Abstracts - Scientific Poster Session 1: Thyroid

. 2015 Apr;14(Suppl 1):S68–S102.

Abstracts - Scientific Poster Session 1: Thyroid

PMCID: PMC4432530

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-01 Blood Neutrophil-to-Lymphocyte Ratio Correlates With Tumor Prognosis in Patients with Papillary Thyroid Cancer

Ze Meng, Peiyong Li, Ming Zhang, Yan Cao, Xiaofei Liang

Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

Objective: The clinical value of pre-operative neutrophil to lymphocyte ratio (NLR) in thyroid cancer prognosis was investigated.

Methods: Total white blood cell and differential counts of 90 papillary thyroid cancer patients were compared with those of 35 sex-matched patients with benign thyroid nodules by fine needle biopsy, Pre- and post-operative blood NLRs in the thyroid cancer patient groups (NLR1, NLR2) and control group (NLR0) were calculated. Clinicopathological variables were stratified by NLR tertiles and analyzed.

Results: Various blood indexes in the benign and malignant groups showed no significant differences, (P > 0.05). Both tumor size and American Thyroid Association (ATA) risk showed significant differences in NLR tertiles of the thyroid cancer groups (P = 0.001 and P = 0.032). No difference between NLR1 and NLR2 was observed (P = 0.112). Correlation analysis showed that a higher NLR was observed in patients with larger tumors in both the benign and malignant groups (P = 0.024, P = 0.002), and was higher in the group with tumors larger than 1 cm than that in the group with tumors <1 cm (P = 0.019). NLR1 was positively correlated with ATA (P = 0.032).

Conclusion: NLR1 was closely related to the size of thyroid cancer. The increase in NLR1 affected the ATA risk and prognosis of thyroid carcinoma.

Address for correspondence:

Dr. Peiyong Li, Department of Nuclear Medicine, Ruijin Hospital,Shanghai Jiaotong University School of Medicine, Shanghai, China. E-mail: peiyli@vip.sina.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-02: Enhance Retention of Radioiodine in Thyroid Cancer Cells and Non-Thyroid Cancer Cells by PAMAM-Ag⁺

Peiyong Li, Yan Cao, Ze Meng

Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

Objectives: The purpose of this study is to synthesize PAMAM-Ag⁺ and apply PAMAM-Ag⁺ to deliver sliver ions into cells to react with iodine. By forming Agl, radioiodine retention in cells will greatly increase, improving radiotherapy performance.

Materials and Methods: Papillary thyroid cancer cells line TPC-1 and liver cancer cells line A 549 which transferred with NIS protein were used in this iodine retention study. It has been reported that due to the existence of various primary, secondary, and tertiary amines, poly (amidoamine) (PAMAM) dendrimer was used as nano-templates to reduce Ag⁺ in situ without any reducing agent to form stable PAMAM-Ag⁺ nanocomposites at room temperature. Through the endocytosis, PAMAM-Ag⁺ entered the cells and the concentration was measured by ICP-MS (inductively coupled plasma mass spectrometry). MTT assays were used to measure the cytotoxicity of PAMAM-Ag⁺. Biodistribution of PAMAM-Ag + in cells was accessed via fluorescence microscopy with TICT- PAMAM-Ag⁺. Retention of radioiodine in cells TPC-1 and A-549 were measured.

Results: PAMAM-Ag⁺ were successfully prepared by using PAMAM dendrimers as templates in water system and characterized by UV-Vis spectmphotometer and TEM. The concentration of silver in cells could be reached between 0.21 and 0.28 ppm as measured by ICP-MS. The MTT results showed the cytotoxicity of PAMAM-Ag⁺ was no difference with PAMAM. After endocytosis, PAMAM-Ag⁺ appeared in cytoplasm as showed by green fluorescence signals. Retention of radioiodine in cancer cells TPC-1 and A-549 with PAMAM-Ag⁺ treatment were much higher than that without treatment.

Conclusion: PAMAM-Ag⁺ treatment can improve the retention of radioiodine in cancer cells.

Address for correspondence:

Dr. Peiyong Li, Department of Nuclear Medicine, Ruijin Hospital,Shanghai Jiaotong University School of Medicine, Shanghai, China. E-mail: peiyli@vip.sina.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-03: Thyroid Carcinoma Detected by Incidental 18F-FDG Uptake in a Patient with Progressive Cerebellar Syndrome: A Case Report

Alexander Kroiss, Christian Uprimny, Sabine Buxbaum, Roy Moncayo, Irene Virgolini

Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria

¹⁸F-FDG PET/CT staging was performed in a 57 year old female patient, suffering from progressive cerebellar syndrome. The clinical indication was to exclude malignancy. Besides a reduced uptake of the cerebellum ¹⁸FFDG PET detected an incidental focal uptake of the right lobe of the thyroid gland. A further nuclear medicine investigation of the thyroid gland was recommended. Sonography verified nodules of the right lob and the isthmus region. ^99mTc scintigraphy showed an unifocal autonomy of the isthmus region. A surgery of the thyroid was recommended, in particular due to the strong focal FDG uptake of the right thyroid lobe. After performing total thyroidectomy histology verified a bilateral papillary thyroid carcinoma, which led consecutively to perform ¹³¹I radioiodine therapy. We conclude that incidental uptakes in ¹⁸F-FDG PET (e.g. thyroid gland) should follow further investigations in order to detect or exclude malignancy.

Address for correspondence:

Dr. Alexander Kroiss, Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria. E-mail: alexander.kroiss@i-med.ac.at

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-04: Prognostic Value of Thyroid Volume Changes in Hyperthyroidism Response to Radioiodine Therapy (A Preliminary Report)

Narjess Ayati, Seyed Rasoul Zakavi

Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Objective: Radioactive iodine (RAI) administration is a well-established treatment in hyperthyroidism. Many studies support this hypothesis that RAI can result in thyroid volume reduction. This study investigated the relationship between thyroid volume changes and the responsiveness of thyroid tissue to RAI administration.

Methods: 43 consecutive hyperthyroid patients who were referred for radioiodine therapy were included in our study. Administered radio-iodine dose per gram of thyroid tissue ranged from 100 to 200 uci/g. Thyroid volume was measured by ultrasonography before and one and 3 month post RAI administration. Responsiveness was defined as hypothyroidism, subclinical hypothyroidism or euthyroidism and was assessed by clinical and paraclinical parameters evaluation at the end of the 1^st and 3^rd month post treatment.

Results: Forty three patients (39 female, 4 male) were studied with mean age of 40.9 ± 16.4 years. Multinodular goiter was seen in 72.1% and diffuse goiter in 27.9%. Mean 24 h radio-iodine uptake was 55.7% ± 17.6%. The total iodine dose ranged from 1.5 to 30 mCi with a mean activity of 9.0 ± 7.8 mCi. Patients were followed up for a mean of 3.9 ± 2.1 months with a rate of 97.6% at 1 month and 90.7% at 3 months. Thyroid weight (on palpation) was significantly decreased from 44.3 ± 23.2 g to 35.8 ± 21.1 g 1 month after therapy (P = 0.002). Using ultrasonography thyroid volume was significantly decreased from 29.8 ± 18.0 to 25.1 ± 20.2 g at 1 month after therapy (P = 0.02) and to 21.6 ± 18.3 gr at 3 months after radio-therapy (P = 0.001). Response rate was seen in 66.6% of patients at 1 month and 76.9% of the patients at 3 months. The mean thyroid volume change at 1 month (using ultrasonography) in patients who responded to therapy was 4.9 ± 8.7 ml while it was −0.65 ml ± 3.7 ml in patients who did not responded to therapy (P = 0.08). It was significantly higher 3 months after therapy (8.1 ± 9.1 ml) in responded compared to nonresponded patients (−2.4 ± 7.1 ml, P = 0.02).

Conclusion: Thyroid volume changes either on palpation or by ultrasonography correlates well with clinical outcome of RAI therapy in hyperthyroidism and can be used as a predictor of treatment efficacy.

Address for correspondence:

Dr. Narjess Ayati, Mashhad University of Medical Sciences, Marshad, Iran. E-mail: ayatin@mums.ac.ir

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-05: Did Standard Activities of Radio-Iodine 131I Useful in the Treatment of Multiple Bone Metastasis from Differentiated Thyroid Carcinoma

Kaouthar Chatti, Nouha Essabbah, Hamza Regaieg, Tarek Kamoun, Raja Sfar, Manel Nouira, Maha Ben Fredj, Najla Ayachi, Mohsen Guezguez, Habib Essabbah

Department of Nuclear Medicine, Sahloul Hospital, Sousse, Tunisia

Radio-iodine 131 (¹³¹I) had been used in the treatment of thyroid carcinoma for almost 50 years. Since a decade, its use in microcarcioma was more and more limited because it didn’t change CDT morbidity and mortality. In this work, we wanted to study through our local experiment, its place in the treatment of multiple bone metastasis.

Patients and methods: Retrospective study of patients with multiple bone metastasis (≥ three foci) from CDT.

Results: seven women had multiple bone metastasis (MBM) from vesicular thyroid carcinoma in six cases and papillary in one. Their age was between 79 and 40 years with a mean of 64 years. It was a pT3 tumour in four cases, a pT1 or a pT2 or a pTx in the others. Bone metastasis were painful in six cases. In one case MBM were diagnosed by imaging. Stimulated thyroglobulin was elevated, always more than 300 ng/mL. Most lesions interested flat bones: mainly spine and pelvis (four cases) also sternum, rib, clavicle. Lesions of long bones were less frequent: lesion of the femur in one case and of the humerus in another. Pulmonary metastasis were associated in two cases and were synchronous. Radioiodine was administered alone as successive standard activities of 3.7 GBq every 4 or 6 months. Surgery was indicated in three cases for compressive neuropathy associated to external radiotherapy in one case. Radioiodine 131I activities varied between 3.7 GBq to 44.4 GBq. There weren’t any metastasis remission. In four cases survival was less than 5 years. In three cases survival was less than 10 years. Survival was independent of radioiodine activity administered.

Conclusion: Radioiodine ¹³¹I with standard activities didn’t improve morbidity and mortality in multiple bone metastasis from differentiated thyroid carcinoma.

Address for correspondence:

Dr. Kaouthar Chatti, Nuclear Medicine Department, Sahloul Hospital, Sousse, Tunisia. E-mail: kaouthar.chatti@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-06: Nonthyroidal Malignancies in Patients with Differentiated Thyroid Carcinoma

Zvezdana Rajkovaca, Ivana Pavkovic, Pedj Kovacevic

Department of Nuclear Medicine, University Hospital, Sarajevo, Bosnia and Herzegovina

Objective: Advances in malignancy treatment and improved survival from malignancy have led to more patients with a second primary tumour. There is a known association between the development of subsequent or antecedent differentiated thyroid carcinoma (DTC) in patients with a primary nonthyroidal malignancies (NTM). Aim of this study was to assess the occurrence of other primary malignancies in conjunction with DTC.

Material and Methods: Clinical records of 517 DTC patients treated and followed in our institution over last 8 years were reviewed. Information collected include medical history, patients and tumor characteristics and treatment modality.

Results: After a follow-up period of 0.5–8 years, the presence of multiple primary malignancy (MPM) was histopathologically confirmed in 22 patients showing a prevalence rate of 4.25%. 21 cases of MPM were antecedent and one case subsequent to the timing of occurrence of thyroid malignancy. Patients with MPM had a lower female-to-male ratio and older age (P < 0,005). Ratio papilllary to follicalary thyroid carcinoma was higher in patients with MPM. According to the tumor size, 59% of patients with MPM were in T1 stage compared to 35% T1 stage in patients without MPM. Nodal and distant metastasis characteristics were similar in patients with MPM and without MPM. The most commonly malignancy were breast (35%) and colon (15%) which are among the 5 most common cancers observed in the general population of our country. 63,6% patients with MPM had a history of external beam radiotherapy (EBRT). Ablative dose of radioactive iodine treatment were not significantly different in patients with MPM and without MPM.

Conclusion: The prevalence of antecedent or subsequent malignancy in patients surgically treated for DTC was 4.25%. Patients with MPM had a lower female/male ratio and older age. Breast and colon malignancies are the most common associated second malignancy with thyroid carcinoma. Constant medical surveillance of patients with malignancy might lead to the detection of DTC. There was no risk for second primary malignancy after radioactive iodine treatment in patients with DTC.

Address for correspondence:

Dr. Zvezdana Rajkovaca, Department of Nuclear Medicine, University Hospital, Sarajevo, Bosnia and Herzegovina. E-mail: zvezdana@blic.net

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-07: Carum Carvi Ingestion May Increase TSH Level in Patients with Thyroid Cancer

Seyed Rasoul Zakavi, Seyede Maryam Naghibi, Mohamad Ramezani, Narjess Ayati

Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Carum carvi is a widely available herb that has been used as a food additive and as a medication in traditional medicine for many years. Its potential biological effects include analgesic, anti-inflammatory, anti-anxiety and antispasmodic activities. We report a 24 years old girl with advanced papillary thyroid carcinoma (T4N1M1) who was under suppressive therapy with levothyroxine (100 ugr/day). She had a history of surgery, external radiotherapy and repeated radio-iodine therapies. She was found to have an elevated TSH level of 60.3mIU/L during her routine visit, while taking levothyroxine. She was not changed the time of her levothyroxin consumption or the dose of the levothyroxine in the last few months. Neither was she taking any other drug. Complete review of the patients’ data and physical examination was done and found that she was taking Carum carvi as a food additive recently. She was asked to discontinue the Carum Carvi with no change in levothyroxine dosage. TSH level was decreased to normal range (TSH = 1.7 mlU/L) 2 months after discontinuation of the Carum carvi. Although the exact mechanism of action of carum cravi remains unknown, this case report highlights the effect of food additives on suppressive therapy in patients with thyroid cancer.

Address for correspondence:

Dr. Seyed Rasoul Zakavi, Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: zakavir@mums.ac.ir

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-08: Incidental Thyroid Carcinoma: Should Surgery or Radioiodine Therapy be the Initial Management for Graves’ Disease with Multinodular Goitre?

Alex Khoo Cheen Hoe, Fadzilah Hamzah, Shueh Lin Lim, Mohamed Ali Abdul Khader

Department of Nuclear Medicine, Penang Hospital, Penang, Malaysia

The management of toxic multinodular goiter (MNG), toxic solitary nodule and Graves’ disease is different in many regions. Clinicians may subject their patients initially to surgery as in Europe or radioiodine therapy as in United States of America (USA). Retrospective studies have shown that in patients who had surgery for these diseases, up to 21.7% have incidental thyroid carcinomas. The incidental carcinomas were not detected in the preliminary studies (e.g., ultrasound, thyroid scan) as most were microcarcinoma. We report a case of a young man with multinodular goitre and classical symptoms of Graves’ disease but later found to have follicular variant of papillary thyroid carcinoma on total thyroidectomy. We discuss the management dilemma and our approach in managing him.

