. RESULTS In normal myocardium, MBF and DMIPP uptake were 1.10 +/- 0.18 ml x g(-1) x min(-1) and 1.18 +/- 0.42 x 10(-2) %ID/g, respectively. In the extracorporal bypass area, flow was reduced to 0.49 +/- 0.20 ml x g(-1) x min(-1) (p < 0.0001 compared to normal), and DMIPP uptake was decreased to 0.75 +/- 0.26 x 10(-2) %ID/g (p < 0.0001 compared to normal). DMIPP uptake and MBF positively correlated in normal (DMIPP uptake = 0.77 +/- 0.23 x MBF; r = 0.41; p < 0.0001) and hypoperfused (DMIPP uptake = 0.35 +/- 0.70 x MBF; r = 0.63; p < 0.0001) myocardium. The heterogeneity, indicated by the coefficient of variation, in normal myocardium was 0.23 +/- 0.05 for MBF and was lower (p < 0.0001) for DMIPP uptake: 0.13 +/- 0.05. During flow reduction, heterogeneity increased significantly (p < 0.0001) for both MBF (0.59 +/- 0.22) and DMIPP uptake (0.37 +/- 0.23). Also heterogeneity of the DMIPP uptake to MBF ratio, as an indicator of agreement, increased from 0.23 +/- 0.07 in normal to 0.46 +/- 0.19 in hypoperfused myocardium (p < 0.0001). CONCLUSION DMIPP detects regionally hypoperfused myocardium, in which agreement between MBF and fatty acid uptake deteriorates. DMIPP uptake shows a different relationship with MBF in hypoperfused compared to normal myocardium. These observations suggest that DMIPP uptake may provide additional, unique information on regional myocardial ischemia.
Collapse
Affiliation(s)
- G W Sloof
- Department of Nuclear Medicine, Free University Hospital, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Pijpers R, Meijer S, Hoekstra OS, Collet GJ, Comans EF, Boom RP, van Diest PJ, Teule GJ. Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nucl Med 1997; 38:366-8. [PMID: 9074519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
UNLABELLED Identification of the sentinel node by using colloidal tracers and a gamma probe or lymphoscintigraphy could be an effective alternative for the complicated original dye-oriented approach. We studied the sentinel node detection rate using early and delayed imaging in breast cancer patients. METHODS Thirty-seven patients were imaged 2 hr and 18 hr after peritumoral injection of 99mTc-colloidal albumin. Preoperatively, axillary foci were located with a handheld gamma probe that was also used to isolate radiolabeled nodes from the axillary dissection specimens. The predictive value of the sentinel node for the axillary tumorstatus was evaluated with histological examination. RESULTS Two and 18 hr after injection, lymphoscintigraphy revealed one to three separate axillary lymph nodes in 33 and 34 patients, respectively. In 30 patients the axillary foci were easily localized with the gamma probe preoperatively. In all 34 patients (92%), with visualized axillary foci, at least one radioactive sample could be retrieved using the gamma probe (total 53 samples). Metastases were found in the sentinel nodes of 11 patients, in seven of 11 being the only tumor-positive lymph node in the axilla. There were no false-negative sentinel nodes. CONCLUSION The selective targeting and prolonged intranodal retention of 99mTc-colloidal albumin allows successful sentinel node identification in most (92%) patients.
Collapse
Affiliation(s)
- R Pijpers
- Department of Nuclear Medicine, Academisch Ziekenhuis van de Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Visser FC, Comans EF, van Eenige MJ, Sloof GW. Iodoheptadecanoic scintigraphy is not related to lipid turnover. Eur J Nucl Med 1994; 21:367-9. [PMID: 8005163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
29
|
Sloof GW, Visser FC, Eenige van MJ, Comans EF, Teerlink T, Herscheid JD, Van der Vusse GJ, Knapp FF. Comparison of uptake, oxidation and lipid distribution of 17-iodoheptadecanoic acid, 15-(p-iodophenyl)pentadecanoic acid and 15-(p-iodophenyl)-3,3-dimethylpentadecanoic acid in normal canine myocardium. J Nucl Med 1993; 34:649-57. [PMID: 8455083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The kinetics of 17-[123I]iodoheptadecanoic acid (IHDA), 15-(p-[125I]iodophenyl)pentadecanoic acid (pIPPA) and 15-(p-[131I]iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPPA) were investigated in normal canine myocardium. After simultaneous intravenous injection, myocardial biopsy specimens and samples of arterial blood were taken over 80 min. IHDA showed the highest myocardial uptake (995 +/- 248 dpm/mg.mCi versus pIPPA: 785 +/- 197 dpm/mg.mCi, ns) and the largest size of oxidation (74% +/- 4% versus pIPPA: 65% +/- 5%, p < 0.05). Myocardial activity of IHDA decreased with a half-time value of 11.2 min (pIPPA: 13.2 min). Phospholipids were the main lipid fraction into which IHDA was incorporated, whereas pIPPA was predominantly incorporated into triacylglycerols. DMIPPA myocardial activity remained constant during the assay period and instead of being oxidized, DMIPPA was mainly incorporated into triacylglycerols (55% +/- 12%). The myocardium-to-blood ratios of DMIPPA were greater than 10:1. The ratios at peak for IHDA and pIPPA were 4.1:1 and 3.9:1, respectively (both p < 0.0001 versus DMIPPA). In conclusion, differences have been found in the myocardial uptake, oxidation and lipid distribution of IHDA, pIPPA and DMIPPA. DMIPPA is a promising tracer for fatty acid uptake studies with single-photon emission computerized tomography because of its prolonged retention and high myocardium-to-blood ratios.
