IAEA Resource Listings
2011
Hyperparathyroidism. Parathyroid scintigraphy SPECT/CT
Case presentation:
Female -27 y.o.
Primary hyperparathyroidism (PHPT), i.e. autonomous hyper-production of parathyroid hormone (PTH), is caused in 80%-90% of the patients by a single adenoma.
History of kidney stones.
Pre-operative imaging localization of parathyroid adenoma(s) is critical for successful surgery, especially for minimally invasive parathyroidectomy.
Teaching points:
MIRP was successfully performed without the need for IQPTH.
Hypercalcemia did not recur during long-term postsurgical follow-up, and the patient is therefore to be considered as cured.
An optimized scintigraphic protocol makes it possible for patients with PHPT due to a solitary adenoma to undergo minimally-invasive radio-guided parathyroidectomy without the need for IQPTH.
2011
Lung cancer. [18F]FDG-PET.
Case presentation:
Male.
59 y.o.
Hypermetabolic area (SUVmax 15.8, June 18, 2008) in the left inferior lung lobe, corresponding to a mass detected on chest x-ray (confirmed by CT of the chest).
Teaching points:
This case shows the efficacy of a high-energy gamma probe (electronically-collimated) in its ability to: a.Intra-operatively detect [18]FDG-avid lung cancer; b. Detect the difference in radioactivity accumulation in tumor and in adjacent normal tissue (thus guiding the surgeon to optimal resection of the margins); c. Perform intra-operative staging (detecting the presence/absence of occult lymph node metastases).
2011
Melanoma. Lymphoscintigraphy SPECT/CT.
Case presentation:
Female.
52 y.o.
Skin lesion on the back of the torso.
February 11, 2009: excision of skin lesion on the back of the torso. -Histology: malignant, epithelioid-cell, non-ulcerated melanoma; Clark’s level IV; Breslow thickness 2.7 mm; mild peritumoral lymphocyte infiltration; resection margins free from neoplastic infiltration.
Teaching points:
Lymphatic mapping and sentinel lymph node biopsy represent a minimally invasive procedure for identifying occult microscopic disease.
The goals of this technique are: 1) regional lymph node staging; 2) regional disease control; 3) potential cure (in patients with stage III disease).
?The examination is usefully complemented by a SPECT/CT study, to correctly determine the anatomical location of sentinel lymph node(s) and to precisely identify in-transit or ectopically located sentinel nodes.
2011
Breast cancer. Lymphoscintigraphy SPECT/CT. [18F]FDG-PET.
Case presentation:
Female.
79 y.o.
Lump in upper outer quadrant of left breast.
Teaching points:
The use of PET-guided surgery is expanding.
?The most recent probes detect intra-operatively either the high-energy annihilation γ rays (with adequate shielding and collimation), or directly the β+ particles (with a beta probe).
?Since β+ particles have a very short range of penetration in tissues, beta-probe counting is only possible in direct contact with tissues (not affected by background γ radiation).
The use of either a high-energy gamma probe or a beta probe in radioguided surgery for assessing postresection [18F]FDG-avid residual disease yields in principle similar results.
?Considering that the radiopharmaceutical used for mapping sentinel lymph nodes is 99mTc-Nanocoll, the intra-operative probe used must detect lowenergy γ rays as well.