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Freudenberg LS, Baraliakos X, Kampen WU, Vereb M, Fischer M, Toenshoff G, Boddenberg-Pätzold B, Czech N, Klett R. [Pain reduction by radiosynoviorthesis in rheumatism-induced synovitis of the elbow : Results of a retrospective multicenter data analysis]. Z Rheumatol 2023; 82:892-897. [PMID: 35066630 DOI: 10.1007/s00393-022-01158-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiosynoviorthesis (RSO) is a nuclear medical local treatment modality for inflammatory joint diseases. It is indicated in patients with rheumatoid arthritis (RA) in joints with persistent synovitis despite adequate pharmacotherapy. Arthritis of the elbow joint occurs in up to 2/3 of patients with RA. Intra-articular radiotherapy using the beta emitter [186Re] rhenium sulfide leads to sclerosis of the inflamed synovial membrane with subsequent pain alleviation. The clinical efficacy in cubital arthritis, however, has so far only been described in small monocentric studies. OBJECTIVE The degree of pain alleviation by RSO was analyzed in patients with rheumatoid cubital arthritis, treated in several nuclear medical practices specialized in RSO. MATERIAL AND METHODS The subjective pain intensity before and after RSO was documented in a total of 107 patients with rheumatic cubital arthritis using a 10-step numeric rating scale (NRS). A difference of ≥ -2 is rated as a significant improvement. Follow-up examinations were done after a mean interval of 14 months after RSO (at least 3 months, maximum 50 months). RESULTS The mean NRS value was 7.3 ± 2.1 before RSO and 2.8 ± 2.2 after RSO. A significant pain alleviation was seen in 78.5% of all patients treated. The subgroup analysis also showed a significant improvement in the pain symptoms in all groups depending on the time interval between the RSO and the control examination. A significant pain progression was not observed. The degree of pain relief was independent of the time of follow-up. CONCLUSION Using RSO for local treatment of rheumatoid cubital arthritis leads to a significant and long-lasting pain relief in more than ¾ of the treated patients.
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Affiliation(s)
- Lutz S Freudenberg
- ZRN Rheinland und ZRN MVZ GmbH, Überseite 88, 41352, Korschenbroich, Deutschland.
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - Willm Uwe Kampen
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstr. 8, 20095, Hamburg, Deutschland
| | - Marika Vereb
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Manfred Fischer
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Gregor Toenshoff
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Radiologie und Nuklearmedizin, Röntgenpraxis Georgstraße, Georgstr. 16, 30159, Hannover, Deutschland
| | - Barbara Boddenberg-Pätzold
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis Nuramed Köln-West, Max-Planck-Str. 27A, 50858, Köln, Deutschland
| | - Norbert Czech
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Zentrum für Nuklearmedizin und PET/CT Bremen im St. Joseph Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Rigobert Klett
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- ÜBAG für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Deutschland
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Freudenberg LS, Freudenberg BJ, Klett R, Herrmann K. [Nuclear Medicine Physicians: A threatened species?]. Nuklearmedizin 2022; 61:358-366. [PMID: 35977672 DOI: 10.1055/a-1907-4122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Zusammenfassung
Einleitung Die demografische Entwicklung in Deutschland führt zu einem ärztlichen Nachwuchsmangel. Ziel dieser Arbeit ist es, aus den von der Bundesärztekammer (BÄK) veröffentlichten Ärztestatistiken der letzten 25 Jahre die Entwicklung und den aktuellen demografischen Status der Nuklearmedizin in Deutschland darzustellen und deren Konsequenzen aufzuzeigen.
Materialien und Methoden Die seit 1996 von der BÄK jährlich veröffentlichten Zahlen der ärztlichen Versorgung in Deutschland wurden systematisch im Hinblick auf die Altersentwicklung und die Geschlechterverteilung in den Fächern Nuklearmedizin, Radiologie und Strahlentherapie zusammengefasst und mit einer deskriptiven Statistik ausgewertet.
Ergebnisse Die Anzahl der berufstätigen Fachärzt*innen hat sich von 1996–2021 in der Nuklearmedizin um 114% erhöht mit einer deutlichen Verschiebung der Altersstruktur in die älteren Altersgruppen: 2021 lag der Anteil der Ärzt*innen unter 40 Jahren bei 13,0% in der Nuklearmedizin und bei 21,0% in der Radiologie und derjenige Anteil über 60 Jahren bei 27,1% in der Nuklearmedizin und bei 22,3% in der Radiologie. Der Anteil an Frauen lag im Jahr 2021 in der Medizin insgesamt bei 48,5%, in der Nuklearmedizin, Radiologie und Strahlentherapie bei 34,4%, 37,1% bzw. 48,0%.
Schlussfolgerungen Die Fachärzt*innen in der Nuklearmedizin sind 2021 deutlich älter als diejenigen in der Strahlentherapie und Radiologie, und der Anteil von Frauen ist unterdurchschnittlich. Wenn die Nuklearmedizin als eigenständiges Fach ihrer klinischen Verantwortung gerecht werden will und eigenständig bestehen bleiben möchte, müssen die Bemühungen vor allem um den weiblichen medizinischen Nachwuchs in der nuklearmedizinischen Gemeinschaft eine maximale Priorität bekommen.
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Affiliation(s)
- Lutz S Freudenberg
- ZRN Rheinland, Korschenbroich, Germany.,Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Ben J Freudenberg
- Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Rigobert Klett
- Überörtliche Berufsausübungsgemeinschaft für Nuklearmedizin, Hanau - Frankfurt - Offenbach - Gießen, Gießen, Germany
| | - Ken Herrmann
- Clinic of Nuclear Medicine, University Hospital Essen, Essen, Germany
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Schenke SA, Campennì A, Tuncel M, Bottoni G, Sager S, Bogovic Crncic T, Rozic D, Görges R, Özcan PP, Groener D, Hautzel H, Klett R, Kreissl MC, Giovanella L. Diagnostic Performance of 99mTc-Methoxy-Isobuty-Isonitrile (MIBI) for Risk Stratification of Hypofunctioning Thyroid Nodules: A European Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12061358. [PMID: 35741167 PMCID: PMC9221758 DOI: 10.3390/diagnostics12061358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
99mTc-MIBI (MIBI) imaging is able to exclude malignancy of hypofunctioning thyroid nodules (TNs) with high probability but false positive results are frequent due to low specificity. Therefore, pre-test selection of appropriate TNs is crucial. For image evaluation visual and semiquantitative methods (Washout index, WOInd) are used. Aim of this study was to evaluate the diagnostic performance of MIBI imaging in hypofunctioning TNs with indeterminate fine-needle aspiration cytology results in a multicentric European setting. Patients with hypofunctioning TNs, EU-TIRADS 4 or 5, Bethesda III/IV and MIBI imaging were included. For visual evaluation the intensity of MIBI uptake in the TN was compared to normal thyroid tissue. 358 patients with 365 TNs (n = 68 malignant) were included. Planar imaging (SPECT) showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 96% (94%), 21% (22%), 22% (15%), 96% (96%), and 35% (32%). The WOInd (38.9% of all cases, optimal cutoff: −19%) showed a sens 100% (spec 89%, PPV 82%, NPV 100%, ACC 93%). For hypofunctioning TNs at intermediate or high risk with indeterminate cytology, a MIBI negative result on visual evaluation is an effective tool to rule-out thyroid malignancy. The semi-quantitative method could considerably improve overall diagnostic performance of MIBI imaging.