Address for correspondence:

Dr. Alex Khoo Cheen Hoe, Department of Nuclear Medicine, Penang Hospital, Penang, Malaysia. E-mail: dr.alexkhoo@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-09: Tailoring Therapy for Benign Thyroid Disease in Private Practice

Masha Maharaj

Umhlanga Molecular Imaging and Therapy, Centre of Excellence, Durban, South Africa

Background of Study: Targeted radionuclide therapy has the potential to selectively deliver radiation to diseased cells with minimal toxicity to surrounding tissues. The cost of radiopharmaceutical, travel, pre and post management have serious financial implications on the private patient.

Aim: The aim is to reduce the costs by providing effective single dose therapy using a simplified clinical and scintigraphicbased model. The total cost with average 4 visits over 12 months can be over R24000. Previous protocol for benign thyroid therapy was Radioactive Iodine (RAI) administered by radiation oncologists and did not require thyroid uptake scans. The doses started from 148 Mbq and escalated to 296 MBq and 444 MBq, depending upon patient’s clinical response and biochemistry, with at least 50% of patients receiving 2^nd and 3^rd doses.

Methodology: 12 patients (11 female and 1 male; average age 48.25 years) were referred to our Centre over a period of 8 months (September 2013–April 2014) for thyroid uptake scans and subsequently for benign thyroid therapy for hyperthyroidism. Thyroid uptake scans were done with 185 MBq Pertechnetate. Pre and post injection syringes were counted for uptake measurements. Anterior, left anterior oblique and right anterior oblique images were done 20 minutes post injection with pinhole collimator. Normal reference range used for uptake was 0.75–4.0%. Five criteria were used to tailor the dose: Size of gland, distribution of activity, percentage thyroid uptake, sex of patient and age of patient. Using these criteria the minimum dose given would be 185 MBq and maximum 555 MBq. Response of therapy was confirmed clinically and on biochemistry based on clinical signs and symptoms of hypothyroidism and/or thyroid function tests (hypothyroid or euthyroid). This was assessed at the 3 month and 6 months follow-up post radioactive iodine administration.

Results: There was confirmed single dose response in 11 of the 12 patients. At 3 months one patient remained hyperthyroid but response was confirmed after the 2^nd capsule. At 3 and/or 6 month (biochemistry and clinically confirmed) follow up 5 patients were Euthyroid and 7 patients were hypothyroid started on eltroxin therapy.

Discussion: The main objective of radioiodine (131I) therapy of benign thyroid diseases is the treatment for hyperthyroidism aiming at euthyroidism or hypothyroidism recompensated by thyroxin medication avoiding the complications of hyperthyroidism. Guidelines have describe complex methods using anatomical or compartment models and computational methods to calculate radio iodine dose. Some authors have recommended fixed doses. There has been a trend toward applying patient-specific dose calculation methods. In theory this should incorporate patient demographics, clinical presentation and scintigraphy pattern.

Conclusion: There appears to be a benefit in applying a simple Clinical and scintigraphic-based Model to achieve single-dose patient-specific radionuclide therapy for benign thyroid disease. In view of the limited number of patients similar studies are needed to verify the reproducibility of the model.

Address for correspondence:

Dr. Masha Maharaj, Umhlanga Molecular Imaging and Therapy: Centre of Excellence, Durban, South Africa. E-mail: drmasha@yahoo.co.uk

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-10: Low Expression of Natrium lodida Symporter and Thyrotropin Receptor in Cases of Papillary Thyroid Carcinoma with Mutant B-Raf through the Role of TGF-β: It‘s Implication in the Management of Papillary Thyroid Carcinoma

Budi Darmawan

Department of Nuclear Medicine and Molecular Imaging, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Objective: Radioactive iodine treatment outcome is determined by NIS and TSH-R. Expression is also important specific thyroid protein molecule in iodine metabolism. Loss of these molecules expression might cause the loss of radioactive iodine avidity in papillary thyroid carcinoma (PTC) and leading to treatment failure. B-RAF mutation in PTC has been correlated in the decrease of NIS and TSH-R expression that affects radioactive iodine treatment effectiveness. Mutant B-RAF expression also correlates with TGF-β expression. Excess of TGF-β/Smad activity in PTC correlates with local invasion, lymph node metastases, mutant B-RAF expression, and inverse correlation with NIS and TSH-R expression. The objective of this study was to evaluate mutant BRAF expression in form of TGF-β expression role in affecting NIS and TSH-R expression in PTC.

Materials and Methods: This is an observational study with a quantitatif design, cross sectional study. This study included 50 objects with classical thyroid papillary carcinoma were identified by immunohistochemistry staining and histo score based on McCarthy, Sample size determine by correlation analysis equation based on estimation correlation coeficient values from various independent and dependent variables. The score divided into strong histoscore value (>8) and weak (<8). Correlation analysis were conducted to determine a correlation between those two independent variables with dependent variables.

Results: There was a intermediated correlation between B-RAF mutation and TGF-β expression (P < 0.001). TGF-β expression was intermediated correlation with membrane NIS expression (P = 0.03). There was weak negative correlation between TGF-β expression and membrane TSH-R expression with phi correlation = −0.294.

Conclusions: Mutant B-RAF expression would correlate with TGF-P expression that may correlate with NIS expression and reduced TSH-R expression.

Address for correspondence:

Dr. Budi Darmawan, Department of Nuclear Medicine and Molecular Imaging, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. E-mail: bedemwan282003@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-11: Clinical Outcome of Patients with Recurrent Well Differentiated Thyroid Carcinoma

Faria Nasreen, Nurun Nahar, Sadia Sultana

National Institute of Nuclear Medicine and Allied Sciences, Dhaka, Bangladesh

Background: Well differentiated thyroid carcinoma (WDTC) has excellent outcome after standard treatment. However there are subsets of patients that develop recurrence with a significant risk for morbidity and mortality from this disease.

Objective: To find out the clinical outcome of WDTC patients developing recurrence and analyze the factors influencing recurrence.

Method: A total of 37 WDTC patients (11 male, 26 female) who received initial treatment (surgery followed by I 131 therapy) between 1994 and 2007 at the National Institute of Nuclear Medicine and Allied Sciences, Dhaka and later on developed recurrence were enrolled in this study. Demographic data of patient, characteristics of tumour and treatment were recorded. Status on last follow up was noted to estimate the survival rate.

Results: A total of 28 patients had papillary carcinoma, eight had follicular and one had follicular variant of papillary (FVPCT) carcinoma. Age range at diagnosis was 18 to 72 years. Patients <45 years were 24 and patients aged ≥45 years were 13 in number. Twenty six patients had stage I, five patients had stage II, five patients had stage III and one patient had stage IVA at initial presentation. No patient had distant metastasis on initial diagnosis. Twenty three patients developed local recurrence, 14 patients developed regional recurrence, five patients developed distant metastasis and five had unspecified recurrence. Four patients died during the whole observation period and three of them were cancer related.

Conclusion: WDTC patients receiving proper treatment have a good prognosis even after recurrence. Age >45 years, advanced initial staging and follicular variant were associated with poor prognosis in patients with recurrence.

Address for correspondence:

Dr. Faria Nasreen, National Institute of Nuclear Medicine & Allied Sciences, Dhaka, Bangladesh. E-mail: fariainm@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-12: Salivary Gland Malignancy as a Late Complication of Radioiodine Therapy

Lutfun Nisa, Nurun Nahar, Raihan Hussain, Sadia Sultana, Faria Nasreen, Zeenat Jabin

National Institute of Nuclear Medicine and Allied Science, Dhaka, Bangladesh

Objective: To focus on the occurrence of second primary malignancy of salivary gland associated with radioiodine therapy.

Materials and Methods: A 31 year old female presented with swelling of the right parotid gland. She had a past history of papillary thyroid cancer and received radioiodine therapy at our department. Analysis of her medical reports showed a cumulative dose of 372mCi of radioiodine for ablation and treatment of subsequent recurrences.

Result: Almost fourteen years after radioiodine treatment, the patient presented with parotid gland tumor and histopathology revealed it to be a mucoepidermoid cancer. The case briefly presented here is a very rare occurrence of salivary gland tumor after a cumulative dose of only 350 mCi of RAI. Second primary cancer reported in literature involved much higher doses.

Conclusion: This finding highlights the long term implication of radioiodine and the importance of vigorous protection of the salivary gland during therapy.

Address for correspondence:

Dr. Latfun Nisa, National Institute of Nuclear Medicine & Allied Science, Dhaka, Bangladesh. E-mail: nisa.lutfun@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-13: Prescription of Iodine-131 (131I) for Treatment of Differentiated Thyroid Carcinoma – What Changed in 10 Years: A Retrospective Analysis

Rita Sousa, Teresa C. Ferreira, Sofia Vaz, Ines P. Carvalho, Angelo Silva, Pedro Ratao, Ana Daniel, Lucilia Salgado

Department of Nuclear Medicine, Portuguese Institute of Oncology, Lisbon, Portugal

Objective: To analyze the evolution in the way of prescribing ¹³¹I therapy in DTC in two groups of patients (pts) who started their treatments with a 10-year interval (1997 and 2007).

Materials and Methods: We performed a single-center, retrospective analysis of 180 ¹³¹I therapies given for DTC in our department in 1997 (group A) and in 2007 (group B). The pts who were given their first course of treatment at those time points were selected: 94 pts were included in group A and 105 pts in group B. In group A, 7 pts were excluded from the study: 6 because of insufficient histological data and 1 because of concomitant medullary thyroid carcinoma. The proportion of males to females was 20:67 and the ages varied from 16 to 86 years (mean of 50.5 year). In group B, 7 pts were excluded because of insufficient histological data. The proportion of males to females was 26:72 and the ages varied from 10 to 81 years (mean of 49.6 year). In group A, 73 pts had papillary carcinomas, 12 had follicular carcinomas and 2 had poorly differentiated carcinomas. In group B, the histological type was papillary in 84 pts, follicular in 12 pts and poorly differentiated in 2 pts. Fixed ¹³¹I activities of 50, 70, 100 and 150 mCi were used. The pts were retrospectively categorized in three levels of risk (high, low and very low), based on their histological features and according to the “European consensus” (Pacini et al., 2006) risk stratification. The additional ¹³¹I therapies performed in the following 7 years were considered for each group.

Results: The mean administered activity of the first therapy was 70.9 and 125.0mCi in groups A and B, respectively. The number of courses of treatment in the following 7 years was, in average, 2.2 in group A and 1.2 in group B. The mean cumulative activity was 201.6 mCi in group A and 156.6 mCi in group B. In group A, 64 pts were classified as high risk, 18 as low risk and 5 as very low risk, while in group B, 58 pts were included in the high risk category, 34 in the low risk category and 6 in the very low risk category. The data regarding the mean activity of the first therapy, the average number of treatments and the mean cumulative activity in the high, low and very low risk categories in each group are presented in the following tables:

Conclusion: The results show that there was a change over the years in the way ¹³¹I therapy was prescribed in thyroid cancer pts.In general, in 1997, lower activities were used in each course of therapy, but each patient was submitted to more therapies, in comparison to 2007. This may be because the concerns about using higher activities decreased, while more effective ways of monitoring the disease have developed, avoiding therapy repetitions.

Address for correspondence:

Dr. Rita Sousa, Portuguese Institute of Oncology Francisco Gentil of Lisbon, Lisbon, Portugal. E-mail: sousa.r.rita@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-14: Psycho – Social Aspects of Thyroid Cancer Patients in Bangladesh

Zeenat Jabin, Fatima Begum, Tanjina Nawshin

National Institute of Nuclear Medicine and Allied Sciences, Dhaka, Bangladesh

Objective: The majority of patients with well-differentiated thyroid cancer remain disease free for the rest of their lives. We consider these patients to have a quite normal life under thyroxine therapy. However, the psycho-social needs and unknown problems they face after being treated are not always considered duly. So, we should care beyond that.

Materials and Methods: By far the largest group of cancer survivors is registered thyroid cancer patients who get treatment and follow up in National Institute of Nuclear Medicine and Allied Sciences (NINMAS) and other Nuclear Medicine centers under Bangladesh Atomic Energy Commission (BAEC). A number of 3833 differentiated thyroid cancer patients were treated in NINMAS in the last 34 years. For assessing the psycho social needs and quality of life (QOL) of these patients a follow up questionnaire to assess physical well-being, spiritual well-being, social well-being and psychological well-being according to our socio-cultural practices is being formulated. Considering these points, we tried to counsel and advocate thyroid cancer patients and thus help them overcome those situations and find out what is related to their psycho-social status besides progression of cancer.

Results: Total number of DTC patients treated with radio-iodine ablation in NINMAS from 1980 to 2014 is 3833. There appears to be some association between selected psycho-social factors and long-term survival from head and neck cancer. Expression of intense psycho-social complaints, higher self-perceived physical ability and self-reported high physical functioning were significantly associated with better response. This ongoing study will further help us assess their quality of life and guide us in changing the way of counseling these patients and approach in a more psychotherapeutic manner to improve their mental health, emotional functions and social competence.

Conclusion: Every cancer patient needs and deserves appropriate support from health care providers in order to improve their quality of life, especially long-term cancer survivors like DTC patients. We are planning to form a multidisciplinary “thyroid cancer support group” to effectively reduce psychological distress, mood disturbance, pain and improve their psycho-social quality of life.

Address for correspondence:

Dr. Zeenat Jabin, National Institute of Nuclear Medicine & Allied Sciences, Bangladesh Atomic Energy Commission, Dhaka, Bangladesh. E-mail: zeenatjabin@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-15: Test of 24-Hour 131-I Uptake in Patients with Autonomous Follicular Toxic Adenoma and Multinodular Toxic Goiter with Disseminated Autonomy; Impact of the Salt lodination and the Possible Influence on the Radioiodine Therapy Planning

Ana Ugrinska, Daniela Miladinova

University “Ss Cyril and Methodius”, Medical Faculty, Institute of Pathophysiology and Nuclear Medicine “A. Isak S Tadzer”, Skopje, Macedonia

Uptake of radioiodine in the thyroid is very important factor in the estimation of the dose of radioiodine necessary for successful therapy of benign thyroid diseases.The radioiodine uptake among other factors is determined by the quantities of iodine in the food. Changes in iodine intake by food can cause changes in the normal radioiodine uptake in the thyroid. The influence of dietary iodine intake to this test in patients with autonomous follicular toxic adenoma (AFTA) and multinodular toxic goiter with disseminated autonomy (MNTG) is not clearly defined. Iodine intake in Macedonia is determined by the consumption of iodinated salt. Until 1999, the salt in Macedonia was iodinated with 10mg/kg of potassium iodide, while after 1999 the amount of iodine in the salt is 20–30 mg/kg in the form of potassium iodat. The objective of this study was to evaluate the 24-hour uptake of ¹³¹I in patients with AFTA and MNTG before and after the changes of iodination of salt in the R. Macedonia. Retrospective analysis of 24-hour ¹³¹ I uptake test in 35 patients with MNTG and 32 patients with AFTA was performed. The patients in the two groups were further divided in two subgroups each. First subgroup (A) was consisted of patients who had an ¹³¹I uptake test between year 1995 and 1999, and the other subgroup (B) represented the patients who had this test between year 2000 and 2004. All the patients were hyperthyroid which was determined by clinical signs, TSH, FT4 and/or FT3. The results showed that the values for 24 hour I131 uptake in patients with MNTG in subgroup A ranged from 28% to 69% with mean value 40.25% (SD 11.13). The range of 24 hour ¹³¹I uptake in subgroup B was from 15% to 39% with mean value 26.48% (SD 6.3). The results showed that there is a statistically significant difference between the two subgroups (P < 0.01). The 24 hour ¹³¹I uptake test in patients with AFTA did not show statistically significant difference between the subgroups A and B. The conclusion is that the 24 hour 131 I uptake in the thyroid of patients with MNTG has decreased after the change of legislation for the iodination of salt in Macedonia. The lower 24 hour 131I uptake in patients with MNTG might influence radioiodine therapeutic doses necessary to obtain euthyroidism or hypothyroidism in these patients.