Collapse
Affiliation(s)
- G W Sloof
- Dept. of Cardiology, Free University Hospital, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Sloof GW, Visser FC, Teerlink T, Comans EF, Eenige van MJ, van der Vusse GJ, Knapp FF. Incorporation of radioiodinated fatty acids into cardiac phospholipids of normoxic canine myocardium. Mol Cell Biochem 1992; 116:79-87. [PMID: 1480157 DOI: 10.1007/bf01270573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to assess the phospholipid distribution of radioiodinated 17-iodoheptadecanoic acid (IHDA), 15-(p-iodophenyl)pentadecanoic acid (p-IPPA) and 15-(p-iodophenyl)-3,3-dimethylpentadecanoic acid (DMIPPA) under normoxic conditions and to compare these data with the fatty acid composition of the phospholipid classes. After simultaneous i.v. injection of the radioiodinated fatty acids (I-123-IHDA; I-131-p-IPPA; I-125-DMIPPA) in open-chest dogs seven myocardial biopsies were taken over 40 min (n = 26). After lipid extraction of the biopsies the organic phase was analyzed for both neutral and polar lipids by two different TLC systems. The following polar lipid fractions were analyzed: lysophosphatidylcholine (LPC), sphingomyelin (SPH), phosphatidylcholine (PC; lecithin), phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE), diphosphatidylglycerol (DPG; cardiolipin) and neutral lipids. Fractions were counted in a gamma well counter and corrected for cross-over and recovery. Results of the polar phospholipids analysis showed that IHDA has the highest incorporation into the phospholipids. The IHDA was mainly incorporated into PI (45.6%) followed by PC (30.9%), PE (14.0%) and PS (5.6%). The p-IPPA was predominantly incorporated incorporated into PC (37.2%), followed by PS (20.1%) and PE (13.7%). In contrast to IHDA, incorporation of p-IPPA into PI was small (6.4%). The DMIPPA analogue was incorporated into phospholipids to only a very small degree, compared to IHDA and p-IPPA.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- G W Sloof
- Dept. of Cardiology, Metabolic Laboratory, Free University Hospital Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
31
|
de Fijter CW, Comans EF, de Vries PM, Oe PL, Roos JC, Smit AJ, Streurman O, Donker AJ. The effect of fenoldopam on renal haemodynamics and natriuresis in chronic renal failure. Neth J Med 1990; 36:267-78. [PMID: 1975651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The effect of oral administration of fenoldopam, a dopamine-1 receptor agonist, on blood pressure, renal haemodynamics and natriuresis was studied in 12 patients with chronic renal insufficiency. In addition, the effect of administering a low intravenous dose of fenoldopam on top of the oral dose was compared with the effect of the same intravenous dose given immediately before oral fenoldopam. Oral administration of fenoldopam (50 mg t.i.d. for 3 +/- 1 days followed by 100 mg t.i.d. for 8 +/- 1 days) induced a significant fall in blood pressure (median MAP from 107 to 101 mm Hg). Compared to baseline values, body weight, effective renal plasma flow (ERPF), glomerular filtration rate (GFR) and fractional sodium excretion remained unchanged. Infusion of fenoldopam (0.05-0.1 micrograms/kg/min) on day 1 led to a significant fall in blood pressure (median mean arterial pressure from 107.0 to 98.5 mm Hg), and a significant rise in effective renal plasma flow (median ERPF from 132 to 146 ml/min/1.73 m2). Median fractional sodium excretion increased significantly from 2.1 to 3.3%. GFR, filtration fraction and plasma aldosterone concentration did not change. No relationship was found between the fenoldopam-induced changes in ERPF and natriuresis, nor between baseline GFR or ERPF and fenoldopam-induced urinary sodium loss. Infusion of fenoldopam while patients were on oral fenoldopam had no effect on blood pressure, ERPF or GFR. However, again natriuresis was induced, which did not differ significantly from the fenoldopam-induced natriuresis on day 1. We conclude that oral fenoldopam has a moderate blood pressure lowering effect in patients with chronic renal insufficiency, but exerts no effect on ERPF or GFR. Secondly, a fenoldopam-induced natriuresis does not appear to be related to changes in ERPF or aldosterone secretion.
Collapse
Affiliation(s)
- C W de Fijter
- Department of Internal Medicine, Free University Hospital, Amsterdam
| | | | | | | | | | | | | | | |
Collapse
|