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Affiliation(s)
- Simone Agnes Schenke
- Clinic of Nuclear Medicine Bayreuth Hospital, Preuschwitzer Straße 101, 95445 Bayreuth, Germany
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany;
- Correspondence:
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Via Consolare Valeria, 98125 Messina, Italy;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Sihhiye, Ankara 06230, Turkey;
| | - Gianluca Bottoni
- Department of Nuclear Medicine, E.O. “Ospedali Galliera”, 16128 Genoa, Italy;
| | - Sait Sager
- Department of Nuclear Medicine, Medical Faculty, Istanbul University-Cerrahpaşa, Koca Mustafapasa Caddesi No: 53, Fatih, Istanbul 34096, Turkey;
| | - Tatjana Bogovic Crncic
- Department of Nuclear Medicine, Faculty of Medicine, University of Rijeka, Brace Branchetta 20/1, 51 000 Rijeka, Croatia;
| | - Damir Rozic
- Department of Nuclear Medicine, University Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina;
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Pinar Pelin Özcan
- Department of Nuclear Medicine, University Hospital Mersin, Ciftlikkoy District, MEU Ciftlikkoy Campus, Yenisehir, Mersin 33110, Turkey;
| | - Daniel Groener
- Department of Nuclear Medicine, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60596 Frankfurt, Germany;
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen & German Cancer Consortium (DKTK), Hufelandstraße 55, 45147 Essen, Germany;
| | - Rigobert Klett
- Practice of Nuclear Medicine Hanau/Giessen/Frankfurt/Offenbach, Paul-Zipp-Straße 171, 35398 Giessen, Germany;
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany;
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Via Officina 3, 6500 Bellinzona, Switzerland;
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Freudenberg LS, Toenshoff G, Kampen WU, Klett R. Radiosynoviorthese des Kniegelenks. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00524-8] [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] [Indexed: 10/18/2022]
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Abstract
The existence of a popliteal Baker's cyst was regarded as a contraindication for radiosynoviorthesis of the knee joint since decades. A so-called "ventile mechanism" was discussed leading to a significant concentration of the intraarticularly applied, high energy beta emitting radiopharmaceutical yttrium-90-colloid in the cyst. This cyst arises from a bursa beneath the tendon of the medial head of the gastrocnemius muscle, normally communicating with the knee joint space. Since the cyst wall is much thinner than the knee joint capsule, a radiogenic rupture of the cyst was feared, leading to severe radiogenic necroses of the surrounding soft tissue. Due to this potential hazard, knee joint ultrasound is mandatory prior to radiosynoviorthesis to check for any popliteal cysts. New studies however decline the risk of a radiogenic cyst rupture after an appropriately performed radiosynoviorthesis of the knee joint.In case of a preexistent cyst rupture, the risk of a radiogenic tissue damage remains an issue and magnetic resonance imaging (MRI) is the method of choice to exclude this potential hazard. However, MRI sometimes leads to equivocal results. Scintigraphy of the knee joint after intraarticular application of Tc-99m-nanocolloid offers the possibility to check for the integrity of the Baker's cyst in these patients to be sure that radiosynoviorthesis will not lead to a relevant extraarticular leakage with soft tissue necroses. This study describes the procedure of intracavitary distribution scintigraphy by means of representative case reports.
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Affiliation(s)
- Willm Uwe Kampen
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Hamburg, Germany
| | | | - Manfred Fischer
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Kassel, Germany
| | - Rigobert Klett
- Standort Gießen, Überörtliche Berufsausübungsgemeinschaft für Nuklearmedizin, Hanau - Frankfurt - Offenbach - Gießen, Giessen, Germany
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Schenke SA, Campenni A, Tuncel M, Piccardo A, Sager S, Bogovic Crncic T, Rozic D, Goerges R, Özcan Kara PP, Groener D, Hautzel H, Klett R, Kreissl MC, Giovanella L. A multicenter survey of current practices of 99mTc-methoxy-isobutyl-isonitrile (MIBI) imaging for the diagnosis of thyroid nodules: more standardization is essential. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Purpose
Molecular imaging with 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI, MIBI) has been used in the assessment of thyroid nodules (TNs) for more than two decades. Many studies showed that MIBI imaging is a suitable tool to rule-out malignancy when negative. However, relatively low specificity and accuracy have been described, thus, limiting its acceptance in clinical practice. Additionally, different technologies, protocols, and interpretation criteria are adopted accounting for heterogeneous data reported in the literature. Therefore, the present study was undertaken to assess the clinical use and methodology of MIBI imaging in patients with nodular thyroid disease in Europe.
Methods
A questionnaire was sent to 12 European centers of Nuclear Medicine. The questionnaire encompassed ultrasound (US) and fine-needle aspiration cytology (FNAC) procedures and their evaluation as well scintigraphy imaging indications, technical procedures, and interpretation criteria of MIBI imaging.
Results
The survey showed a good agreement of different centers in approaching TNs by TSH measurement, US evaluation and 99mTc-pertechnetate thyroid scintigraphy. MIBI imaging is mainly used to assess TNs with inconclusive/indeterminate cytological findings and selection of target nodule(s) for FNAC in patients with multi-nodular goiter. Technical procedures adopted in different centers are globally comparable and the recorded differences are unlikely to impact clinical results. However, as the main result of the present study, substantial differences were found in interpretation criteria adopted in different centers.
Conclusions
Our survey supports the urgent need of standardized interpretation criteria of thyroid MIBI imaging in order to improve its diagnostic performance and make results comparable in clinical practice.
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Freudenberg LS, Klett R, Fischer M, Boddenberg-Pätzold B, Tönshoff G, Czech NJ, Kampen WU. [RSO in clinical practice: Status in Germany 2020]. Nuklearmedizin 2021; 60:224-232. [PMID: 33759147 DOI: 10.1055/a-1400-3537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Radiosynoviorthesis (RSO) is a local radionuclide therapy of inflammatory joint diseases, successfully performed since several decades mainly as an outpatient-protocol in ambulatory health care centers or nuclear medicine practices. Despite of long-term experience in some centers, only very few valuable or comparable data about the procedure itself and/or the clinical results of this treatment are available. OBJECTIVES The aim of this online survey is to assess reliable data of the current status in Germany. MATERIALS AND METHODS A web-based questionnaire was designed to evaluate the status of RSO in Germany including demographic data, training, pretherapeutic diagnostics, clinical procedures, and follow-up. The survey was distributed via the supplier of RSO-nuclides, national nuclear medicine societies, and personal networks. It was available for 28 days and closed on November 30, 2020. RESULTS A total of 78 specialists in nuclear medicine answered the questionnaire, which corresponds to a response rate of 23 %. Several differences and concordances in pre-therapeutic diagnostics, in the procedure of RSO itself, and follow-up were documented in this survey for the first time. Most important, less than 70 nuclear medicine specialists in Germany perform more than 75 % of all RSO-procedures and most of them are older than 50 years of age. This implies the urgent need of a dedicated advancement of young academics in nuclear medicine and a professional advanced training in RSO to offer this beneficial treatment to future patients. CONCLUSIONS To achieve these goals, an association of RSO experts would be useful, through which, among other things, an RSO training curriculum is developed and theoretical and practical trainings are organized. Moreover, possible cooperation agreements between ambulant and inpatient institutions would foster the education of young nuclear medicine specialists interested in RSO.
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Affiliation(s)
| | - Rigobert Klett
- ÜBAG für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Gießen
| | - Manfred Fischer
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Kassel
| | | | - Gregor Tönshoff
- Röntgenpraxis Georgstraße, Radiologie und Nuklearmedizin, Hannover
| | - Norbert J Czech
- Zentrum für Nuklearmedizin und PET/CT Bremen im St.-Joseph-Stift, Bremen
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Abstract
AIM The study examines the influence of a radiosynoviorthesis of the knee joint on the Baker's cyst volume over time. METHODS Patients with radiosynoviorthesis of the knee joint with simultaneous Baker's cyst were retrospectively selected and asked for a sonographic control. The presence of a pre-therapeutic sonography with imaging of the Baker's cyst in longitudinal and cross-sectional view to determine the volume was necessary. Exclusion criterion was an intermediate therapy with influence on the volume of the Baker's cyst. Groups were formed with a time interval of 3 months (2 to 4 months, 5 to 7 months, etc.) after radiosynoviorthesis. If the number of patients within a group was too small, the group was combined with the following group. Pre- and posttherapeutic Baker's cyst volumes were compared. In 4 evaluable groups, the significance level was determined to p = 0.0125 using Bonferoni-correction. RESULTS 102 radiosynoviorthesis in 84 patients aged between 23 and 86 years could be evaluated. These could be assigned to groups with a distance to the radiosynoviorthesis of 2 to 4 months, 5 to 7 months, 8 to 16 months as well as 20 and more months. In group 1 the volume decreased by 53 % (p < 0.007), in group 2 by 47 % (p < 0.007), in group 3 by 18 % (p < 0.005) and in group 4 by 73 % (p < 0.0007). No serious complications occurred with any radiosynoviorthesis. CONCLUSION The study shows a positive effect of a radiosynoviorthesis on an existing Baker's cyst, even over a longer period of time. Therefore, it seems reasonable to establish radiosynoviorthesis as a component of a multimodal therapy, for example before surgical intervention.