Address for correspondence:

Dr. Ana Ugrinska,

University “Ss Cyril and Methodius”, Medical Faculty, Institute of Pathophysiology and Nuclear Medicine “A. Isak S Tadzer”, Skopje, Macedonia.

E-mail: ugrinskaana@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-16: Incidence of Second Primary Malignancy in Patients Treated With Ablative I131 Doses

Mariela Agolti, Martin Rettore, Rocio Brezan, Maria Celeste Fernandez

Centro de Medicina Nuclear Clinica Modelo, Parana, Argentina

Objective: To observe the incidence of second primary malignancy in our patients treated with I131 during November 2008/December 2009 with ablative doses, at least 100 mCi (3,7 GBq) in our center, with a minimum follow up of 4 years.

Material and Methods: 58 Patients were treated with 100 mCi of I131 in our center during November 2008 to December 2009 with a minimum follow up of 4 years. 5 patients were excluded of the study because they were lost to follow up. We did an observational retrospective study through a survey done by especialized physicians and in the positive cases the diagnosis was confirmed with biopsy and citometric cytogenetic.

Results: A total of 53 Patients were evaluated 46 were females and 7 males. Related to the histopatology all of them were papillar or follicular except 1 was Hurtle cell carcinoma. The ages were between 29 and 86, mean age of 51 years. All the patients received complete surgical thyroidectomy previously to the ablative dose, 32 patients were treated with at least 100 mCi and 21 were treated with more than 100 mCi, but none of them received more than 300 mCi (11.1 GBq). 3 patients have second primary malignancy in our study, with a follow up of at list 4 years, of them 1 patient had LNH, in mediastinum following 200 mCi (7.4 GBq) accumulated dose in a very big rest of thyroid tissue in mediastinum, 1 female had an Acute Myeloid leukemia, the literature says it is probably associated with I131 treatment, although with higher doses, and 1 female patient had breast cancer, but she had familiar incidence.

Conclusion: we found 2 patients of 53 patients with second primary malignancy clearly associated with I131 ablative treatment, that means a 3,77% of our patients had second carcinoma probably related to I131 treatment. The third patient who had Breast carcinoma is difficult to associate with Iodine treatment.

Address for correspondence:

Dr. Mariela Agolti, Centro de Medicina Nuclear ClÍnica Modelo, Paraná, Argentina. E-mail: marielsmednuc@hotmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-17: A Case of Basedow-Graves Thyrotoxicosis Associated With the Follicular Variant of Papillary Carcinoma

Iulia Andreea Chiriac, Raluca Mihaela Mititelu, Roxana Irina Rosca, Andrei Liviu Goldstein, Catalin Victor Mazilu, Daniela Neamtu

Department of Nuclear Medicine, Central Universitary Emergency Military Hospital, Bucharest, Romania

Background: Thyroid cancers are rare neoplasms, representing less than 2% of all human cancers, and traditionally, Basedow-Graves disease and low thyroid-stimulating hormone (TSH) values were considered a protection against thyroid cancer.

Patient Findings: The subject of this presentation is a 48-year-old lady who was diagnosed with Graves’ disease at the age of 44, with clinical features of thyrotoxicosis associated with goiter. Thyroid function tests results revealed very low TSH with high fT4 values and elevated TSH receptor antibodies (TRAb), anti-thyroid peroxidase (ATPO), and anti-thyroglobulin antibodies (TGL).

Methods and Results: Ultrasound revealed thyroid enlargement with diffuse inhomogeneous hypoechoic pattern and containing multiple small hypoechoic lesions in the entire gland. In the inferior half of the right lobe was noticed a large hypoechoic nodule, very inhomogeneous, with peripheral halo and high peripheral vascularity, which was compressing the trachea. An enlarged lymph node was found in the left supraclavicular region. After 11 months of anti-thyroid and L-thyroxine suppression medication, the patient gave her consent for a surgical intervention and had a near total thyroidectomy. On histological examination, the larger nodule was well encapsulated and follicular variant of papillary thyroid carcinoma (FVPTC) was found. Fine needle biopsy of the lymph node diagnosed it as a benign, reactive type lesion. After the surgery, the patient continued L-thyroxine suppression treatment. Post-operative, a residual thyroid parenchyma was seen on ultrasound and a thyroid scintigraphy with 131-I demonstrated a hyperactive area localized in the right thyroid region. No other uptake was seen on the 131-I whole body scan. The patient underwent two ablative radioiodine therapy sessions with 131-I (50mCi each) and is now in remission.

Conclusions: Basedow-Graves was considered a protection against thyroid cancer, but now, some authors acknowledge it as a risk factor in the development of thyroid carcinomas, because of the chronic abnormal stimulation of the thyroid gland by the TRAb antibodies. In patients with a dominant nodule in a Basedow-Graves multinodular goiter the need for vigilance should be higher and regular follow-up of the nodule should be mandatory.

Address for correspondence:

Dr. lulia Andreea Chiriac, Central Universitary Emergency Military Hospital “Dr Carol Davila”, Bucharest, Romania. E-mail; iulia.chiriac@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-18: Comparison of Post Operative 99mTc Pertechnetate Scan and Post Ablative 131I Scan for the Management of Differentiated Thyroid Carcinoma

Shankar Kumar Biswas, Shaila Sharmin, Fatema Sultana Haque, Mohana Hossain, Tania Sultana, Afroza Akhter, Rubina Begum, Farhana Rahman, Sadia Hossain, Rawna Afrin, Mazharul Islam, Sanowar Hossain

Bangladesh Atomic Energy Commission, Dhaka, Bangladesh

Objectives: Incidence of differentiated thyroid cancer is still high in the developing country with a female preponderance. Due to the advancement of surgical techniques and high resolution ultrasonography procedures total thyroidectomy is quite possible leaving minimum residual thyroid tissue. Nuclear medicine playing pivotal role for the subsequent management and follow up of these groups of patients. However there is some debate about the pre therapy ¹³¹I scanning in a fear of stunning or suboptimal therapeutic effect. This study was designed to unravel the impact of post operative ^99mTc-pertechnetate scan in comparison with the post therapy (¹³¹I) scan.

Materials and Methods: Fifty differentiated thyroid cancer patients (Female: 40) were enrolled retrospective for this study. All patients were sent for radioiodine ablation after total thyroidectomy in a tertiary level hospital. ^99mTcpertechnetate scan (2 mci i/v) was done to evaluate any remnant at the thyroid bed and baseline TSH, Tg, Thyroid antibodies and serum calcium were estimated as a routine procedure in our centre. Stimulated TSH and Tg (after 3 wks of surgery without thyroxine replacement) levels were 77 ± 19 mIU/ml and 9 ± 33 ng/ml respectively. Radioiodine therapy (¹³¹I) was given according to the size of the nodule and histopatholgical findings according to institutional protocol (eg., if the nodule is >3cm 75 mci and for <3 cm nodule 50 mci was given, in case of cervical nodal metastasis 150 mci and for distant metastasis 250 mci was given). Post therapy whole body scan (On 5^th day during discharge those who are taking 50 mci and on 10^th day those who are taking ≥70 mci) findings were recorded. Scan images were evaluated by two senior nuclear medicine physicians independently; finally pre therapy and post therapy scan findings were compared meticulously.

Results: Twenty eight (64%) patients showed focal (single/multiple) tracer uptake in the thyroid bed on post surgical scan with ^99mTc pertechnetate. On post ¹³¹I therapy scan there was good accumulation of tracer at the thyroid bed. Out of 50 patients, one patient only showed mediastinal focal tracer uptake on whole body ¹³¹I scan. There were some nonspecific intestinal uptake on ¹³¹I scan in 3 patients.

Conclusions: Post operative ^99mTc-Pertechnetate scan may miss extra thyroidal lesion in differentiated thyroid cancer. However considering the cost effectiveness, radiation burden and socioeconomic condition ^99mTc-Pertechnetate scan still would be the first option for assessment of the patient before radioiodine ablation in a developing country like Bangladesh.

Address for correspondence:

Dr. Shankar Kumar Biswas, Bangladesh Atomic Energy Commission, Dhaka, Bangladesh. E-mail: drsbiswas09@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-19: Do All Patients with Raised Thyroglobulin Need Treatment in TENIS Syndrome?

Kanhaiyalal Agrawal, Bhagwant Rai Mittal, Chinmoy Kumar Biswal, Rohit Kumar Phulsunga, Rajender Basher, Ashwani Sood, Anish Bhattacharya

Postgraduate Institute of Medical Education & Research, Chandigarh, India

Objectives: To determine the changing trend in the thyroglobulin level on follow up without any treatment in patients with thyroid cancer who have detectable serum thyroglobulin (Tg) and negative diagnostic radioiodine scan (TENIS).

Materials and Methods: This is a single centre retrospective study. We studied the change in Tg level during follow up in patients with TENIS syndrome who were followed up with TSH suppression without any treatment. The patients with differentiated thyroid cancer who had stimulated Tg >2.0 ng/mL and a negative ¹³¹I whole body scan were included as TENIS syndrome.

Results: 36 patients (14 males, 22 females; age range 20–77 years; mean age 41.5 years) were included in this study. Stimulated Tg was in the range of 2.2–419 ng/mL (mean 69.1 ng/mL). The patients were followed up with stimulated Tg for a period of 6 months-4 years. 16 (44.4%) showed persistently decreasing trend in stimulated Tg level on follow up, 9 (25%) showed increasing trend, 7 (19.4%) showed stable Tg level and 4 (11.1%) had declining trend initially followed by either stable or increasing Tg later on. However, only two patients achieved Tg level <1.0 ng/mL during follow-up.

Conclusion: Although complete remission is rare in patients with TENIS who are kept on TSH suppression, almost half of the patients show persistent decreasing trend in Tg level.

Address for correspondence:

Dr. Kanhaiyalal Agrawal, PGIMER, Chandigarh, India. E-mail: drkanis@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-20: Recurrent Differentiated Thyroid Cancer: Analysis of Factors and Causes

Ganna Grushka, Natalia Luhovicka, Olga Astapyeva, Olga Paskevych

Grigorev Institute for Medical Radiology, Kharkiv, Ukraine

Objective: To study the causes of occurrence and the frequency of recurrence and dissemination of differentiated thyroid cancer (DTC) in relation to tumor stage, morphological aggressiveness and applied treatment modalities.

Materials and Methods: The analysis was performed in 189 patients with DTC who were treated at our hospital between 1996 and 2014. The clinical characteristics of thyroid cancer were examined in 3 groups of patients: Group I - 45 patients with tumor recurrence after postoperative 131I thyroid remnant ablation; Group II - 50 patients with remnant disease in the thyroid bed or cervical lymph nodes or with distant metastases, receiving adjuvant therapy; Group III - 94 cured patients after surgical treatment and RAI (i.e. free of disease).

Results: (1) Gender and age: The gender distribution was dominated by female patients and the average age of surveyed patients did not exceed 50 years. The groups were homogeneous for age and parity between men and women [Table 1]. (2) Tumor type: The large majority of patients had papillary thyroid carcinoma, that is, 37 (82.2%) in Group I, 38 (76%) in Group II and 75 (79.8%) in Group III, respectively [Table 2]. (3) Stage of disease: Evaluating the distribution of patients by stage of disease [Table 3], there were significant differences (P < 0.05) between the number of patients with stage II and III in Groups I, II, and III, as indicated with an asterix in the table. (4) Histopathological aggressiveness: Histopathological signs of aggressive growth of thyroid cancer were identified in 31 (62%), 34 (68%) and 76 (80.1%) patients in Groups I, II and III, respectively [Table 4]. (5) Type of surgery: Analyzing the types of the surgery which were performed prior to RAI ablation/therapy, it was found that the large majority of patients had undergone radical surgery, that is, 38 (84.4%), 35 (70%) and 88 (93.6%) patients in Group I, II and III, respectively. Repeated surgical treatment (completing thyroidectomy) was conducted at various time intervals after the first operation and as a result we saw the progression of thyroid cancer. Irradical surgery more often took place in Group II, that is, in 15 (30%) patients, which constitutes a significant (P < 0.05) difference between Groups II and III [Table 5]. (6) Interval to recurrence: It was found that recurrences in Group I occurred at different time intervals after RAI, that is, within 1 year in 14 (31.1%) cases, between 1 and 3 years in 16 (35.6%), from 5 to 10 years in 7 (15.5%) cases. These data are presented in Table 6. (7) Postoperative treatment: Table 7 shows the various treatment modalities, which were applied as postoperatively. (8) Administered RAI activity: For the comparative analysis of the effectiveness of RAI, we have identified 5 levels total ablative activity of radioiodine for all groups: 1^st - patients who received up to 3700 MBq, 2^nd – from 3701 to 7400 MBq, 3^rd –7401–14800 MBq, 4^th –14801–22200 MBq and 5^th - more than 22201 MBq. When comparing Group I and Group II Fisher’s exact method was applied; when comparing Group I with Group III and Group II with Group III the xi-square was used. Analyzing the obtained data, it was found that the average total ablative activity of radioiodine ranged from 3701 to 7400 MBq for patients of Groups I and III, and that in most of these cases thyroid cancer ablation was achieved after 2 courses of RAI with an interval of 4-6 months. Among the patients in Group II, in order to achieve thyroid ablation, 16 (32%) received 7401 to 14,800 MBq of radioiodine over a period of more than 3 years and 12 (24%) patients required an even larger total activity of radioiodine, that is, 14,801–22200 or more than 22201 MBq. Conclusions: Recurrence of DTC may occur 1–10 years after postoperative 131I thyroid remnant ablation. There was a positive correlation (r = 0.97) between tumor stage and the recurrence and disease prolongation. Also a significant positive association between the kind of the surgery and recurrences of DTC was established (r = 0.39). When comparing the degree of morphological aggressiveness of thyroid tumors and the frequency of recurrences and the achievement thyroid ablation a very honest and positive relationship (r = 0.6 and r = 0.85, respectively) was demonstrated. Furthermore we found a strong positive association between the number of surgically removed metastases of thyroid cancer and the emergence of a further tumor recurrence (r = 0.85). The probable relationship between ablative radioiodine activities and occurrence of recurrence and metastases of DTC has not been identified. This may be due to the relatively small number of patients in the groups studied and would require further study in a larger patient population.