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Affiliation(s)
- Rigobert Klett
- Überörtliche Berufsausübungsgemeinschaft für Nuklearmedizin, Hanau - Frankfurt - Offenbach - Gießen, Standort Gießen, Gießen, Germany.,Justus Liebig Universitat Giessen Fachbereich Medizin, Giessen, Hessen, Germany.,Professur für Manuelle Medizin und Nuklearmedizinische Schmerztherapie, University for Digital Technologies in Medicine and Dentistry, Wiltz, Luxembourg
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Kiltz U, Braun J, Becker A, Chenot JF, Dreimann M, Hammel L, Heiligenhaus A, Hermann KG, Klett R, Krause D, Kreitner KF, Lange U, Lauterbach A, Mau W, Mössner R, Oberschelp U, Philipp S, Pleyer U, Rudwaleit M, Schneider E, Schulte TL, Sieper J, Stallmach A, Swoboda B, Winking M. [Long version on the S3 guidelines for axial spondyloarthritis including Bechterew's disease and early forms, Update 2019 : Evidence-based guidelines of the German Society for Rheumatology (DGRh) and participating medical scientific specialist societies and other organizations]. Z Rheumatol 2020; 78:3-64. [PMID: 31784900 DOI: 10.1007/s00393-019-0670-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | | | - A Becker
- Allgemeinmedizin, präventive und rehabilitative Medizin, Universität Marburg, Karl-von-Frisch-Str. 4, 35032, Marburg, Deutschland
| | | | - J-F Chenot
- Universitätsmedizin Greifswald, Fleischmann Str. 6, 17485, Greifswald, Deutschland
| | - M Dreimann
- Zentrum für Operative Medizin, Klinik und Poliklinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Deutschland
| | | | - L Hammel
- Geschäftsstelle des Bundesverbandes der DVMB, Metzgergasse 16, 97421, Schweinfurt, Deutschland
| | | | - A Heiligenhaus
- Augenzentrum und Uveitis-Zentrum, St. Franziskus Hospital, Hohenzollernring 74, 48145, Münster, Deutschland
| | | | - K-G Hermann
- Institut für Radiologie, Charité Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | | | - R Klett
- Praxis Manuelle & Osteopathische Medizin, Fichtenweg 17, 35428, Langgöns, Deutschland
| | | | - D Krause
- , Friedrich-Ebert-Str. 2, 45964, Gladbeck, Deutschland
| | - K-F Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - U Lange
- Kerckhoff-Klinik, Rheumazentrum, Osteologie & Physikalische Medizin, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | | | - A Lauterbach
- Schule für Physiotherapie, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt, Deutschland
| | | | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland
| | - R Mössner
- Klinik für Dermatologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | | | - U Oberschelp
- , Barlachstr. 6, 59368, Werne a.d. L., Deutschland
| | | | - S Philipp
- Praxis für Dermatologie, Bernauer Str. 66, 16515, Oranienburg, Deutschland
| | - U Pleyer
- Campus Virchow-Klinikum, Charité Centrum 16, Klinik f. Augenheilkunde, Charité, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Rudwaleit
- Klinikum Bielefeld, An der Rosenhöhe 27, 33647, Bielefeld, Deutschland
| | - E Schneider
- Abt. Fachübergreifende Frührehabilitation und Sportmedizin, St. Antonius Hospital, Dechant-Deckersstr. 8, 52249, Eschweiler, Deutschland
| | - T L Schulte
- Klinik für Orthopädie und Unfallchirurgie, Orthopädische Universitätsklinik, Ruhr-Universität Bochum, Gudrunstr. 65, 44791, Bochum, Deutschland
| | - J Sieper
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07743, Jena, Deutschland
| | | | - B Swoboda
- Abteilung für Orthopädie und Rheumatologie, Orthopädische Universitätsklinik, Malteser Waldkrankenhaus St. Marien, 91054, Erlangen, Deutschland
| | | | - M Winking
- Zentrum für Wirbelsäulenchirurgie, Klinikum Osnabrück, Am Finkenhügel 3, 49076, Osnabrück, Deutschland
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Klett R, Beyer L, Ehlenbeck S. Manuelle Medizin – vielseitig, umfassend und praxisorientiert in die Zukunft. Manuelle Medizin 2020. [DOI: 10.1007/s00337-019-00639-4] [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] [Indexed: 11/28/2022]
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Schenke S, Klett R, Seifert P, Kreissl MC, Görges R, Zimny M. Diagnostic Performance of Different Thyroid Imaging Reporting and Data Systems (Kwak-TIRADS, EU-TIRADS and ACR TI-RADS) for Risk Stratification of Small Thyroid Nodules (≤10 mm). J Clin Med 2020; 9:jcm9010236. [PMID: 31963140 PMCID: PMC7019412 DOI: 10.3390/jcm9010236] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Received: 12/03/2019] [Revised: 12/30/2019] [Accepted: 01/10/2020] [Indexed: 12/18/2022] Open
Abstract
Due to the widespread use of ultrasound, small thyroid nodules (TNs) ≤ 10 mm are common findings. Standardized approaches for the risk stratification of TNs with Thyroid Imaging Reporting and Data Systems (TIRADS) were evaluated for the clinical routine. With TIRADS, the risk of malignancy in TNs is calculated by scoring the number or combination of suspicious ultrasound features, leading to recommendations for further diagnostic steps. However, there are only scarce data on the performance of TIRADS for small TNs. The aim was to compare three different TIRADS for risk stratification of small TNs in routine clinical practice. We conducted a retrospective cohort analysis of TNs ≤ 10 mm and their available histology. Nodules were classified according to three different TIRADS. In the study, 140 patients (n = 113 female) with 145 thyroid nodules (n = 76 malignant) were included. Most of the malignant nodules were papillary carcinoma (97%), and the remaining 3% were medullary carcinoma. For all tested TIRADS, the prevalence of malignancy rose with increasing category levels. The highest negative predictive value was found for ACR TI-RADS and the highest positive predictive value for Kwak-TIRADS. All tested variants of TIRADS showed comparable diagnostic performance for the risk stratification of small TNs. TIRADS seems to be a promising tool to reliably assess the risk of malignancy of small TNs.
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Affiliation(s)
- Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
- Correspondence: ; Tel.: +49-391-671-3000
| | - Rigobert Klett
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Am Klinikum 1 A4U1, 07740 Jena Lobeda-Ost, Germany;
| | - Michael C. Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital, Leipziger Straße 44, 39120 Magdeburg, Germany;
| | - Rainer Görges
- Department of Nuclear Medicine, Essen University Hospital, Hufelandstraße 55, 45122 Essen, Germany;
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau/Giessen/Offenbach/Frankfurt, Paul-Zipp-Straße 171, 35398 Gießen, Germany; (R.K.); (M.Z.)
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Schenke S, Klett R, Acker P, Rink T, Kreissl MC, Zimny M. Interobserver Agreement of Planar and SPECT Tc99m-MIBI Scintigraphy for the Assessment of Hypofunctioning Thyroid Nodules. Nuklearmedizin 2019; 58:258-264. [DOI: 10.1055/a-0894-4843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Introduction Thyroid scintigraphy with 99mTc-methoxyisobutylisonitrile (MIBI) is a helpful tool for the risk stratification of thyroid nodules (TN). Whereas a nodule with low or hypointense MIBI uptake has a low risk for malignancy, a hyperintense uptake may indicate a malignant nodule, which requires surgical resection. The appropriate diagnostic or therapeutic regimen of an isointense nodule with an uptake similar to the paranodular tissue is discussed controversially. Aim of this study was to assess the interobserver agreement (IA) for the assignment of TN to the three categories: hypo-, iso-or hyperintense.
Methods Retrospective analysis of planar and SPECT images of MIBI scintigraphy was performed in 36 randomly selected patients with hypofunctioning TN and histological diagnosis. Four observers with different levels of experience in MIBI-scintigraphy analyzed MIBI uptake and assigned the nodules to the appropriate category. To assess the IA, Fleiss‘ Kappa was calculated.
Results The study cohort included 11 patients with papillary thyroid carcinoma (diameter 20.3 mm) and 25 patients with benign nodules (diameter 24.8 mm). The IA for all nodules using planar images was 0.76 compared to 0.80 for SPECT images. The IA was better in the subgroup of malignant nodules for planar images as well as SPECT images (Kappa 0.91 and 0.90, respectively) compared to benign nodules (0.65 and 0.76, respectively). Using SPECT images, only one thyroid carcinoma presented with hypointense uptake, the remainder with hyper- or isointense uptake. In contrast, benign nodules were found in all categories.
Conclusion MIBI scintigraphy shows a good IA for the interpretation of thyroid carcinoma. The IA is further improved if MIBI scintigraphy is performed in SPECT technique.
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Affiliation(s)
- Simone Schenke
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital
- Institute for Nuclear Medicine Hanau/Gießen/Offenbach/Frankfurt
| | - Rigobert Klett
- Institute for Nuclear Medicine Hanau/Gießen/Offenbach/Frankfurt
| | - Peter Acker
- Institute for Nuclear Medicine Hanau/Gießen/Offenbach/Frankfurt
| | - Thomas Rink
- Institute for Nuclear Medicine Hanau/Gießen/Offenbach/Frankfurt
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Magdeburg University Hospital
| | - Michael Zimny
- Institute for Nuclear Medicine Hanau/Gießen/Offenbach/Frankfurt
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Klett R. Neue Muster-Weiterbildungsordnung – manuelle Medizin, quo vadis? Manuelle Medizin 2018. [DOI: 10.1007/s00337-018-0448-8] [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] [Indexed: 10/28/2022]
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Abstract
Summary:Radiosynoviorthesis (RSO) with the β-particle-emitting nuclide yttrium-90 is an established concept for the treatment of persistent synovitis of the knee joint. The aim of this study was to investigate the biological radiation effect on the basis of a characteristic radiation parameter. Patients, methods: After RSO procedures with yttrium-90 citrate colloid and subsequent immobilisation of the knee, blood specimens of 10 patients were collected immediately before RSO and 11 to 13 days after the intervention. The yield of dicentric chromosomes in the lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, activity leakage was measured by wholebody bremsstrahlung-scintigraphy. Results: No statistically significant increase in the number of dicentric chromosomes (26 before treatment and 34 after treatment) in 20 192 cells analyzed from the 20 blood samples could be found as a result of RSO. However, the analysis of at least 1000 cells per blood sample demonstrates a tendency for a biological radiation effect in the blood of patients on the basis of this characteristic radiation parameter. Two of the 10 RSO patients had undergone a second RSO using yttrium- 90 citrate, whereby one patient displayed activity transport out of the knee joint, amounting to 6 MBq. Only for him a radiation effect (about 130 mGy per single RSO) could be calculated by biological dosimetry. Conclusion: Since in general, based on the analysis of dicentric chromosomes in at least 1000 lymphocytes per individual, detection limits for groups of persons after long-term exposures to low-LET radiation of 50-100 mGy are possible, we assume that RSO with yttrium-90 should be associated with a low whole-body radiation exposure.
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Klett R. Der neue DGMM-Präsident stellt sich vor. Manuelle Medizin 2017. [DOI: 10.1007/s00337-017-0265-5] [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] [Indexed: 11/24/2022]
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Schenke S, Zimny M, Rink T, Stahl U, Fritzel M, Klett R. [99mTc-MIBI scintigraphy of hypofunctional thyroid nodules. Comparison of planar and SPECT imaging]. Nuklearmedizin 2014; 53:105-10. [PMID: 24510009 DOI: 10.3413/nukmed-0619-13-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/23/2014] [Indexed: 11/20/2022]
Abstract
UNLABELLED 99mTc-MIBI-scintigraphy allows to assess the dignity of hypofunctional thyroid nodules. A concordant pattern in MIBI- and pertechnetate-scintigraphy excludes malignancy with high accuracy. For increased MIBI-uptake histological evaluation is advised. The assessment of MIBI-isointense nodules is discussed controversially. Objective of our study was to analyse the prevalence of malignancy for isointense nodules and the diagnostic accuracy of image acquisition in SPECT-technique. PATIENTS, METHODS MIBI-scintigraphies were analysed retrospectively. Imaging was performed 60 min after intravenous injection of 510 MBq 99mTc-MIBI. Thyroid nodules were assessed as hypo-, iso- or hyperintense compared to the paranodular tissue. RESULTS 83 of 225 patients underwent thyroid surgery (age 48.6 ± 12.6 years, 72% women). In 12 (14.5%) cases a papillary carcinoma was diagnosed. In planar imaging 12, 34 and 37, in tomographical imaging 16, 21 and 46 nodules, respectively, were classified as hypo-, iso- oder hyperintense. Among hypo-, iso- and hyperintense nodules in planar imaging 1, 5 and 6 carcinomas were found, resp. In tomographical imaging no, 4 and 8 carcinomas were found, respectively. Classification of iso- and hyperintense nodules as "suspicious for malignancy" showed for planar imaging a sensitivity, specificity, NPV and PPV of 91.7, 15.5, 91.7 and 15.6%, for tomographical imaging of 100, 22.5, 100 and 17.9%, respectively. CONCLUSION Hypofunctional thyroid nodules with iso- and hyperintense MIBI-Uptake have a comparable prevalence of malignancy. Image acquisition in SPECT-technique results in improved diagnostic sensitivity and negative predictive value.
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Affiliation(s)
- S Schenke
- Dr. med. Simone Schenke, ÜBAG für Nuklearmedizin Hanau Leimenstr. 20, 63450 Hanau, E-Mail:
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Schenke S, Klett R, Braun S, Zimny M. Thyroiditis de Quervain. Are there predictive factors for long-term hormone-replacement? Nuklearmedizin 2013; 52:137-40. [PMID: 23653018 DOI: 10.3413/nukmed-0536-12-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 04/08/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Subacute thyroiditis is a usually self-limiting disease of the thyroid. However, approximately 0.5-15% of the patients require permanent thyroxine substitution. Aim was to determine predictive factors for the necessity of long-term hormone-replacement (LTH). PATIENTS, METHODS We retrospectively reviewed the records of 72 patients with subacute thyroiditis. Morphological and serological parameters as well as type of therapy were tested as predictive factors of consecutive hypothyroidism. RESULTS Mean age was 49 ± 11 years, f/m-ratio was 4.5 : 1. Thyroid pain and signs of hyperthyroidism were leading symptoms. Initial subclinical or overt hyperthyroidism was found in 20% and 37%, respectively. Within six months after onset 15% and 1.3% of the patients developed subclinical or overt hypothyroidism, respectively. At latest follow-up 26% were classified as liable to LTH. At onset the thyroid was enlarged in 64%, and at latest follow-up in 8.3%, with a significant reduction of the thyroid volume after three months. At the endpoint the thyroid volume was less in patients in the LTH group compared with the non-LTH group (41.7% vs. 57.2% of sex-adjusted upper norm, p = 0.041). Characteristic ultrasonographic features occurred in 74% of the patients in both lobes. Serological and morphological parameters as well as type of therapy were not related with the need of LTH. CONCLUSIONS In this study the proportion of patients who received LTH was 26%. At the endpoint these patients had a lower thyroid volume compared with euthyroid patients. No predictive factors for LTH were found.
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Affiliation(s)
- S Schenke
- Department of Nuclear Medicine, Klinikum Hanau, Germany.
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Klett R, Schnurbus-Duhs A, Mödder G, Schmid E, Voth M. Biological dosimetry after radiosynoviorthesis with rhenium-186 sulphide and erbium-169 citrate. Nuklearmedizin 2011; 51:17-25. [PMID: 21931934 DOI: 10.3413/nukmed-0423-11-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 09/05/2011] [Indexed: 11/20/2022]
Abstract
UNLABELLED Radiosynoviorthesis (RSO) with the nuclides rhenium-186 sulphide (186Re) and erbium-169 citrate (169Er) is an established concept for the treatment of persistent synovitis of medium and small sized joints. THE AIM of the present studies was to investigate the biological radiation effect based on analysing chromosome aberrations. PATIENTS, METHODS Immediately before and 17 to 19 days (186Re) or 45 to 50 (169Er) days after RSO with 186Re or 169Er colloid and subsequent immobilisation of the treated joint, blood samples of a total of 23 patients were collected. The yield of dicentric chromosomes in lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, for 186Re the activity leakage was measured three days after RSO by whole-body scintigraphy. RESULTS No statistically significant increase in the number of dicentric chromosomes (40 and 88 before and 59 and 105 after treatment with 186Re and 169Er, respectively) in a total of 47017 cells analysed from 46 blood samples could be found as a result of RSO. For 186Re an activity leakage of 3.9%±7% with a maximum of 23.4% corresponding to an effective dose of 2.8±4.5 mSv , respectively 13.8 mSv, was determined. Also in the case of the maximum leakage no significant increase of dicentric chromosomes were detected. CONCLUSIONS No significant biological radiation effect can be detected after RSO with 186Re and 169Er, also in cases of high leakage. Therefore, RSO can be classified as a save therapeutic procedure without a relevant radiation risk.