Table 1.

Distribution of patients by gender and age

graphic file with name WJNM-14-68-g001.jpg

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Table 2.

Distribution of patients by morphological variant of DTC

graphic file with name WJNM-14-68-g002.jpg

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Table 3.

Distribution of patients by stage of disease (TNM)

graphic file with name WJNM-14-68-g003.jpg

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Table 4.

Characteristic aggressive morphological features DTC patients

graphic file with name WJNM-14-68-g004.jpg

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Table 5.

Distribution of patients by the type of the surgical treatment before RAI

graphic file with name WJNM-14-68-g005.jpg

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Table 6.

Interval to recurrence after postoperative 131I thyroid remnant ablation

graphic file with name WJNM-14-68-g006.jpg

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Table 7.

The various treatment modalities, which were applied as postoperatively

graphic file with name WJNM-14-68-g007.jpg

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Address for correspondence:

Dr. Ganna Grushka, Grigorev Institute for Medical Radiology, Kharkiv, Ukraine. E-mail: grushka.ganna@ukr.net

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-21: Effect of Single Dose of Radioiodine Therapy on Volume Reduction of Thyroid Gland in Hyperthyroidism

Shamrukh Khan, Faridul Alam, Fatima Begum

Department of Nuclear Medicine, United Hospital Limited, Dhaka, Bangladesh

The aim of the present study was to see the reduction of thyroid volume and its relation to thyroid status. In this study 10–12 mci dose of radioactive iodine was used for the treatment of hyperthyroidism and volume measurement of thyroid gland before and after the treatment was done by ultrasonogram. Total 117 patients from July 2009 to June 2010 were studied at Institute of Nuclear Medicine and Ultrasound, BSMMU campus. Patients with diffuse toxic goitre, toxic multinodular goitre and single toxic nodular goitre of any age after puberty were included in this study. All the patients were under went through physical examination, thyroid scan with ^99mTc, radioactive iodine uptake test and FT₄^, TSH level. Thyroid volume was measured by Ellipsoid method of ultrasonography. Patients were followed up after 3 months and 6 months by evaluating thyroid volume and hormone assay. In this study 86 patients were having diffuse toxic goitre and 31 had nodular goitre. Of these 31 nodular goitre, 10 had single nodule and 21 had multiple nodule. Mean volume of the thyroid gland was 24 ml which reduced to 14 ml at 1^st follow up and became 9.1 ml after 2^nd follow up. Volume reduction of thyroid gland was 42% at 3 months and 66.1% at 6 months. Single dose of radioactive iodine therapy is very effective for diffuse toxic goitre, toxic multinodular goitre and single toxic nodule.

Address for correspondence:

Dr. Shamruk Khan, Department of Nuclear Medicine, United Hospital Limited, Dhaka, Bangladesh. E-mail: shamrukh@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-22: Clinical Outcome of Radioiodine Therapy in Adolescent Hyperthyroidism: Single Centre Experience

Teik Hin Tan, Boon Nang Lee, Siti Zarina Amir Hassan

Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia

Introduction: In adolescent hyperthyroidism, rendering non-hyperthyroidism after first dose is usually desired to avoid prolonged hyperthyroid sequelae and multiple radiation exposure. As higher dose is usually required for larger goiter, our center adopted estimated-dose method based on clinical palpation to determine the radioiodine dosage. The purposes of this study were (1) to evaluate the efficacy and outcome of such method in treating adolescent hyperthyroidism; and (2) to determine the determinants that may influence the outcome.

Methology: We reviewed 126 consecutive hyperthyroid adolescents (F: M = 6, 10–19 year-old) receiving radioiodine at the Nuclear Medicine Clinic, Kuala Lumpur General Hospital, between January 2000 and December 2012. Twelve patients were excluded. Thyroid volume was estimated by clinical examination based on WHO classification into non-palpable, small, moderate and large. Range of estimated radioiodine activity in non-palpable, small, moderate and large goitre was (5–10 mCi), (7–15 mCi), (10–25 mCi) and (20–25 mCi) respectively. Patients were followed up 4-monthly with thyroid function test to maximum of 8 months. Therapeutic response was defined as elimination of hyperthyroidism biochemically on follow-up. Second dose was given if response was not seen at first 4-month. The dose of second radioiodine varied according to goitre size, and biochemical marker. Patients who remained hyperthyroidism at 8-month follow up were considered poor respondent.

Results: The mean patients’ age when the first radiodioine dose administered was 17.1 ± 1.8 years. Overall success rate after 1^st dose and 2^nd dose was 53.0% and 88.7% respectively; where non-palpable, small, medium and large goitre were (50.0%, 100%), (57.6%, 97.0%), (47.8%, 87.0%), (33.3%, 66.7%) respectively. Using estimated-dose method based on clinical palpation, response rate among difference sizes of goitre does not show significant difference (P = 0.57). Significantly poor response was seen in male (P = 0.05); whereas no difference in response rate was observed between Graves’ disease and nodular goitre (58.3% vs. 33.3%, P = 0.24). High incidence of hypothyroidism was seen in successfully treated patients (73.9% and 82.6% after 1^st and 2^nd dose respectively). Conclusions: In aldolescent hyperthyroidism with various sizes of goitres, estimated-dose method using clinical palpation has demonstrated an acceptable therapeutic success rate in treating such patients.

Address for correspondence:

Dr. Teik Hin Tan, Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia. E-mail: teikhin.tan@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-23: Serum Thyroglobulin Kinetics as the Predictor of Differentiated Thyroid Carcinoma Treatment Outcome

Ayu Rosemeilia Dewi, Budi Darmawan, Basuki Hidayat, A Hussein, S Kartamihardja, Trias Nugraha, Johan S Masjhur

Department of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, University Padjadjaran, Bandung, Indonesia

Objective: To know the role of serum thyroglobulin (Tg) kinetics in predicting the differentiated thyroid carcinoma (DTC) treatment outcome.

Materials and Methods: Patients with DTC were retrospectively selected from 320 patients underwent total thyroidectomy followed by radioablation from the year 2007 to 2013 in Hasan Sadikin Hospital, Bandung. Patients without preablation (preTg) and postablation Tg level measurement were excluded. Clinical and pathological characteristics were assessed. Percentage of serum Tg kinetics (ΔTg) was calculated by subtracting preTg level (preTg) with Tg level at 6 months postablation (Tg-6 mos). ΔTg were classified as increased, stable, and decreased (<−25%, −25% to 25%, and >25%, respectively). Disease remission criteria are Tg at 12 months (Tg-12 mos) level < 3 ng/mL with negative antithyroglobulin antibody (ATA), or if ATA were positive, there were negative wholebody scan and/or ultrasound finding.

Results: From a total of 320 subjects, only 56 subjects (14 males and 42 females) fulfilled the inclusion criteria. Subjects were histopathologically classified as papillary (60.71%), follicular (21.43%), and follicular variant of papillary thyroid carcinoma (17.86%). Subjects age 14–76 years, mean 45.89 ± 13.86 years. Remission was higher in subjects belongs to decreased ΔTg group (73.53% from 34 subjects), compared with those found in stable ΔTg group (37.50% from 8 subjects), and increased ΔTg group (35.71% from 14 subjects). ΔTg vary between 25% and 100% (average 89.50%) in decreased ΔTg group, average with preTg level 5.89 (range 0.10–67.50) ng/mL, and average Tg-6 mos level 0.30 (range 0.02–22.00) ng/mL. Average ΔTg in stable and increased ΔTg group were − 8.25% ± 6.07% and − 61.75% ± 30.52%.

Conclusion: Decreased ΔTg (>25%) is related to better treatment outcome. Further prospective study with more subjects and longer follow up is recommended.

Address for correspondence:

Dr. Ayu Rosemeilia Dewi, Department of Nuclear Medicine and Molecular Imaging, Universitas Padjadjaran, Bandung, Indonesia. E-mail: ayurosemeiliadewi@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-24: Correlation Between Serum Tg-on and Persistent Disease in Patients with Well Differentiated Thyroid Carcinoma

Budy Darmawan, Febby Hutomo, Johan S Masjhur

Indonesian Society of Nuclear Medicine, Bandung, Indonesia

Introduction: Although differentiated thyroid cancer (DTC) is characterized by an excellent prognosis after thyroidectomy and remnant ablation, recurrences often occur in 10–15% cases. American Thyroid Association (ATA) recommended follow up with serum thyroglobulin (Tg) measurement. In Indonesia, to achieve optimal sensitivity thyroid hormone withdrawl are used because rTSH and T3 are not widely available. However, thyroid hormone withdrawl induced poorly tolerated side effects of hypothyroidism. An elevated serum Tg level is a sensitive marker of residual cancer. We purpose measurement serum Tg measured during TSH suppression (Tg-on) as follow up, to avoid any side effect of hypothyroidism.

Materials and Methods: Forty nine subjects with near total thyroidectomy and remnant ablation are enrolled in this study. Tg-on 3 months after remnant ablation and Tg-off 6 months after remnant ablation measurement were performed; any other follow up also considered.

Result: Forty nine subjects including papillary thyroid carcinoma, follicular thyroid carcinoma and papillary thyroid carcinoma variant follicular. There are strong correlation between Tg-on and Tg-off (r = 0.93). All subjects with raised Tg-on (>1 ng/dl) have elevated Tg-off 6 months after remnant ablation, therefore in this cases therapy with radioactive iodine is needed; but there is no correlation between Tg-on and Tg-off in subjects with negative Tg-on (<1 ng/dl).

Conclusion: In cases with high Tg on level, there is strong correlation between Tg-on and persistent disease; however low Tg-on level doesn’t have any correlation with persistent disease.

Address for correspondence:

Dr. Febby Hutomo, Indonesian Society of Nuclear Medicine, Bandung, Indonesia. E-mail: raphaela.febby@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P1-25: Incremental Value of Regional Single-Photon Emission Computed Tomography-Computed Tomography While Performing Whole Body I-131 Scan of the Patients Suffering from Differentiated Thyroid Cancer - Its Impact on Clinical Decision Making

Soumendranath Ray, Jayanta Das, Manoj Shaw

TATA Medical Center, Kolkata, West Bengal, India

Introduction: Whole body I-131 scan is routinely performed after radioiodine therapy and during post therapy follow up of the patients suffering from differentiated thyroid cancer to localize functioning post operative residual thyroid tissue, lymphnodal and distant metastasis. Usually the whole body anterior and posterior views are obtained along with planer spot views of the area of interest. Anatomical localization of focal I-131 concentration was found to be poor especially in the areas other than neck. It is extremely important to locate the site of abnormal radiotracer uptake as it has very important therapeutic implications. In this pictorial assay the incremental values of SPECT-CT is demonstrated with reference to the above mentioned clinical context.

Materials and Methods: Whole body I-131 scan was performed with high energy general purpose (HEGP) collimator in a dual head gamma camera (GE Infinia Howkey 4). Regional SPECT-CT of the area of interest was performed in step and shoot method (360 rotation, 60 views 20 s/view). Data of first 20 patients are presented in this study.

Results: In this preliminary report of 20 studies SPECT-CT performed anatomical localization of the focal radiotracer uptake, which was otherwise not possible with planer whole body or spot views. SPECT-CT provided additional incremental information in equivocal whole body I-131 scan. It could differentiate the physiological uptake from the pathological lesion. Proper anatomical localization was very useful in management planning for example identificaion of the involvement of the spinal cord, localization of metastatic focus on a weight bearing area of the bone or differentiating a midline focal concentration as lymphnode or bone uptake.

Conclusion: SPECT-CT provided incremental information in equivocal cases of whole body I-131 scan and can be used as a problem solving tool in discriminating the abnormal focal uptake from physiological radiotracer concentration and also for appropriate anatomical localisation of the abnormal uptake. Its impact on the management of the differentiated thyroid cancer will be underlined with examples in this poster.

Address for correspondence:

Dr. Soumendranath Ray, TATA Medical Center, Kolkata, India. E-mail: drsoumenray@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

Abstracts – Scientific Poster Session 2: Personalized Medicine: Peptide Receptor Radionuclide Therapy, Prostate Cancer: P2-01 The First Meta-Iodobenzylguanidine Therapy in the Philippines

Patricia Bautista, Jonas Francisco Santiago

St. Luke's Medical Center - Global City, Metro Manila, Philippines

Neuroblastoma is an embryonal tumor of children that frequently presents with metastases. Our patient is a 6-year-old girl who was diagnosed to have neuroblastoma with diffuse metastatic disease throughout the skeleton as seen in her123I-MIBG scan in the United States. 18F-FDG PET/CT scan was done in the Philippines after chemotherapy and gene therapy, and before 131I-MIBG therapy. No additional lesions were seen on PET. 131I-MIBG therapy was then performed and an131I-MIBG scan with SPECT/CT thereafter, which showed an increase in size and extent of the lesion in the head and a decrease in number of the skeletal metastases. New 131I-MIBG-avid posterior cervical lymph nodes were also localized through SPECT/CT. For this patient, a follow-up 123I/131I-MIBG scan would be more cost effective in assessing response to therapy. Sectional imaging may be done to obviate the need for sedation of this young patient.

Address for correspondence:

Dr. Patricia Bautista, St. Luke's Medical Center - Global City, Metro Manila, Philippines. E-mail: pattybautista@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-02: Experience and Results of 38 Patients After 177Lu-Octreotate Therapy in the Federal Capital of Brazil

Gabriela Lobo, Janaina Souto, Flavia Marciano, Gustavo Gomes, Marcelo Gomes, Dalton Anjos, Joao Arratia, Rodrigo Furtado, Roberta Araujo, Jose Ulysses Calegaro, Enio Gomes

NÚCLEOS - Centro de Medicina Nuclear de Brasília, Brasilia, Brazil

Introduction: Neuroendocrine tumors (NET) generally express somatostatin receptors (SR), allowing its treatment by radiolabeled somatostatin analogues (SA). Other tumors expressing these receptors are also amenable to such therapy.

Objectives: This paper aims to present the experience and treatment results of 38 patients with 177Lu-octreotate in the Federal Capital of Brazil.