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Affiliation(s)
- R Klett
- Nuclear medicine practice, Paul-Zipp-Strasse 171-173, 35398 Giessen, Germany.
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Schlechter BL, Larson PS, Yang Q, Klett R, Armstong K, de las Morenas A, Rosenberg CL. Value of quantitative DNA fingerprinting in classification of second breast tumors and association with outcome. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10552] [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] [Indexed: 11/20/2022] Open
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Busemann Sokole E, Płachcínska A, Britten A, Lyra Georgosopoulou M, Tindale W, Klett R. Routine quality control recommendations for nuclear medicine instrumentation. Eur J Nucl Med Mol Imaging 2010; 37:662-71. [DOI: 10.1007/s00259-009-1347-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Klett R, Steiner D, Laurich S, Bauer R, Kordelle J. Evaluation of aseptic loosening of knee prostheses by quantitative bone scintigraphy. Nuklearmedizin 2008; 47:163-6. [PMID: 18690376 DOI: 10.3413/nukmed-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED In not infected knee prostheses bone scintigraphy is a possible method to diagnose mechanical loosening, and therefore, to affect treatment regimes in symptomatic patients. However, hitherto studies showed controversial results for the reliability of bone scintigraphy in diagnosing loosened knee prostheses by using asymptomatic control groups. Therefore, the AIM of our study was to optimize the interpretation procedure and to evaluate the accuracy using results from revision surgery as standard. METHODS Retrospectively, we were able to examine the tibial component in 31 cemented prostheses. In this prostheses infection was excluded by histological or bacteriological examination during revision surgery. To quantify bone scintigraphy, we used medial and lateral tibial regions with a reference region from the contralateral femur. RESULTS To differentiate between loosened and intact prostheses we found a threshold of 5.0 for the maximum tibia to femur ratio of the both tibial regions and a threshold of 18% for the difference of the ratio of both tibial regions. Using these thresholds, values of 0.9, 1, 0.85, 1, and 0.94 were calculated for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy, respectively. To get a sensitivity of 1, we found a lower threshold of 3.3 for the maximum tibia to femur ratio. CONCLUSION Quantitative bone scintigraphy appears to be a reliable diagnostic tool for aseptic loosening of knee prostheses with thresholds evaluated by revision surgery results being the golden standard.
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Affiliation(s)
- R Klett
- Clinic of Nuclear Medicine, University Hospital Giessen and Marburg, Friedrichstrasse 25, Giessen, Germany.
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Klett R, Lange U, Haas H, Voth M, Pinkert J. Radiosynoviorthesis of medium-sized joints with rhenium-186-sulphide colloid: a review of the literature. Rheumatology (Oxford) 2007; 46:1531-7. [PMID: 17596287 DOI: 10.1093/rheumatology/kem155] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 11/12/2022] Open
Abstract
Hypertrophy and inflammation of the synovium with various underlying pathologies - such as rheumatoid arthritis, osteoarthritis, haemophilia and spondyloarthropathy - can be treated successfully by radiosynoviorthesis (RSO). For medium-sized joints (shoulder, elbow, wrist, hip and ankle), the radionuclide of choice is rhenium-186. We review the evidence for the efficacy of this local, relatively non-invasive therapy and evaluate its benefits and risks. We conclude good evidence of rhenium-186 RSO in rheumatoid arthritis and haemophilic arthropathy. In the remaining pathologies, up to now, the therapeutic efficacy has not been confirmed by today's most stringent criteria for clinical studies. The available data support rhenium-186 RSO as a suitable second-line treatment for patients in whom other therapies (including locally injected corticoids) have failed, as long as proper attention is paid to correct administration - including post-treatment immobilization and the co-administration of corticoids.
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Affiliation(s)
- R Klett
- Department of Nuclear Medicine, University Hospital Giessen and Marburg, Giessen, Germany.
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Csoti I, Fornadi F, Klett R, Puille M, Bauer R. Experiences with DaTSCAN™ SPECT in the clinical practice in our Parkinson-Center. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hackstein N, Buch T, Rau WS, Weimer R, Klett R. Split renal function measured by triphasic helical CT. Eur J Radiol 2007; 61:303-9. [PMID: 17011152 DOI: 10.1016/j.ejrad.2006.09.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [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: 04/06/2006] [Revised: 08/26/2006] [Accepted: 09/01/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE To present a method for calculating split renal function solely from routine triphasic helical computed tomography (CT). SUBJECTS AND METHODS We retrospectively included 26 adult patients who received renal scintigraphy and triphasic CT within 4 weeks in the years 2003 and 2004. All scans were performed using a standard abdominal protocol. Split renal function was calculated as relative single-kidney glomerular filtration rate (GFR) using a simplified "two-point Patlak plot" technique. As a reference method, split renal function was determined from renal scintigraphy using the standard technique. RESULTS Linear correlation between the two methods was r=0.91, split renal function (CT)=0.0266+0.9573 x split renal function (scintigraphy). CONCLUSION Split renal function can be measured accurately by minimally extended triphasic CT.
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Affiliation(s)
- Nils Hackstein
- Radiologische Gemeinschaftspraxis am Evangelischen Krankenhaus, Paul-Zipp-Str. 171, 35398 Giessen, Germany.
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Schmid E, Selbach HJ, Voth M, Pinkert J, Gildehaus FJ, Klett R, Haney M. The effect of the beta-emitting yttrium-90 citrate on the dose-response of dicentric chromosomes in human lymphocytes: a basis for biological dosimetry after radiosynoviorthesis. Radiat Environ Biophys 2006; 45:93-8. [PMID: 16733726 DOI: 10.1007/s00411-006-0045-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Accepted: 03/29/2006] [Indexed: 05/09/2023]
Abstract
The production of dicentric chromosomes in human lymphocytes by beta-particles of yttrium-90 (Y-90) was studied in vitro to provide a basis of biological dosimetry after radiosynoviorthesis (RSO) of persistent synovitis by intra-articular administration of yttrium-90 citrate colloid. Since the injected colloid may leak into the lymphatic drainage exposing other parts of the body to radiation, the measurement of biological damage induced by beta-particles of Y-90 is important for the assessment of radiation risk to the patients. A linear dose-response relationship (alpha = 0.0229 +/- 0.0028 dicentric chromosomes per cell per gray) was found over the dose range of 0.2176-2.176 Gy. The absorbed doses were calculated for exposure of blood samples to Y-90 activities from 40 to 400 kBq using both Monte Carlo simulation and an analytical model. The maximum low-dose RBE, the RBE(M) which is equivalent to the ratio of the alpha coefficients of the dose-response curves, is well in line with published results obtained earlier for irradiation of blood of the same donor with heavily filtered 220 kV X-rays (3.35 mm copper), but half of the RBE(M) relative to weakly filtered 220 kV X-rays. Therefore, it can be concluded that for estimating an absorbed dose during RSO by the technique of biological dosimetry, in vitro and in vivo data for the same radiation quality are necessary.
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Affiliation(s)
- E Schmid
- Radiobiological Institute, University of Munich, Schillerstr. 42, 80336, Munich, Germany.
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Csoti I, Fornadi F, Klett R, Puille M, Bauer R. Experiences with DaTSCAN™ SPECT in the clinical practice in our Parkinson-Center. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939119] [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] [Indexed: 10/20/2022]
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Klett R, Puille M, Steiner D, Bauer R. [Radiation synovectomy of the knee joint: Evaluation of bremsstrahlung-detection by using a corpse phantom]. Nuklearmedizin 2006; 45:57-61. [PMID: 16493515 DOI: 10.1267/nukl06010057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM Multiple procedures for the quantification of activity leakage in radiation synovectomy of the knee joint have been described in the literature. We compared these procedures considering the real conditions of dispersion and absorption using a corpse phantom. METHODS We simulated different distributions of the activity in the knee joint and a different extra-articular spread into the inguinal lymph nodes. The activity was measured with a gamma-camera. Activity leakage was calculated by measuring the retention in the knee joint only using an anterior view, using the geometric mean of anterior and posterior views, or using the sum of anterior and posterior views. The same procedures were used to quantify the activity leakage by measuring the activity spread into the inguinal lymph nodes. In addition, the influence of scattered rays was evaluated. RESULTS For several procedures we found an excellent association with the real activity leakage, shown by an r(2) between 0.97 and 0.98. When the real value of the leakage is needed, e. g. in dosimetric studies, simultaneously measuring of knee activity and activity in the inguinal lymph nodes in anterior and posterior views and calculation of the geometric mean with exclusion of the scatter rays was found to be the procedure of choice. CONCLUSION When measuring of activity leakage is used for dosimetric calculations, the above-described procedure should be used. When the real value of the leakage is not necessary, e. g. for comparing different therapeutic modalities, several of the procedures can be considered as being equivalent.
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Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Universitätsklinikum Giessen und Marburg, Friedrichstrasse 25, 35385 Giessen.
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Voth M, Klett R, Lengsfeld P, Stephan G, Schmid E. Biological dosimetry after yttrium-90 citrate colloid radiosynoviorthesis. Nuklearmedizin 2006; 45:223-8. [PMID: 17043734] [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: 05/12/2023]
Abstract
UNLABELLED Radiosynoviorthesis (RSO) with the ss-particle-emitting nuclide yttrium-90 is an established concept for the treatment of persistent synovitis of the knee joint. The AIM of this study was to investigate the biological radiation effect on the basis of a characteristic radiation parameter. PATIENTS, METHODS After RSO procedures with yttrium-90 citrate colloid and subsequent immobilisation of the knee, blood specimens of 10 patients were collected immediately before RSO and 11 to 13 days after the intervention. The yield of dicentric chromosomes in the lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. In addition, activity leakage was measured by wholebody bremsstrahlung-scintigraphy. RESULTS No statistically significant increase in the number of dicentric chromosomes (26 before treatment and 34 after treatment) in 20 192 cells analyzed from the 20 blood samples could be found as a result of RSO. However, the analysis of at least 1000 cells per blood sample demonstrates a tendency for a biological radiation effect in the blood of patients on the basis of this characteristic radiation parameter. Two of the 10 RSO patients had undergone a second RSO using yttrium-90 citrate, whereby one patient displayed activity transport out of the knee joint, amounting to 6 MBq. Only for him a radiation effect (about 130 mGy per single RSO) could be calculated by biological dosimetry. CONCLUSION Since in general, based on the analysis of dicentric chromosomes in at least 1000 lymphocytes per individual, detection limits for groups of persons after long-term exposures to low-LET radiation of 50-100 mGy are possible, we assume that RSO with yttrium-90 should be associated with a low whole-body radiation exposure.
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Affiliation(s)
- M Voth
- Klinik für Nuklearmedizin, Universitätsklinikum Giessen und Marburg, Friedrichstrasse 25, 35385 Giessen, Germany
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Puille M, Steiner D, Bauer R, Klett R. Radiation synovectomy of the knee joint. Nuklearmedizin 2006. [DOI: 10.1055/s-0038-1623935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: Multiple procedures for the quantification of activity leakage in radiation synovectomy of the knee joint have been described in the literature. We compared these procedures considering the real conditions of dispersion and absorption using a corpse phantom. Methods: We simulated different distributions of the activity in the knee joint and a different extra-articular spread into the inguinal lymph nodes. The activity was measured with a gammacamera. Activity leakage was calculated by measuring the retention in the knee joint only using an anterior view, using the geometric mean of anterior and posterior views, or using the sum of anterior and posterior views. The same procedures were used to quantify the activity leakage by measuring the activity spread into the inguinal lymph nodes. In addition, the influence of scattered rays was evaluated. Results: For several procedures we found an excellent association with the real activity leakage, shown by an r² between 0.97 and 0.98. When the real value of the leakage is needed, e. g. in dosimetric studies, simultaneously measuring of knee activity and activity in the inguinal lymph nodes in anterior and posterior views and calculation of the geometric mean with exclusion of the scatter rays was found to be the procedure of choice. Conclusion: When measuring of activity leakage is used for dosimetric calculations, the above-described procedure should be used. When the real value of the leakage is not necessary, e. g. for comparing different therapeutic modalities, several of the procedures can be considered as being equivalent.
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Abstract
OBJECTIVE To evaluate the effect of dose rate on the therapeutic success of radioiodine therapy (RIT) by retrospective analysis of two groups of patients with different dose rates during RIT. METHODS The average dose rate until deposition of 50% of the total radiation dose achieved (the DL50 value) was calculated. Ninety patients with autonomy of the thyroid receiving radiation doses between 300 and 400 Gy were separated in groups with high DL50 values (the DL50 H group) and low DL50 values (the DL50L group). Before and 4 months after RIT free triiodothyronine (FT3), free thyroxine (FT4), basal thyroid stimulating hormone (TSHB), stimulated TSH (TSHS), thyroidal technetium uptake (TcTU), and the existence of focal abnormalities in thyroid scintigraphy were evaluated. RESULTS The DL50 H and DL50L groups showed no differences before RIT in the parameters assessed as well as in total achieved dose and autonomous thyroid volume. After therapy a significant difference was found in TSHB with higher values in DL50 H (1.89+/-1.49 vs. 1.31+/-1.48 mU . l, P<0.05), FT4 showed a trend to lower values (13.8+/-4.0 vs. 16.1+/-6.2 pmol . l, P=0.09). CONCLUSION The DL50 value has an influence on therapeutic success of RIT. This influence is only discrete and not likely to produce clinically relevant effects in the practical use of RIT.
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Affiliation(s)
- Max Puille
- Clinic for Nuclear Medicine, Justus Liebig University, Giessen, Germany.
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Abstract
AIM In this study, the accuracy of antigranulocyte scintigraphy as a diagnostic means prior to revision in infected total knee replacement was compared to that of preoperative joint aspiration and laboratory parameters. The most efficient combination of all diagnostic methods was calculated and thus a diagnostic algorithm recommended. The value of PCR was compared to commonly used techniques of microbiological culturing. METHODS Preoperative diagnostic means for infection of 50 total knee replacements in 45 patients requiring revision surgery, were retrospectively analyzed. Inclusion criteria were the intraoperative microbiological and histological verification of infection. Sensitivity, specificity, negative and positive prediction value of C-reactive protein (CRP) and leukocytes, antigranulocyte scintigraphy with (99m)Tc-labeled antibodies, and preoperative joint aspiration were calculated. Furthermore, the accuracy of the different techniques of culturing was compared to that of the polymerase chain reaction (PCR) based on the intraoperative histological findings. Two blinded examiners evaluated specimens taken intraoperatively according to the criteria of Mirra. RESULTS We observed a sensitivity of 1.0, a specificity of 0.82, a positive prediction value of 0.83 and a negative prediction value of 1.0 for the antigranulocyte scintigraphy. The sensitivity of preoperative joint aspiration was 0.5, the specificity 1.0, and the positive and negative prediction values were 1.0 and 0.5. Correlated to the intraoperative histological findings the accuracy of PCR and culturing was comparable. The highest accuracy was obtained for blood culture samples. CONCLUSION Compared to preoperative joint aspiration the antigranulocyte scintigraphy proved to be more sensitive in the diagnosis an infected knee replacement while having a high specificity. An advantage of PCR compared to the common microbiological culturing techniques was not observed.
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Affiliation(s)
- J Kordelle
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Giessen.
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Bena-Boupda NF, Rezai SS, Klett R, Eigenbrodt E, Bauer R. Value of tumor M2-PK in thyroid carcinoma: a pilot study. Anticancer Res 2003; 23:5237-40. [PMID: 14981996] [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: 04/29/2023]
Abstract
BACKGROUND Tumor M2-PK (Tu M2-PK) as the inactive dimeric form of pyruvate kinase M2 has been proven to be elevated in breast, lung, renal and gastrointestinal malignancies. We compared this marker in 26 patients with metastatic thyroid carcinoma using the established tumor marker thyroglobulin (Tg). MATERIALS AND METHODS Plasma Tu M2-PK was measured using an ELISA assay (Schebo Biotech, Giessen, Germany) and Tg was measured in serum using an electrochemiluminescence Immunoassay (Tg Elecsys Systems, Roche, Germany), as a part of the routine follow-up of the patients. RESULTS At a cut-off of 15 U/ml, Tu M2-PK was elevated in 50% of the patients; at a cut-off of 20 U/ml (grey zone 15-20 U/ml), Tu M2-PK was elevated in 27% of the patients. The correlation coefficient between serum Tg level and Tu M2-PK was -0.093. CONCLUSION Tu M2-PK is less valuable for the detection of malignant thyroid disease than Tg.