Materials and Methods: Thirty-eight patients with progressing neuroendocrine and no neuroendocrine tumors with SR expression started the Rotterdam protocol with 177Lu-octreotate, from January 2008 to August 2014. These patients were selected after staging by anatomic imaging methods and SA affinity confirmed by scintigraphy, observing proper inclusion and exclusion criteria. Adverse effects during and after the doses administration were analyzed. Thirty-two patients completed at least one cycle of treatment (4 doses of 200 mCi) and were assessed for clinical, laboratorial and anatomic response (complete, partial, stable or progression).

Results: After 125 doses, there was good tolerance, with minimal complications during and after treatment, being nausea and mild abdominal pain the most common symptoms in patients with large tumors. Patients without prior chemotherapy and/ or radiation therapy had fewer complications. Of the 38 patients initially selected, 6 did not enter the analysis because 4 were lost on follow-up and 2 started the protocol recently. Of the 32 patients who completed the first cycle, 75% reported clinical improvement. Regarding the laboratory response, 53% had complete or partial response (normalization or drop of all the markers initially altered), 22% showed stability and 25% progression of at least one serum marker. Considering the anatomical response, 34.4% achieved a complete or partial response, 37.6% stability and 28% progression of the disease. The anatomical response was better in patients with higher uptake on scintigraphy and those with gastroenteropancreatic neuroendocrine tumors.

Conclusion: This ongoing experience of therapy with 177Lu-octreotate reproduced the literature data for safety and also for low incidence of side effects. Not only patients with NET, but also those with other tumors expressing affinity for the somatostatin analogs were benefited from this therapy.

Address for correspondence:

Dr. Gabriela Lobo, NÚCLEOS - Centro de Medicina Nuclear de Brasília, BrasÍlia, Brazil. E-mail: gabihaje@hotmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-03: Response Time Pattern (Delayed Response) after PRRT with [177Lu-DOTA]- D-Phe1-Tyr3-Octreotide (177Lu-DOTATOC)

Richard P Baum, Karin Niepsch, Cees van Echteld

Zentralklinik Bad Berka, Bad Berka, Germany

Background: PRRT is conceptually a fractionated radiotherapy. In contrast to EBRT, though, its administration frequently follows individualized regimens, guided by response assessments, typically 3–4 months after the 1^st cycle. To test the appropriateness of this approach, we characterized the lapse of time between 1^st PRRT and initial and best responses, respectively.

Methods: 56 subjects with progressive NET (GEP, lung, atypical) treated with 1-4 cycles ¹⁷⁷Lu-DOTATOC (3.01, 3.02, and 4.24 months for 1^st, 2^nd and 3^rd interval; 6.92 ± 1.03 GBq/cycle), were assessed for response at baseline and prior to each subsequent cycle (RECIST 1.1).

Results: Objective Response (OR), and Disease Control (DC) were observed in 33.9% (19/56) and 66.1% (37/56), respectively (CR 16%, PR 18%, SD 32%). Initial response (SD or better) was found in 68% (25/37) within 4, in 100% within 8 months from 1^st cycle. To induce initial response, 86% of subjects required one, 11% two, and 3% three cycles. Best response was found in 51% (19/37) within 4, and in 76% (28/37), within 8 months, while it took in 24% >9, in 21% >15, and in 5% >22 months to develop. Notably, 47% (9/19) of OR were first observed >9 months from 1^st PRRT, and up to 20 months after last PRRT (late responders, no further therapy).

Discussion: 14% of subjects required >1¹⁷⁷Lu-DOTATOC cycle, and 32% >4 months, to induce DC when PD was present at baseline. Hence, clinical information from first re-staging (available typically at 3–4 months, before 2^nd cycle), proved to be inadequate in 32% of cases to correctly assess the potential of scheduled PRRT to induce DC, and in 51% to predict future best response to therapy, which may take >22 month from 1^st PRRT to develop. Therefore, individual treatment modification decisions, based on 1^st re-staging information should be avoided. Rather, considering the observed slow biological response, and the cumulative nature of a fractionated therapy, PRRT in NET should be evaluated for efficacy, only after administration of the prescribed dose, as established in EBRT. A suitable time point might be restaging after a 3^rd cycle, when initial response was present in all our patients.

Address for correspondence:

Dr. Cees van Echteld, ABX-CRO Advanced Pharmaceutical Services, Dresden, Germany. E-mail: vanEchteld@abx-cro.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-04: Uptake of 68Ga-DOTA-Conjugated Peptides in Uncinate Process of Pancreas - Characteristics and Clinical Significance

Amrita Kasat, Zoe Zhang, Xuexian Yan

Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore

Objectives: 68Ga-DOTA-conjugated peptides are somatostatin analogues tracer used for imaging neuroendocrine tumours (NET). A number of organs demonstrate normal physiological uptake of which the uncinate process of pancreas is of particular concern not only because pancreas itself is a common site for NET but also the great variability of the tracer uptake that may make the interpretation difficult. Thus the aim of the study is to define the characteristics of normal distribution of 68Ga-DOTA-conjugated peptides in uncinate process and its usefulness in distinguishing pathology versus normal.

Methods: 66 (68Ga-DOTATATE 58, 68Ga-DOTATOC 8) PET/CT scans from 19 patients done between May 2009 and Oct. 2014 were reviewed retrospectively. Disease involvement of the uncinate process was excluded based on clinical and radiological evaluation including at least 1 year follow-up. Visual inspection is used to determine the pattern of tracer distribution in the uncinate by two nuclear medicine physicians. The reconstructed axial PET images were used to determine the SUV in uncinated process, spleen, pituitary and aorta. Statistical analyses including linear regression were performed.

Results: There are 3 types of distribution, diffuse (most common), focal and multifocal. The distribution pattern has nothing to do with uptake intensity. There is dramatic intrapatient and interpatients variability of the uptake (The average SUVmax for uncinate process is 6.7 ± 8.9, range 1.29-74.59). There is strong positive correlation between the uptake in uncinate process and in pituitary (P = 0.031) with a ratio of approximately 1.0 (6.7:7.0). Otherwise, uncinate uptake is not associated with any other factors such as patient age, gender, creatinine, tracer type (DOTATATE vs DOTATOC), dose, uptake time, and SUVmax in other organs including spleen and aorta.

Conclusion: The distribution pattern and intensity of uptake in uncinate process varies greatly between patients and between scans; the pattern and intensity have no value in differentiating normal from tumor. Pituitary uptake may serve as a reference in judging the nature of uncinated process uptake. Calling disease involvement in uncinate process can only be based on other imaging correlations and/or biopsy results, not the presentation on PET scan.

Address for correspondence:

Dr. Xuexian Yan, Singapore General Hospital, Singapore. E-mail: sean.yan.x.x@sgh.com.sg

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-05: 68Ga-DOTANOC PET/CT Imaging in Detection of Primary Site in Patients with Metastatic Neuroendocrine Tumours of Unknown Origin and its Impact on Clinical Decision Making: Experience from a Tertiary Care Centre in India

Ankur Pruthi, Promila Pankaj, Ritu Verma, Harsh Mahajan

Department of Nuclear Medicine and PET/CT, Mahajan Imaging Centre, Sir Ganga Ram Hospital and Research Centre, Rajendra Nagar, New Delhi, India

Neuroendocrine tumours (NETs) are rare, heterogeneous group of tumours which usually originate from small, occult primary sites and are characterized by over-expression of somatostatin receptors (SSTRs). Positron emission tomography/computed tomography (PET/CT) using 68Ga labeled somatostatin analogues has shown superiority over other modalities for imaging of NETs.

Purpose: To retrospectively evaluate the efficacy of ⁶⁸Ga-DOTANOC PET/CT imaging in detecting the primary site in patients with metastatic neuroendocrine tumours of unknown origin and its impact on clinical decision making in such patients.

Patients and Methods: Between December 2011 and September 2014, a total of 263 patients underwent ⁶⁸Ga-DOTANOC PET/CT study in our department for various indications. Out of them, 68 patients (45 males, 23 females, mean age 54.9 ± 10.7 years, range 31-78 years) with histopathologically proven metastatic neuroendocrine tumours and unknown primary site on conventional imaging underwent ⁶⁸Ga-DOTANOC PET/CT as part of their staging work-up. Histopathology (wherever available) and/ or follow-up imaging with biochemical markers were taken as reference standard. Quantitative estimation of somatostatin receptor (SSTR) expression in the form of maximal standardized uptake value (SUVmax) of detected primary and metastatic sites was calculated. Follow up data of individual patients was collected through careful survey of electronic medical records and telephonic interviews.

Results: Maximum patients presented to our department with hepatic metastasis (50 out of 68 patients) and grade I neuroendocrine tumours (>50%). ⁶⁸Ga-DOTANOC PET/CT scan identified primary sites in 40 out of these 68 patients that is, in approximately 59% patients. Identified primary sites were: Small intestine (19), Rectum (8), Pancreas (7), Stomach (4), Lung (1) and one each in rare sites in Kidney and Prostate. In one patient, 2 primary sites were identified (one each in stomach and duodenum). Mean SUV max of the detected primary sites was 25.1 ± 18.0 (median 16.25, range 2.1-150). Significant positive correlation was found between SUV max of primary tumor and histopathologically proven sites of metastasis (r = 0.662; P < 0.0001). Based on the findings of the ⁶⁸Ga-DOTANOC PET/CT scan, 3 out of 40 patients underwent definitive treatment for their primary tumour (1 gastric, 1 ileal and 1 prostatic tumour). 1 patient was being planned for resection of primary rectal lesion. 32/68 patients were started on long acting somatostatin analogues or chemotherapy or targeted therapy. 1 patient underwent multiple cycles of peptide receptor radionuclide therapy (PRRT) using ⁹⁰Y and ¹⁷⁷Lu labeled somatostatin analogues.

Conclusion: Our findings indicate that ⁶⁸Ga-DOTANOC PET/CT is a promising imaging modality in patients with metastatic neuroendocrine tumours of unknown origin for detection of the primary site and in guiding their therapeutic management.

Address for correspondence:

Dr. Ankur Pruthi, Sir Ganga Ram Hospital & Research Centre, New Delhi, India. E-mail: ankur.pruthi2004@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-06: Peptide Receptor Radionuclide Therapy Proves to be Safe and Immediately Efficient in Elderly Patients with Symptomatic Neuroendocrine Tumors

Heying Duan, Alexander Haug, Stephan Witoszynskyi, Markus Raderer, Martha Hoffmann

Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria

Background: Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogues is a promising treatment modality in patients with neuroendocrine tumors. It is a non-invasive therapy with little side effects which reduces not only tumor size but also hormonal production resulting in symptomatic relief. Although used for several years, little is known about the safety and efficacy of PRRT in the eldery patient.

Methods: 11 patients (8 females and 3 males) aged over 80 years (84 ± 4 years) with a progressing and symptomatic neuroendocrine tumor (6 of the small intestine, 2 of the pancreas, 1 of the stomach, 1 of the appendix) and 1 oxyphillic thyroid carcinoma underwent PRRT with Lu-177 labelled somatostatin analogues. The therapy was given along with nephroprotective (Arginin 25 mg and Lysin 25 mg) and antiemetic agents (Odansetron 8mg). Dosimetry was performed during the first cycle in all patients. 8 patients received 4 cycles, 1 patient 3, and 2 patients 2 cycles.

Results: Prior to the first cycle, 10 patients out of 11 had severe symptoms related to their disease, e.g., flush symptoms, diarrhea, dyspnea. In 6 out of the 10 patients an improvement in the frequency of their flush symptoms and diarrhea started after just one cycle. At the end of the last cycle all patients had a complete relief of tumor associated symptoms. In the conducted blood collections a slight decrease in the leucocytes count was seen after every cycle which improved over time. Kidney parameters were within the normal range during therapy and follow up.

Conclusion: We conclude that Lu-177 PRRT is an efficient and safe, non-invasive therapy for elderly patients suffering from the symptoms of their neuroendocrine tumors.

Address for correspondence:

Dr. Heying Duan, Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Vienna, Austria. E-mail: heying.duan@meduniwien.ac.at

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-07: Complementary Role of Somatostatin Receptor Scintigraphy and Positron Emission Tomography Using F-18 Fluorodeoxyglucose in Selection of the Patients with TENIS Syndrome for peptide radio-receptor therapy

Marina Vlajkovic, Milena Rajic, Milos Stevic, Radan Dzodic, Emil Matovina, Vera Artiko, Milovan Matovic

CNM, Clinical Center Niš, Nis, Serbia

Precise localization of thyroid cancer lesions is essential to decide upon the therapeutic strategy, especially in patients who cannot benefit from radioiodine therapy. The aim of this study is to present the role of somatostatin receptor scintigraphy (SRS) using Tc-99m- HYNIC-[D-Phe1,and positron emission tomography using F-18 FDG as a potential tool for the detection of recurrences in patients with non-iodine avid DTC (TENIS Sy) and to indicate possible selection of these patients for peptide radio-receptor therapy (PRRT) based on imaging results. Study enrolled 7 patients with radioiodine-negative DTC and elevated Tg values (4 women and 3 men, 33–77 years). Patients were followed for 4-11 years after the surgery accompanied by radioiodine ablation. Elevated Tg was detected after 1-5 years following surgery. Patients were subjected to Tc-99m- HYNIC-[D-Phe1, Tyr3-Octreotide] and F-18 FDG PET/CT scan in the period of less than one month. Patients were selected for PRRT if focal accumulation on SRS matched with 18-F-FDG-PET/CT or if more lesions are visualized by mean of SRS than by 18F-FDG PET/ CT scan in the same region. Somatostatin receptor scan was found positive in 6 and FDG in all patients. Five out of 7 patients have meet the inclusion criteria for PRRT and were treated using Y90-D0TA-T0C (one) and dual isotope using Y90-DOTA-TOC/Lu177-DOTA-TATE in 4 patients. Two out of five patients were excluded as a candidate for PRRT. In one of the excluded patient F-18-FDG PET/CT detected more lesions than SRS, while in the other patient SRS and F-18-FDG were found positive but in different anatomical regions. Our results demonstrated that SRS using Tc-99m- HYNIC-[D-Phe1, Tyr3-Octreotide] cannot safely be used as a single marker for assessment of residual and recurrent disease in patients with TENIS sy. The results presented suggest that F-18-FDG PET/CT should be included in diagnostic work up and the decision making in management the patients with TENIS sy.