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Affiliation(s)
- Nicole Françoise Bena-Boupda
- Klinik fuer Nuklearmedizin, Medizinisches Zentrum fuer Radiologie, Universitaetsklinikum Giessen, Friedrichstrasse 25, 35385 Giessen, Germany.
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Kordelle J, Klett R, Stahl U, Sternkopf U, Haas H, Jürgensen I, Schleicher I. Stufendiagnostik bei postinfektiöser Hüft- und Knie-TEP-Implantation: Aussagekraft von Laborparametern und Antigranulozytenszintigraphie. ACTA ACUST UNITED AC 2003; 141:547-53. [PMID: 14551841 DOI: 10.1055/s-2003-42838] [Citation(s) in RCA: 4] [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: 10/27/2022]
Abstract
AIM In the case of two-stage infect revision arthroplasties of hip and knee joint, of primary resection arthroplasties and before implantation of arthroplasties after septic arthritis the accuracy of preoperative laboratory parameters and antigranulocyte scintigraphy was analysed. Furthermore, we stained the intraoperatively taken joint synovial samples with hematoxylin-eosin and also with antibodies against human neutrophil elastase in order to investigate if immunohistological examination provides further or different information. METHOD In 24 patients with intraoperative verification of infection we calculated sensitivity, specificity, positive and negative predictive values for laboratory tests, antigranulocyte scintigraphy and the most suitable combination of both. The joint synovial samples stained with antibodies against human neutrophil elastase were compared to those stained with hematoxylin-eosin according to the criteria of Mirra. RESULTS We observed the best results for the combination of C-reactive protein and antigranulocyte scintigraphy with a sensitivity of 1, a specificity of 0.92, a positive predictive value of 0.75 and a negative predictive value of 1. No additional or different information was observed by the immunohistological stained samples. CONCLUSION Stage diagnostic using C-reactive protein and antigranulocyte scintigraphy provides accurate information to assess the status of infection before hip and knee replacement after infect revision. Additional immunohistological staining besides the routinely taken hematoxylin-eosin staining of joint synovial samples is not recommended.
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Affiliation(s)
- J Kordelle
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum Giessen.
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Klett R, Kordelle J, Stahl U, Khalisi A, Puille M, Steiner D, Bauer R. Immunoscintigraphy of septic loosening of knee endoprosthesis: a retrospective evaluation of the antigranulocyte antibody BW 250/183. Eur J Nucl Med Mol Imaging 2003; 30:1463-6. [PMID: 14579084 DOI: 10.1007/s00259-003-1275-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2003] [Accepted: 06/27/2003] [Indexed: 12/23/2022]
Abstract
Immunoscintigraphy with the use of the antigranulocyte antibody BW 250/183 is a reliable method for detecting infection, especially in septic loosening of hip prostheses, for which purpose quantitative interpretation of the time-activity course is employed. Therefore, we retrospectively studied whether similar results could be achieved in knee prostheses. We verified 28 scintigraphic examinations in 26 patients by histology. Scintigraphy was performed during an early (4-6 h post injection) and a late phase (23-25 h post injection). Infection was diagnosed when activity around the knee prosthesis increased by more than 10% compared with bone marrow. We found a sensitivity and a negative predictive value of 100%, a specificity of 80%, a positive predictive value of 81% and an accuracy of 89%. Specificity and accuracy are lower than in the evaluation of hip prostheses; however, in comparison to other scintigraphic modalities, scintigraphy with the antigranulocyte antibody BW 250/183 is superior in excluding infection and has better specificity and accuracy. Therefore, as in the case of hip prostheses, the described methodology appears to be the scintigraphic modality of choice for knee prostheses.
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Affiliation(s)
- Rigobert Klett
- Clinic of Nuclear Medicine, University Hospital Giessen, Friedrichstrasse 25, 35385, Giessen, Germany.
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Klett R, Matter HP, Gerdesmeyer L, Mittelmeier W, Bauer R. [Radiosynoviorthesis in active arthrosis. Will radiotherapy eliminate joint pain?]. MMW Fortschr Med 2003; 145:50-1. [PMID: 12652826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Universitätsklinikum Giessen, Friedrichstr. 25, D-35385 Giessen.
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Steiner D, Klett R, Puille M, Doppl W, Bauer R. Diagnosis of focal nodular hyperplasia with hepatobiliary scintigraphy using a modified SPECT technique. Clin Nucl Med 2003; 28:136-7. [PMID: 12544136 DOI: 10.1097/01.rlu.0000048512.77895.2f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dagmar Steiner
- Department of Nuclear Medicine, Justus-Liebig University, Giessen, Germany.
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40
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Klett R, Khalisi A, Haas H, Puille M, Steiner D, Stürz H, Bauer R. [Staged diagnosis of septic hip endoprosthesis loosening with laboratory parameters and antigranulocyte scintigraphy]. Z Orthop Ihre Grenzgeb 2001; 139:415-9. [PMID: 11605293 DOI: 10.1055/s-2001-17984] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The value of serial diagnosis of septic loosening of hip endoprosthesis using laboratory parameters and antigranulocytes scintigraphy was investigated and compared to joint aspiration. METHOD In 35 patients with intraoperative verification of infection, we calculated sensitivity, specify and prevalence dependent positive and negative predictive values for antigranulocyte scintigraphy, laboratory tests and the most suitable combination of both. We also calculated predictive values of joint aspiration using sensitivity and specify values given in the literature. RESULTS From negative and positive predictive values, of the sedimetation rate and leukocyte count provided no increase of information. We found the same result for positive predictive values of C-reactive protein. For antigranulocyte scintigraphy alone, we found a distinct but still unsatisfying increase of information. Nevertheless, in both cases infection could be excluded definitely. Therefore, the combination of C-reactive protein and antigranulocyte scintigraphy was suitable and the positive predictive values of this combination were only about 5% lower than those of joint aspiration. But with joint aspiration, infection could not be excluded. CONCLUSION A positive result in serial diagnosis using C-reactive protein and antigranulocyte scintigraphy leads to an distinct increase in the probability of infection which is comparable to that of joint aspiration. The additional advantages of this procedure are the certain exclusion of infection and the absence of invasiveness.
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Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Universitätsklinikum Giessen.
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Leweke F, Milch W, Brosig B, Hornig CR, Klett R, Reimer C. [A patient with Gulf war syndrome. On discussion of an uncertain disease picture]. Nervenarzt 2001; 72:541-5. [PMID: 11478226 DOI: 10.1007/s001150170079] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Gulf War syndrome represents neurological and neuropsychological disorders in veterans of the Persian Gulf war. Until today, the various symptoms observed could not be attributed to any defined disease. As a possible cause, exposure to neurotoxic agents such as the organophosphates used during the war has been suggested by many authors. We report on a 29-year-old man who suffered from dysmnesia, disturbance of orientation, cognitive impairment, and double vision. His history revealed several front-line operations in 1990 and 1991 during the Gulf War. Physical examinations showed a complex eye-movement disturbance and a horizontal nystagmus, which was neuro-ophthalmologically confirmed. The early auditory potentials referred to a brainstem dysfunction and the cognitive disturbances correlated to changes in the late-appearing component of event-related potentials (P 300). Brain imaging with CCT, MRI, SPECT, PET, and EEG and CSF showed no pathologies. Neuropsychological tests disclosed severe cognitive impairment especially concerning memory. Three-month follow-up studies in a department of psychosomatic medicine excluded a dissociative disorder as a feature of a post-traumatic stress or a conversion disorder. This is the first case of Gulf War syndrome in Germany. We focus on an unfamiliar complication after the war. The recent literature is reviewed.
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Affiliation(s)
- F Leweke
- Klinik für Psychosomatik und Psychotherapie der Justus-Liebig-Universität Giessen
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Klett R, Steiner D, Puille M, Khalisi A, Matter HP, Stürz H, Bauer R. [Antigranulocyte scintigraphy of septic loosening of hip endoprosthesis: effect of different methods of analysis]. Nuklearmedizin 2001; 40:75-9. [PMID: 11475076] [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: 02/20/2023]
Abstract
AIM Diagnosis of infection with help of antigranulocyte scintigraphy near body stem is difficult because of contemporary visualisation of bone marrow. Therefore, we investigated, whether it is possible to improve the accuracy in diagnosing septic loosening of hip endoprosthesis by changing the analyzing methods. METHODS In 28 patients, the results of a visual interpretation of late scan, a visual interpretation and a quantitative interpretation of time-activity-course were compared. These results were verified by histology respectively microbiology. RESULTS Histological and microbiological verification found 14 septic loosening and 14 aseptic loosening of the hip prothesis. Therefore, sensitivity, specificity, negative and positive predictive value for the visual interpretation of late scan were 0.86, 0.57, 0.80 and 0.67. For visual and quantitative interpretation of time-activity-course we found 0.86, 0.79, 0.85 and 0.80 respectively 1, 0.93, 1, 0.93. For interobserver agreement we found kappa coefficients of 0.28 +/- 0.2 for visual interpretation of late scan, 0.48 +/- 0.17 for visual interpretation and 1.0 +/- 0 for quantitative interpretation of time-activity-course. CONCLUSION In all investigated values quantitative interpretation of time-activity-course was superior to the other analyzing methods. Therefore, antigranulocyte scintigraphy for septic loosening of hip endoprosthesis should be interpreted quantitatively.
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Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Justus-Liebig-Universität Giessen, Deutschland.
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Klett R, Grau K, Puille M, Matter HP, Lange U, Steiner D, Bauer R. Comparison of HIG scintigraphy and bloodpool scintigraphy using HDP in arthritic joint disease. Nuklearmedizin 2000; 39:33-7. [PMID: 10726255] [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: 02/15/2023]
Abstract
AIM Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients. METHODS In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues. RESULTS In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 x 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 x 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated. CONCLUSION This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and lower cost, investigation of synovitis should be performed by bloodpool scintigraphy.
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Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Klinikum der Justus-Liebig-Universität Giessen, Deutschland
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Grau K, Puille M, Matter HP, Lange U, Steiner D, Bauer R, Klett R. Comparison of HIG Scintigraphy and Bloodpool Scintigraphy Using HDP in Arthritic Joint Disease. Nuklearmedizin 2000. [DOI: 10.1055/s-0038-1632240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Aim: Because of a similar tracer accumulation, we assumed to get the same information about synovitis in arthritic joint disease with HIG scintigraphy and bloodpool scintigraphy using HDP. Therefore, we compared retrospectively 23 patients. Methods: In HIG scintigraphy, synovitis was diagnosed according to increasing activity from early to late image. In bloodpool scintigraphy according to an increased activity in comparison to the surrounding tissues. Results: In 694 joints comparison of both scintigraphic modalities was possible, resulting in a 2 × 2 kappa coefficient of 0.93 or 0.97 by using late-phase bone scintigraphy as an anatomical marker. For intra- and interobserver agreement, 2 × 2 kappa coefficients of 0.93 and 0.88 in HIG scintigraphy, respectively 0.96 and 0.90 in blood-pool scintigraphy were calculated. Conclusion: This study shows an excellent agreement in the visualization of synovitis by HIG and bloodpool scintigraphy. Because of its higher objectivity and lower cost, investigation of synovitis should be performed by bloodpool scintigraphy.
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Lange U, Boss B, Teichmann J, Klett R, Stracke H, Bretzel RG, Neeck G. Thyroid disorders in female patients with ankylosing spondylitis. Eur J Med Res 1999; 4:468-74. [PMID: 10585302] [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: 02/14/2023] Open
Abstract
The association between rheumatological and thyroid disorders has long been known, the most common being the association of rheumatoid arthritis and autoimmune thyroiditis. Little is known as to possible thyroid involvement in ankylosing spondylitis (AS). In 22 female patients with AS and 22 healthy age-matched control subjects parameters of thyroid gland function, rheumatic activity, as well as a subtle drug anamnesis of the rheumatic medication, and an ultrasonographic examination of the thyroid gland were determined. Thyroid function was tested by intravenous injection of 400 microg thyrotropin-releasing hormone (TRH). In parallel basal levels of reverse-T3 (rT3), calcium and anti-thyroid antibodies were estimated. In the AS-group an enlarged thyroid volume was seen in 10 cases, basal FT4, FT3 and TT3 were significantly lower, TSH and TT4 were found to be in the normal range and rT3 was significantly increased. The prevalence of anti-thyroid antibodies was significantly higher in the AS-group. The AS-patients responded as well as the controls with thyroid hormone secretion to TRH, within an observation period of 2 hours. No differences were observed in TSH response. Free serum calcium showed in both groups no significant difference. To summarize our results, female patients with AS showed a
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Affiliation(s)
- U Lange
- Kerckhoff Clinic and Foundation, Department of Rheumatology, Ludwig Str. 37-39, D-61231 Bad Nauheim, Germany.
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Klett R, Puille M, Matter HP, Steiner D, Stürz H, Bauer R. [Activity leakage and radiation exposure in radiation synovectomy of the knee: influence of different therapeutic modalities]. Z Rheumatol 1999; 58:207-12. [PMID: 10502020 DOI: 10.1007/s003930050172] [Citation(s) in RCA: 31] [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: 10/28/2022]
Abstract
In rheumatic diseases, radiation synovectomy is a reliable method. Meanwhile, radiation synovectomy is an outpatient therapy. In addition, combination with arthroscopic synovectomy is an increasing therapeutic modality. In comparison to the hitherto inpatient modality, a greater lymphatic emigration of the radionuclide and, therefore, a higher radiation exposure is possible. In 35 patients we found radionuclide emigration in 17 cases by whole body scintigraphy, resulting in a 50%-percentile with 68.27%-confidence interval of 1.8 (0.45-4.78)% of the injected yttrium-90-activity. Comparison of 3 groups with the above mentioned therapy modalities resulted in no statistical difference (p>0.05). Because of the found radionuclide emigration, a radiation dose of 0. 1 (0.05-0,18) mSv in women and 0.2 (0.1-0.38) mSv in men was calculated. For lymph nodes, liver, spleen and whole body radiation doses of 619 (154-1644) mSv, 62 (15-165) mSv, 62 (15-165) mSv and 37 (9-99) mSv were calculated. Gonadal radiation dose can be neglected and the morbidity rate for tumors because of the whole body radiation dose is low with a value of 0.4 per thousand. Therefore, radiation synovectomy can be used unlimited by patients age and independent of the therapeutic modality.
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Affiliation(s)
- R Klett
- Klinik für Nuklearmedizin, Klinikum der JLU, Giessen, Friedrichstr. 25 D-35385, Giessen
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Leweke F, Damian MS, Kern A, Klett R, Dorndorf W. Zweizeitige Kohlenmonoxidintoxikation: Akinetisches Syndrom und Leukoenzephalopathie. Akt Neurol 1999. [DOI: 10.1055/s-2007-1017614] [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] [Indexed: 10/21/2022]
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Steiner D, Steiss JO, Klett R, Miller J, Bauer R, Weidner W, Rascher W. The value of renal scintigraphy during controlled diuresis in children with hydronephrosis. Eur J Nucl Med 1999; 26:18-21. [PMID: 9933657 DOI: 10.1007/s002590050354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Dynamic renal scintigraphy (DRS) during controlled diuresis is the method of choice to diagnose the functional relevance of urinary tract obstruction in children with sonographically demonstrated hydronephrosis. However, there are no commonly accepted scintigraphic criteria for surgical intervention. On the basis of our findings, we propose four stages of washout (WO) of tracer following diuresis: in stage I, WO>50%, neither further diagnosis nor intervention is necessary; in stage II, 50%>/=WO>/=12%, repetition of DRS is advised within 3-4 months; and in stage III, 12%>WO>/=5%, DRS should be repeated within 1-2 months. Only in stage IV, WO<5%, should surgery be done immediately. This procedure reduces surgical interventions by 50% without increasing the risk of residual renal damage.
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Affiliation(s)
- D Steiner
- Clinic for Nuclear Medicine, Justus-Liebig Universitaet Giessen, Germany
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50
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Klett R. [Radiosynoviorthesis: therapeutic possibility in arthrosis?]. Z Orthop Ihre Grenzgeb 1998; 136:Oa15-6. [PMID: 9823626] [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: 02/09/2023]
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