Address for correspondence:

Dr. Marina Vlajkovic, CNM, Clinical Center Niš, Niš, Serbia. E-mail: vlajkovicm@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-08: Atypical Bronchial Carcinoid: Different Approaches

Llanos Geraldo Roig, Dorota Kendler, Sabine Buxbaum, Irene Virgolini

Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria

Carcinoid tumors most commonly arise in the submucosa of the bronchopulmonary and gastrointestinal tracts. Metastatic disease occurs in 30-50% of patients and approximately 20% have metastatic disease at initial presentation. Atypical bronchial carcinoid tumors are about 10-20% of all neuroendocrine bronchopulmonary tumors (typical and atypical). They are considered much more aggressive, with higher incidence of metastases to liver, bone, adrenal glands or brain at the time of diagnosis. The 5-year survival is 44-78% for all atypical bronchial carcinoids, and 20-30% for patients with poorly differentiated tumors with primary distant metastatic disease. There are an increasing number of treatment modalities that may result in a better quality of life and longer survival (even in the presence of metastatic disease, patients can survive for several years with current treatment strategies). Diagnostic imaging plays a pivotal role in the initial assessment as well as in the monitoring of therapy response. We present the case of two patients aged 74 and 20 years with bronchial carcinoid and extended metastatic disease. The first one was diagnosed in March 2011 with a right pulmonal nodule as well as an ipsilateral hiliar lymphadenopathy, liver and bone metastases (both hepatic lobes, vertebrae, ribs, pelvis and femur). Histology demostrated an atypical bronchial carcinoid with Ki67 Index of 12%. The patient underwent Everolimus therapy from 2011 to 2013, and afterwards Peptide Receptor Radionuclide Therapy (PRRT) with 90Yttrium-D0TAT0C (4 cycles, final activity of 15,69 GBq), achieving stabilisation of the disease. 68Ga-D0TA-T0C PET/CT control always showed the right pulmonar lesion, ipsilateral hilar lymphnode, liver and known bone lesions, all of them without significant morphological or functional changes. Whole body 18F-FDG PET was negative. Nowadays the patient is receiving cold octreotide as interval therapy. The younger patient was diagnosed in 2010 with atypical bronchial carcinoid with a Ki67 Index of maximal 3%. He underwent a left inferior lobectomy with mediastinal lymphadenectomy, as well as a additional resection of tumoral rests. 68Ga-DOTA-TOC PET/CT controls demonstrated multiple diseminated liver metastases in 2012. The patient is receiving long-acting octreotide at present with a stabilisation of the disease. An increasing number of therapeutic options are available for metastatic carcinoid disease. Surgery remains the only curative. The treatment with new tumor-targeted radiolabeled somatostatin analogs is well tolerated, help reduce clinical symptoms, and may help stabilize disease in most patients. The use of 177Lu-octreotate has shown promising results. However, it has side effects like the detriment of renal function. Our second patient is receiving only long-acting octreotide after resection of the primary, with stabilisation of the disease and minimal side effects. In this sense, patient age, renal function and tumor proliferation were taken into consideration for the therapeutic decision.

Address for correspondence:

Dr. Llanos Geraldo Roig, Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria. E-mail: Llanos.geraldo-roig@uki.at

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-09: Response of Urothelial Carcinoma to Peptide Receptor Radionuclide Therapy

Lorenza Scarpa, Margarida Rodrigues, Dorota Kendler, Sabine Buxbaum, Daniel Putzer, Michael Gabriel, Günther Gastl, Irene Virgolini

Department of Nuclear Medicine, Medical University of Innsbruck, Innsbruck, Austria

Somatostatin receptors (SSTR) can be overexpressed in a variety of neoplasms, including neuroendocrine tumors, meningioma, mesenchymal tumors, lymphoma, glioma and, with a low incidence and density, in renal cell carcinoma as well. We report two cases: (1) A 70-year-old male was presented with an incidental lesion in the processus uncinatus which was positive in ⁶⁸Ga-D0TA-T0C-PET. Patient underwent nephrectomy, partial resection of pancreas and splenectomy due to an urothelial carcinoma with pancreatic metastasis. He underwent treatment with ¹⁷⁷Lu-DOTA-TATE (total activity: 14.4 GBq) and stereotactic radiofrequency ablation (SRFA) of liver lesions 7 and 9 years respectively thereafter due to progression of multiple liver metastases. Follow-up (3 years) including ⁶⁸Ga-DOTA-TOC-PET, ¹⁸F-FDG-PET and CT showed nearly complete remission. 2) A 78-year-old male with urothelial carcinoma metastasis after surgical resection of the right kidney, part of the ureter, and bladder, and 3 cycles of chemotherapy was referred for PRRT. He was treated with ⁹⁰Y-DOTA-lanreotide (total activity: 37.38 GBq). Because of adequate PRRT response confirmed with ⁶⁸Ga-DOTA-lanreotide, ¹⁸F-FDG-PET, and MRI, surgical resection of the solitary cervical metastasis was feasible. The patient remains in complete remission (10 years follow-up) from urothelial carcinoma. These cases illustrate the indication of SSTR imaging for diagnosing and the possible value of peptide receptor radionuclide therapy in patients with urothelial carcinoma.

Address for correspondence: Dr. Lorenza Scarpa, Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria. E-mail: lorenza.scarpa@uki.at

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-10: Strontium-89 Chloride in the Palliative Treatment of Patients with Painful Skeletal Metastases

Ljiljana Jaukovic, Sanja Dugonjic, Zoran Jankovic, Dragan Pucar

Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia

Objective: Patients with cancer frequently have skeletal metastases complicated by pain and leading to a deterioration in quality-of-life. The process is mediated by parathyroid hormones, cytokines, and tumor-derived factors. The treatment options include the use of analgesics, external beam radiotherapy, bisphosphonates, chemotherapy, and bone seeking radiopharmaceuticals. Several radiopharmaceuticals as strontium-89, samarium-153 and rhenium-186 were developed for this purpose. Strontium-89 (Metastron®) is a pure beta- emitter selectively absorbed at bone locations with increased osteoblastic activity, used for palliative therapy. The aim of this study was to determine the efficacy and toxicity of strontium-89 chloride in the palliation of painful bone metastases in patients with various malignancies.

Materials and Methods: One hundred and two treatments with strontium-89 chloride were performed in our Institution between 1989 and 2000. We retrospectively analyzed the data of 69 patients (aged 22 to 85 years, middle age 61.2 years) with painful bone metastases due to prostate (44.9%), lung (23.1%), breast (10.1%) and other (21.9%) cancers. Forty five patients received single intravenous dose of Strontium- 89 chloride activity of 148 MBq and 24 patients multiple (up to 4) doses in the average interval of 3.2 months. All patients had an interview using standardized sets of questions before and after therapy for 6 and 12 weeks. Pain relief, consumption of analgesic drugs and improvement of mobility and life quality were used for estimating the effects of therapy (scale 0-5; 0- no effect to 5-excellent effect). Blood counts were taken after three and after six weeks.

Results: Palliative therapy using Strontium-89 chloride showed response rate of over 80%. The effect was described as excellent in 19 (27.5%) patients, and as no effect in 10 (14.5%) patients. Bone pain palliation to some degree (mean 3.37) was induced in the remaining 40 patients. The average duration of palliation after first treatment was 3.7 months. Hematological toxicity was in generally mild, making repetitive treatment relatively safe. Severe hematological toxicity (thrombocytopenia and pancytopenia) was registered only in two patients.

Conclusion: administration of Strontium- 89 chloride was shown as effective in pain palliation without induction of severe side effects. Better effects would be expected in patients under good clinical conditions and life expectancy over three months.

Address for correspondence:

Dr. Ljiljana Jaukovic, Institute of Nuclear Medicine, Military Medical Academy, Belgrade, Serbia. E-mail: lilaj2805@gmaiol.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-11: Cu-64 Prostate-Specific Membrane Antigen Positron Emission Tomography in Prostate Cancer

Siroos Mirzaei, Charlotte Sonneck-Koenne, Peter Knoll

Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria

Aim: Prostate specific membrane antigen (PSMA) is overexpressed in most cases of prostate cancer. The aim of this study is to evaluate the possible role of Cu-64 PSMA PET in patients with prostate cancer.

Patients and Methods: One patient with progressive local disease and five patients with suspected recurrent disease were prospectively enrolled. PET images were performed 1hour in all cases, 3 and 24 hours p.i. in four cases (Siemens, Exact, Knoxville).

Results: In all, but one patient there was at least one focally enhanced tracer accumulation suspicious for recurrent disease. The metabolic suspicious lesions were already visible in the one hour images. The patient with locally progressive disease showed only enhanced uptake in the prostate lobes and no nodal involvement.

Conclusion: The preliminary results of this study demonstrate the potential of Cu-64 PSMA PET in patients with recurrent disease and in primary staging of selected patients with progressive disease.

Address for correspondence:

Dr. Siroos Mirzaei, Institute of Nuclear Medicine with PET-Center, Wilhelminenspital, Vienna, Austria. E-mail: siroos.mirzaei@wienkav.at

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-12: Lactate Dehydrogenase as Predictive Factor of the Pain Free Syndrome Duration after Radionuclide Bone Metastases Treatment in Patients with Breast Cancer

Nigora Rasulova, Dauranbek Arybzhanov, Vladimir Lyubshin, Gayrat Arifhodjaev, Yulia Shakirova, Valery Krylov

Department of Nuclear Medicine, Republic Specialized Center of Surgery, Tashkent, Uzbekistan

Introduction: LDH is involved in tumor initiation and metabolism. Cancer cells rely on anaerobic respiration for the conversion of glucose to lactate even under oxygen-sufficient conditions. According to the literature chemical inhibition of LDH A has demonstrated marked changes in metabolic processes and overall survival carcinoma cells. Chemical inhibition of LDH A has demonstrated marked changes in metabolic processes and overall survival carcinoma cells. However there are controversial data if LDH expression can act as a general marker in the prognosis of cancers? Progression of the primary tumor may lead to progression of the bone metastasis and develop new bone secondaries which lead to appearance of the pain syndrome.

Objective: to estimate if serum LDH level can play a role as predictor of cancer cell activity and proliferation of primary tumor and can prognosis the pain free syndrome s duration after radionuclide therapy.

Materials and Methods: Out of 300 patients who received radionuclide therapy from November 2009 to July 2014 we selected 62 breast cancer patients (29-67 years old, mean age 53.2 #9.5), who received radionuclide therapy due to pain syndrome, with known serum LDH level before Sm-153 oxabifore therapy, known the duration of the pain free period, and without any non-cancer diseases which could influence on LDH level. Sm-153 0xabifore was administrated in standard dose 37MBq/kg of weight. All patients were on bisphosphonate therapy before and after Samarium-153 treatment. Patients were divided into two groups: I group included patients who received Sm-153 oxabifore therapy alone (n = 23) and II group: patients who received radionuclide therapy together with therapy of primary tumore (n = 39). For each group correlation between serum LDH level and duration of the pain free syndrome was estimated.

Results: For group (I), serum LDH level before radionuclide therapy was 284-918 IU/L (mean 633.1#347.8); in group (II) 244-985 IU/L (mean 553.9#189.4). P I-II = 0.13 (t-test). Between the groups there was no statistically significant difference in T and N stages T (I) 2.8#1; T (II) 2.6#0.8 pI-II = 0.3; N (I) 1,36#0.4; N (II) 1.38#0.4; pI-II = 0.9. After radionuclide therapy there was statistically significant pain free period between the groups: group (I) 10.4#8.7 (3-36 months) versus group (II) 24.7#13.9 (5-57.9 months); P I-II = 0.00001(t-test). There was strong negative correlation between serum LDH level and duration of pain free period in group (I) r = −0.84 and no correlation between LDH level and duration of pain free period in group II r = 0.13.

Conclusion: According to our data, in breast cancer patients, serum LDH level can prognosis the duration of the pain free period after radionuclide therapy. Since pain free period in group (II) was significantly longer, LDH level could be useful for choosing patients who may need additional to Sm-153 therapy treatment of primary tumour.

Address for correspondence:

Dr. Nigora Rasulova, Nuclear Medicine Department of Republic Specialized Center of Surgery, Tashkent, Uzbekistan. E-mail: niga_r@mail.ru

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-13: Therapy with 89-Sr in Painful Bone Metastasis Due to Breast Cancer

Raluca Mititelu, Iulia Chiriac, Catalin Mazilu, Sorin Mititelu, Carmen Tipar

Central Universitary Emergency Military Hospital Bucharest, Bucharest, Romania

Aim: To analyze results of treatment with 89Sr performed in our department, at patients with breast cancer and metastatic bone disease.

Materials and Methods: We performed a retrospective review of 13 consecutive patients with breast cancer and widespread bone metastasis which were treated in our department in the past 2 years for refractory bone pain from multiple metastasis. We administered 150 MBq, single dose in 11 cases; in 2 patients a second dose was administered at 6 or 9 months respectively. All patients had a bone scan prior administration of the radiopharmaceutical for demonstrating the osteoblastic component of the bone metastasis. In all patients haematological status and renal function were assessed.

Results: Significant pain relief was seen in 6 patients; 4 patients had moderate response. No response was seen in 3 patients. Most serious side effects were myelosuppression in 5 patients which was mild to moderate; pain flare occurred in 7 patients and correlated well with pain relief.

Discussions: There are few studies on the therapeutic effect of bone seeking agents on pain relief in patients with breast cancer. Efficacy of these agents, particularly of 89-Sr was well documented in osteoblastic metastasis due to prostate cancer. In breast cancer, due to some lytic component of the bone lesions it is possible that efficacy of bone seeking agents is lower; however, with proper selection of patients we have obtained good results in terms of pain relief, reduction of analgesic doses and improvement of life quality.

Conclusions: 89Sr allows significant pain relief in patients with breast cancer and bone metastasis, with controllable side effects and good compliance of patients.

Address for correspondence:

Dr. Raluca Mititelu, Central Universitary Emergency Military Hospital, Bucharest, Romania. E-mail: ralunuclear@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-14: Detection of Bladder Neck Recurrence with Ga68 Prostate-Specific Membrane Antigen Positron Emission Tomography/ Computed Tomography Scans in Post Prostatectomy Patients of Carcinoma Prostate

Vineet Pant, Ishita Sen, Abhinav Singhal

Fortis Memorial Research Institute, Gurgaon, Haryana, India

Introduction: Prostate cancer with bladder neck involvement was initially considered as advanced disease, similar to external sphincter and/or rectal involvement and categorized as pT4 disease. However in recent years several studies have shown that microscopic bladder neck invasion is not an independent predictor of progression after radical prostatectomy, and the prognosis of patients with bladder neck invasion is more dependent on other pathologic features such as extraprostatic extension, seminal vesicle invasion, positive lymph nodes, and positive surgical margins. We present here three patients with isolated bladder neck recurrence on Ga 68 PSMA PET CT scan

Materials and Methods: 9 patients with biopsy proven prostate cancer and rising prostate- specific antigen (PSA) levels after radical prostatectomy were subjected to 68Ga-PSMA positron emission tomography (PET)/CT. Quantitative assessment of tracer uptake was performed 90 minutes post- injection by analysis of maximum standardized uptake values (SUVmax).

Results: 3 of the 9 patients showed evidence of isolated bladder neck recurrence on the PSMA PET CT scans. On retrospectively assessing their post operative histopathology these patients had no other adverse features on initial histopathology except microscopic bladder invasion.

Conclusion: Ga 68 PSMA PET CT scans detect sites of recurrent prostate cancer in the bladder neck with a high sensitivity. This small study suggests that microscopic bladder neck invasion in the prostatectomy sample in prostate cancer may be a significant predictor of bladder neck recurrence.

Address for correspondence:

Dr. Vineet Pant, Fortis Memorial Research Institute, Gurgaon, India. E-mail: dr.vineet.pant@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-15: 68Ga-Prostate-Specific Membrane Antigen Uptake of Pulmonary Metastases in Patients of Carcinoma Prostate: Not a Reliable Tool in Isolation

Vineet Pant, Ishita Sen, Abhinav Singhal

Fortis Memorial Research Institute, Gurgaon, Haryana, India

Introduction and Objective: Lung metastases are rarely a significant factor in the management of prostate cancer. Lung metastases in late-stage prostate cancer are uncommon and have low clinical incidence. The usual pattern of spread is via lymphatic pathways, with pulmonary metastases virtually always occurring with osseous metastases. Solitary or multiple pulmonary metastases from prostate cancer, in the absence of gross osseous or lymphatic involvement, is an unusual presentation and warrants the question of metastasectomy. Recently Ga 68 PSMA PET CT scan is being used in the management of carcinoma prostate, particularly in the setting of metastatic castration resistant carcinoma prostate. Our objective in this study was to evaluate the variable 68 Gallium PSMA uptake in metastatic pulmonary nodule and weather it can be used as a tool to differentiate benign nodule from metastatic ones.

Materials and Methods: 40 patients with biopsy proven Prostate cancer and rising prostate- specific antigen (PSA) levels were subjected to 68Ga-PSMA positron emission tomography (PET)/CT. 10 out of these 40 patients had pulmonary lesions. Quantitative assessment of tracer uptake in pulmonary nodules was also performed 90 minutes post- injection by analysis of maximum standardized uptake values (SUVmax).

Results: 10 out of 40 patients (28%) had pulmonary nodules. All had multiple pulmonary nodules in bilateral lungs. Out of these 10 patients the pulmonary nodules in only 4 patients showed increased ⁶⁸Ga-PSMA uptake (mean SUV Max: 7.8). Out of 6 non ⁶⁸Ga-PSMA avid pulmonary metastases three patients had pulmonary lesion which were more than centimeter in size (4 cm, 3.5 cm and 1.1 cm in diameter respectively). 2 patients who did not have any other systemic disease were subjected for biopsy from the lung mass which was proven as metastasis for the primary carcinoma prostate.

Conclusion: This study suggests metastatic pulmonary nodules in carcinoma prostate show variable ⁶⁸Ga-PSMA avidity. In literature variable PSMA staining has been reported in metastatic pulmonary nodules which may explain variable ⁶⁸Ga-PSMA uptake in these lesions. In this small study we can conclude that ⁶⁸Ga-PSMA avidity in isolation is not a reliable tool to differentiate between metastatic and benign pulmonary nodules.

Address for correspondence:

Dr. Vineet Pant, Fortis Memorial Research Institute, Gurgaon, India. E-mail: dr.vineet.pant@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-16: First Experience of Ra 223 Dichloride Therapy in Latvia

Antra Berzina, Kirils Kravcovs, Ginta Lace

Riga East University Hospital, Riga, Latvia

Incidence of prostate cancer raised up progressively in latvia-958 new patients in 2013 comparing with 822 primary cases in 2007; 885- in 2009 (CDPC data base, www. vm.gov.lv). It is the second major cause of mortality from cancers in men after pulmonary cancer. Prostate cancer is associated with reduced quality of life due to painful metastatic bone disease, causing vertebral body collapse, nerve root compression and pathological fractures. One of the options to manage metastatic bone disease is systemic radiopharmaceutical therapy with alpha particle emitting radium Ra-223 dichloride ( Xofigo). Ra-223 dichloride mimics calcium and selectively targets bone metastases by forming complexes with hydroxyapatite, emits short range alpha particles (<10 cell diameters) minimising damage to surrounding normal tissue, leads to double-strand DNA breaks in tumour cells, resulting in a potent cytotoxic effect on bone metastases.

Clinical Case: 78 years old mail patient suffering from prostate cancer since 2007, with painful progressive bone metastases after hormonaltherapy, therapy with docetaxel, denusomab, abiretarone acetate, bisphosphonates and external beam irradiation. After excluding of visceral metastases (CT thorax, abdomen, pelvis) was sent to Ra223 dichloride therapy. Prior the therapy bone scan detected multiple lesions in vertebrae, pelvis, ribs, cranium and long bones. Haematological evaluation- absolute neutrophil count 3.36 × 10⁹/l; the platelet count 181 × 10⁹/l; haemoglobin 11.8 × 10⁹ g/dl; alkaline phosphatase (ALP) 247 U/l; PSA 584, 7 ng/ml; CEA 16,5 ng/ml 08.04. 2014 the first Ra223 dichloride therapy was performed. Patient received i/v 50 kBq per body weight, 6 injections with interval of 4 weeks. There were no adverse reactions such as nausea, vomiting or diarrhoea. Haematological evaluation was performed before each injection, there were no neutropenia or thrombocytopenia, slightly decreasing of haemoglobin level was observed (10, 8 x 10⁹ g/dl in July and 10,5x 10⁹ g/dl in August). Pain relief efficacy and decreasing of ALP (level normalised in July) and CEA (7, 83 ng/ml in September) levels were observed. PSA level in 2 weeks after the first injection increased till 644 ng/ml (flare phenomena?), but reduced in 4 weeks – 522,9 ng/ml. In August the PSA levels starting increase, in spite of positive dynamic in the bone scan in September (small lesions in the ribs disappeared, significantly decreased metabolic activity in all metastatic foci, no new foci), MRI – tumour (mts) in right side temporal lobe was detected.

Discussions: Systemic radionuclide therapy of bone metastases with Ra-223 dichloride by our very little experience seems to be easy performed, good tolerated and efficient therapy method leading to reducing pain and metabolic activity of metastatic bone disease (ALP and bone scan data). Increasing of PSA level could be caused by flare phenomena or progressive visceral metastatic disease. Due to high cost and no reimbursement performing of Ra-223 dichloride therapy is very limited in Latvia.

Address for correspondence:

Dr. Antra Berzina, Riga East University Hospital, Riga, Latvia. E-mail: dr.antra@inbox.lv

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P2-17: Incremental Role of 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography Over 18 F Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in Imaging of Primary Renal Cell Carcinoma and Evaluation of Its Metastases

Vineet Pant, Ishita Sen, Abhinav Singhal

Fortis Memorial Research Institute, Gurgaon, Haryana, India

Introduction and Objective: Renal cell carcinoma (RCC) is the most lethal of all urologic malignancies with a high metastatic potential. Because RCC tends to cause few symptoms, nearly half of cases are discovered incidentally during the work-up of unrelated complaints. About 25% of patients have stage IV disease at presentation and up to 40% of patients have recurrence after nephrectomy. Although FDG PET CT is a very effective imaging modality in staging a variety of cancers, it currently has a limited role in evaluating renal cell carcinoma. Several have shown that the sensitivity of FDG-PET is inferior to CT and MR imaging in the evaluation of suspicious primary or metastatic renal cell carcinoma. Besides prostate cancer, PSMA has been shown to be expressed in the neovasculature of various solid malignant tumours including cell renal cell carcinoma. Gallium PSMA PET CT may serve as a valuable imaging tool for evaluation of RCC.

Materials and Methods: A patient of multiple brain metastases underwent FDG PET CT for localization of possible primary lesion. FDG PET CT scan showed a heterogeneously enhancing non FDG avid mass at the upper pole of right kidney with metastasis to left 9^th rib and multiple brain metastases. A 68 Gallium PSMA PET CT scan was done for better lesion characterization. Gallium PSMA scan showed intense uptake in the primary renal mass as well as skeletal and brain metastases. Quantitative assessment of tracer uptake in pulmonary nodules was also performed 90 minutes post- injection by analysis of maximum standardized uptake values (SUVmax).

Discussion: We present to our knowledge the first reported case of initial staging of a patient primary RCC with 68Ga-PSMA PET CT. To our knowledge this is also the first case where a lesion by lesion comparison of the primary tumor as well as the metastatic lesions were done for both 18 F FDG and 68 Gallium PSMA PET CT scans. In this case the primary renal cell mass as well as metastatic lesions were better visualized on 68 Gallium PSMA scan. We can conclude that 68 Gallium PSMA PET CT can serve as a potential candidate for the primary staging in RCC and further studies are warranted to evaluate its potential benefit in this field.

Address for correspondence:

Dr. Vineet Pant, Fortis Memorial Research Institute, Gurgaon, India. E-mail: dr.vineet.pant@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

Abstracts - Scientific Poster Session 3: Radiopharmacy/Physics/IGDT/ Miscellaneous: P3-01 Labeled Graphene Oxide Nanostructures: Novel Therapeutic Agents

Seyed Yousef Fazaeli Hoseini Nezhad

Nuclear Science and Technology Research Institute (NSTRI), Karaj, Iran

Graphene oxide (GO) sheets functionalized by aminopropyl groups (8.0 wt%) were labeled by ^198,199Au nanoparticle radioisotopes (obtained through reduction of HAuCl₄ in sodium citrate solution followed by thermal neutron irradiation) for fast in vivo targeting and SPECT imaging of tumors. Using instant thin layer chromatography method, the physicochemical properties of the amino-functionalized GO sheets labeled by ^198,199Au NPs (^198,199Au@AF-GO) were found high enough stable in organic phases, e.g., a human serum, to be reliably used in bioapplications. In vivo biodistribution of the ^198,199Au@AF-GO nanoconposite was investigated in rats bearing fibro sarcoma tumor after various post injection periods of time. The ^198,199Au@AF-GO nanocomposite exhibited a rapid as well as high tumor uptake (with uptake ratio of tumor to muscle of 167 after 4h intravenous injection), resulted in an efficient tumor targeting/imaging. Meantime, the low lipophilicity of the ^198,199Au@AF-GO caused to its fast excretion (~24 h) throughout the body by kidneys (as also confirmed by the urinary tract). Because of the short half-life of ^198,199Au radioisotopes, the ^198,199Au@AF-GO with an excellent tumor targeting/ imaging and fast washing out from the body can be suggested as one of the most effective and promising nanomaterials in nanotechnology-based cancer diagnosis and therapy.

Address for correspondence:

Dr. Seyed Yousef Fazaeli Hoseini Nezhad, Nuclear Science and Technology Research Institute, Karaj, Iran. E-mail: youseffazaeli@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-02: Porphyrin Complexes of 111In: Possible Imaging/PDT Agents

Seyed Yousef Fazaeli Hoseini Nezhad, Ali Sattari

Nuclear Science and Technology Research Institute (NSTRI), Karaj, Iran

Aim: Due to the interesting pharmacological and photodynamic properties of metal-porphyrin complexes and wide range of usage in photodynamic therapy treatment, [ⁿ¹In] labeled 5, 10, 15, 20-tetra phenyl porphyrin ([ⁿ¹In] TPP) was developed as the complex for PDT and SPECT in this work.

Materials and Methods: [¹¹¹In] indium chloride was prepared by 25 MeV proton bombardment of the enriched cadmium-112 target at a 30 MeV cyclotron. [ⁿ¹In]- TPP was prepared using freshly prepared [ⁿ¹In] InC^ and 5, 10, 15, 20-tetra phenyl porphyrin (TPPH 2) for 2 hours at reflux condition. The partition coefficient was calculated for the compound. The biodistribution of the labeled compound in vital organs of rats (normal and tumorous) was studied using scarification studies and SPECT up to 24 h and a detailed comparative pharmacokinetic study was performed for [¹¹¹In] cation and [¹¹¹In] TPP as well.

Results: [¹¹¹In] complex was produced via excellent radiochemical purity (>96% ITLC, >99% HPLC) and the complex was observed to be stable up to 48h at at 37°C.

Conclusion: The results show that a rapid, quantitative preparation of a “carrier-free” [ⁿ¹In] TPP complex is feasible provided that [¹¹¹In] TPP and its homologs could be suitable lead compounds for developing possible SPECT tracers as well as PDT agents, however considering the fast wash-out and the short half life, [ⁿ¹In] can be a suitable candidate for labeling of PDT agents as a tracer for accurate biological evaluation of other PDT agents such as Photofrin and its homologs.

Address for correspondence:

Dr. Seyed Yousef Fazaeli Hoseini Nezhad, Science and Technology Research Institute, Karaj, Iran. E-mail: youseffazaeli@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-03: Radio Synthesis and Preclinical Dosimetric Estimation of [111In] 5, 10, 15, 20-tetra Phenyl Porphyrin Complex as a Possible Imaging/PDT Agent

Seyed Yousef Fazaeli Hoseini Nezhad, Saeed Shanehsazzadeh, Afsaneh Lahooti, Amirreza Jalilian

Nuclear Science and Technology Research Institute, Karaj, Iran

This study describes the preparation, biodistribution and absorbed dose prediction of [¹ⁿIn] labeled 5, 10, 15,20-tetra phenyl porphyrin ([ⁿ¹In] TPP) in human organs, based on biodistribution rats data. After thequality control studies, the final radioactive solution was injected intravenously. Five rats were sacrificed at exact time intervals and the percentage of injected dose per gram of each organ was measured by direct counting from rats data from 12 harvested organs. The Medical Internal Radiation Dose (MIRD) formulation was applied to extrapolate from rats to human and to project the absorbed radiation dose for various organs in humans. From rat data we estimated that injection of [¹¹¹In] TPP into the humans would result in an estimated effective absorbed dose of 0.09 mSv/MBq in the whole body. In conclusion, the skin dose will four times higher compare to the other 111In compounds which was due to magnificent skin uptakes. According to the fast wash-out and the short half life, [111In] can be a suitable candidate for labeling of photo dynamic therapy (PDT) agents as a tracer for accurate biological evaluation of other PDT agents such as Photofrin and its homologs.

Address for correspondence:

Dr. Seyed Yousef Fazaeli Hoseini Nezhad, Nuclear Science and Technology Research Institute, Karaj, Iran. E-mail: youseffazaeli@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-04: Production, Quality Control and Application of 62Zn/62Cu Radio Isotope Generator in Iran

Seyed Yousef Fazaeli Hoseini Nezhad

AEOI, Karaj, Iran

The use of cyclotron produced radiopharmaceuticals offers the chance of non-invasive imaging to improve diagnostic procedures and monitoring therapeutic treatments over the last few decades. Among them, zinc-62 (HL = 6.9 h, EC: 3%, β+: 97%) is a positron-emitting radionuclide which its production and labeling with its daughter radioisotope (⁶²Cu) are of interest. ⁶²Zn is a rather long half life PET radioisotope mostly used in preparation of ⁶²Zn/⁶²Cu generators, but its direct use has been reported in labeling or imaging studies. [⁶²Zn] -bleomycin, [⁶²Zn]-EDDA, [⁶²Zn]-AMD3100 and [⁶²Zn]-laserphyrin® are suggested as possible PET tracer for studies. It is worth mentioning that, because of the decay mode of Zinc-62, it provides copper-62 as daughter radio nuclide, and hence the biological and imaging results originate from both radionuclides. Therefore, this work was focused on the evaluation or the production of the ⁶²Zn/⁶²Cu in high yield (up to 7 Ci) and examination of the new targetry based on the thick electro deposition of natural copper on extra pure gold surface and respective chemical separation. The results showed that this generator can contribute to clinical PET studies as a unique source of Zinc-62 and Copper-62 for labeling purposes.

Address for correspondence:

Dr. Seyed Yousef Fazaeli Hoseini Nezhad, Nuclear Science and Technology Research Institute, Karaj, Iran. E-mail: youseffazaeli@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-05: Production of 103Pd via (n, alpha)-Reaction and Its Separation by Spontaneous Electrodeposition

Imtiaz Abbasi

Pakistan Institute of Nuclear Science and Technology Nilore, Islamabad, Pakistan

Objective: ¹⁰³Pd is a radionuclide used in brachytherapy sources for the treatment of prostate cancers, ocular tumors and is also a candidate for intravascular brachytherapy.[1] Generally, it is produced in cyclotron. Until 2002, more than 10 cyclotrons have been installed in the USA with the exclusive aim to produce ¹⁰³ Pd.[2] Recently a permanent breast seed implant (PBSI) technique has been developed as a new form of adjuvant radiation therapy for early stage breast cancer and the use of ¹⁰³Pd as PBSI has been found safe.[3] ¹⁰³Pd is generally produced either in a cyclotron by proton or deuteron irradiation of rhodium or silver via the ¹⁰³Rh (p, n) ¹⁰³Pd, ¹⁰³Rh (d, 2n) ¹⁰³Pd or ^natAg (p, x) ¹⁰³Pd reaction or with neutron irradiation in a nuclear reactor via the ¹⁰²Pd (n,γ) ¹⁰³Pd reaction. The (n, γ) reaction is not very useful since the achievable specific activity is rather low. Production feasibility studies via ¹⁰⁶Cd (n,a) ¹⁰³Pd process and its separation by spontaneous electrodeposition were pursued and reported in this work.

Materials and Methods: 20 mg of the natural cadmium foil was irradiated at a fast neutron flux density of 7.5 × 10¹³ cm^-2s^-1 for a period of 12 hours for the production of ¹⁰³Pd via the (n,α)-reaction. Thereafter, ¹⁰³Pd was separated by spontaneous electrodeposition using three-chambered cell [Figure 1]. The deposited radioactive palladium was removed by dipping the platinum electrode in nitric acid.

Three-chambered cell for the spontaneous electrodeposition of ¹⁰⁹Pd

Results: Production feasibility studies showed that at a fast flux neutron density of 7.5 × 1013 cm2s^-1 and an irradiation time of 120 h, using 100% enriched 106Cd target 340 MBq of no-carrier-added ¹⁰³Pd per batch can be produced. The method is thus suitable for medium-scale production of this radionuclide. The separation factor achieved was reasonable (1.3 X 106). The process is not sensitive to Cd (NO₃)₂ and HNO₃ concentrations. Deposition velocity (4.119 ± 0.353). 10^-2 min^-1 and deposition constant 0.1211 cm/min were calculated and from the temperature dependence of the deposition velocity constants, the activation energy (0.1155 ± 0.3169 eV) was also determined.

The thermodynamic spontaneity can be satisfied at different concentrations of Pd2 + ions. The process was found to be irreversible giving a highly pure yield of carrier-free 109Pd and/or ¹⁰³Pd [Figure 2].

Effect of the duration on electrodeposition Composition: left half-cell: 1M Cd (NO₃)₂, right half cell: 1M HNO₃+Pd₂+ (various amounts)

Conclusions: Production method of ¹⁰³Pd via ¹⁰⁶Cd (n,a) ¹⁰³Pd is suitable for medium-scale production of the said radionuclide. The method of spontaneous electrodeposition for the separation of ¹⁰³Pd is an attractive technique.This technique needs no external electromotive force. The process was found very simple and needs little manipulation and amenable to automation and remote processing.

Address for correspondence:

Dr. Imtiaz Ahmed Abbasi, Pakistan Institute of Nuclear Science & Technology, Nilore, Islamabad, Pakistan. E-mail: Imtiaz abbasi@yahoo.com

References

1 Cassette P, Bé MM, Jaubert F, Lépy MC. Measurement of a 103Pd solution using the TDCR method by LSC. Appl Radiat Isot 2004;60:439.45.

2 Sudár S, Cserpák F, Qaim SM. Measurements and nuclear model calculations on proton-induced reactions on 103Rh up to 40 MeV: evaluation of the excitation function of the 103Rh (p, n) 103Pd reaction relevant to the production of the therapeutic radionuclide 103Pd. Appl Radiat Isot 2002;56:821.31.

3 Keller B, Sankreacha R, Rakovitch E, O'brien P, Pignol JP. A permanent breast seed implant as partial breast radiation therapy for early.stage patients: A comparison of palladium.103 and iodine.125 isotopes based on radiation safety considerations. Int J Radiat Oncol Biol Phys 2005;62:358.65.

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-06: Production of Glass-Based Microsphere Labeled with 90Y and 198Au for Treatment of Liver Cancer

Hosein Poorbaygi, Shahab Sheibani, Reza Naghdi, Aliakbar Habibpanah, Elham Mohagheghpoor

Nuclear Science and Technology Research Institute, Radiation Applications Research School, Tehran, Iran

Background: Microspheres labeled with therapeutic radionuclides are used for liver cancer. Post-administration visualization of the 90Y-MS is possible through bremsstrahlung SPECT imaging, but the quality is poor. In this work, the effect of doping a gamma emitter such as 198Au in structure of 90Y glass microspheres was investigated for the imaging purposes.

Materials and Methods: (90Y + 198Au)-YAS (Au)-MS was containing two radionuclides, 90Y and 198Au which the ratio activity of 198Au to 90Y was considered 0.2%. It was elaborated through sol-gel method and the results of the preparation of glass-based microspheres labeled with 89Y and 197Au shown that 40% of Y203 and 0.002% of 197Au were incorporated in an alumina-silicate glass. In this technique, gel microspheres directly were formed of sol droplets using oil gelation chamber and spherical glass microspheres with 20 to 50 μm particle size obtained.

Results: The results of the microsphere test with the optical microscope and scanning electron microscope (SEM) confirmed that the microspheres have the desired dimensions [Figure 1]. The result of gamma spectrometry shows level of long-lived impurity was very low and this product safe for patient prescription [Figure 2].

(a) Optical micrograph of the YAS (Au) microspheres were prepared by sol-gel synthesis, (b) Electron micrograph (SEM)

The gamma spectra for (90Y+198Au)-YAS (Au)-MS using γ-spectrometry at 17dayes after E.O.B.

Conclusion: (90Y + 198Au)-YAS (Au)-MS can be located with a gamma camera in nuclear medicine department due to the γ-line which emitted from 198Au and allows SPECT imaging so bio distribution is possible with better resolution.

Address for correspondence:

Dr. Hosein Poorbaygi, Nuclear Science and Technology Research Institute, Radiation Applications Research School, Tehran, Iran. E-mail: hpoorbaygi@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-07: Preparation of 32P Labeled Albumin Particles for Internal Radiotherapy of Refractory Solid Tumors

Shahnaz Tolooee, Hosein Poorbaygi, Shahab Sheibani, Mohammad Mazidi, Mahasti Amoui

Nuclear Science and Technology Research Institute, Radiation Applications Research School, Tehran, Iran

Purpose: Preparing and quality control of 32P labeled albumin particles utilizing in therapeutic methods for inoperable solid tumors with remarkable vascularization.

Methods: A process for preparing 32P labeled albumin particles was developed by combining biocompatible Human Serum Albumin and 32P phosphoric acid salt. Factor affecting the interaction process were investigated and labeling conditions optimized. Several tests for determination of size distribution, shape and radiochemical stability of particles were performed. Bio distribution of the particles was examined after intravenous injection in Wistar rats. Studies for in vivo stability and distribution of the radioactive particles in animals such as mice and rabbits were evaluated with different administration methods.

Results: Optical microscopic examinations revealed that the particles have narrow size distribution with 20-50 µm after sterilization and dispersing in a mixture of normal saline and HSA and or Tween 80 solution. The particles prepared with high radiochemical stability and purity of 99%. Tissue distribution in animals and static images of 32P particles using gamma camera showed that high radioactivity accumulated in the lung as a vascular tumor model.

Conclusions: Albumin 32P particles are useful nuclear medical therapeutic agents for producing localized radiation effect after interstitial injection in remarkable vascularization tumors or in interventional methods.

Address for correspondence:

Dr. Shahnaz Tolooee, Nuclear Science and Technology Research Institute, Radiation Applications Research School, Tehran, Iran. E-mail: ssstolo@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-08: 99mTc-Colloidal Rhenium Sulphide: Influence of Different Generator's Eluates on Fluctuations in Radiochemical Purity

Aljosa Stankovic, Dragana Milakovic, Zvezdana Rajkovaca

Department of Pharmaceutical, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina

Background: 99mTc-colloidal rhenium sulphide (nanocolloid) is an important radiopharmaceutical for lymphoscintigraphy. During quality control of radiochemical purity (RCP), there has been fluctuations between each vial, sometimes with the percentage of impurities greater than 5%. The differences in RCP were also noticed by another radiopharmaceutical, 99mTc-sestamibi, where RCP after reconstitution from nitrate-containing wet-column (NCWC) generator was significantly decreased in comparison with 99mTc-eluate from nitrate-free dry-column (NFDC) generator. Therefore, the aim of our study was to evaluate is there any influence of 99mTc-eluate from these two generators, that are used intermittently, on RCP of Nanocolloid radiopharmaceutical.

Materials and Methods: During two years, Nanocolloid kits (Nanocis-IBA molecular) were prepared reconstituting with 99mTc-eluate obtained from Elumatic III generator-IBA, which is NCWC containing 0.05 mg/mL of sodium nitrate and ⁹⁹Mo/^99mTc-Vinca which is NFDC generator. RCP was determined using Whatman 1 chromatography strip (1 × 10 cm) as the stationary phase and methylethylketone as the mobile phase.

Results: Twenty-eight Nanocolloid kits were prepared with 99mTc-eluate from ⁹⁹Mo/^99mTc-Vinca generator and average RCP was 95.85% (9 of 28 kits were below 95%). The same number of Nanocolloid kits were prepared with Elumatic III generator-IBA and average RCP was 95.35% (11 of 28 kits were below 95%). The vials with the same batch number had fluctuations in RCP from 89% till 99%.

Conclusions: Eluates from both NCWC and NFDC generators did not have influence on fluctuations in RCP of 99mTc-colloidal rhenium sulphide, because there was no significant difference in RCP (0.5%) between the vials reconstituted with eluates from both generators. The difference in RCP between the vials with the same batch number, pointed that other factors such as use of hypodermic needle, heating temperature, technologist's skills, have influence on RCP of Nanocolloid. Influence of those factors should be examined in the future.

Address for correspondence:

Dr. Aljosa Stankovic, Pharmaceutical Department, University Hospital Clinical Center, Banja Luka, Bosnia and Herzegovina. E-mail: aljosa.stankovic@kc-bl.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-09: Development of Radiopharmaceutical Based on Heat-Sensitive Polymer and 153Sm for Local Therapy

Vladimir Duflot, Nikolay Bolbit, Tatyana Altynnikova

Branch of Karpov Institute of Physical Chemistry, Obninsk, Russian Federation

Introduction: Operating principal. The presented radiopharmaceutical is based on the usage of heat-sensitive copolymer N-isopropylacrylamide as a radionuclide carrier, aqueous solutions of which have a thermotropic phase transition at the temperature close to the temperature of human body.[1] Injected next to a solid tumor or into a tumor the aqueous solution of the radiopharmaceutical upon reaching the temperature of a human body turns into dense polymeric coagulate which provides strong loss of translation mobility of poly-N-isopropylacrylamide macromolecules and tied radionuclides. As a result, sources of local therapeutic irradiation are formed at the site of injection. Complex of some development works based on the above mentioned principle is described in several patents of Battelle Corporation.[234] Description: Procedure. Allylamine units are compounded into macromolecules composition at the stage of synthesis through which as a result of esterification with polymeric chain macromolecules are chemically bound with molecules of diethylene triamine pentaacetic acid (DTPA). Trivalent radioactive cations ¹⁵³Sm³⁺ due to complexing reaction are captured by DTPA with forming of stable complexes.

Results: Performed studies allowed to synthesize polymer carries of various molecular weights (10⁴-10⁵ D) and content of linker units (0.5–5 mol. %); on the basis of these carries radiopharmaceuticals with radioactivity of 10-100 MBq/ml, radiochemical purity more than 95% and heat stability over three days at the temperature of 37°C were produced. Solutions of the radiopharmaceutical have low viscosity (20–50 mPa s) at the room temperature, which is eligible for sampling with an injection syringe with a standard needle; and at the temperature of 37°C experience reversible transformation into a thermoelastic gel with modulus of rupture ~ 10⁴ Pa. Pre-clinical trial is next in turn. Conclusions: The developed radiopharmaceutical can be applied for endoradiotherapy of solid tumors or for target therapy of cancer cells of thyroid gland, prostate, malignant lymphoma. Potential additional application areas should be considered in case of expansion of thermocollapsing radiopharmaceutical nomenclature by replacing radionuclides, for example, ¹⁵³Sm can be replaced with ⁹⁰Y or ¹⁸⁸Re.

Address for correspondence:

Dr. Vladimir Duflot, Branch of Karpov Institute of Physical Chemistry, Obninsk, Russian Federation. E-mail: duflot@karpovipc.ru

References

1. Galaev IY. Smart polymers in biotechnology and medicine. Usp Khim (Prog Chem) 1995;65:505.24.

2. Stimulus Sensitive Gel with Radioisotope and Methods of Making; US 6,869,588.

3. Thermogelling Oligopeptide Polymers; US 7,087,244.

4. Multiple Stimulus Reversible Hydrogels; US 7,033,571.

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-10: Preparation of Radioresistant Therapeutic Radiopharmaceutical ¹³¹I-MIBG

Vitaliy Pozdeev, Yuriy Kuptsov

Branch of Karpov Institute of Physical Chemistry, Obninsk, Russian Federation

Introduction: Therapeutic radiopharmaceutical Iodine-131 metaiodobenzylguanidine (131I-MIBG) is widely employed in radionuclide therapy for neuroendocrine tumors such as neuroblastoma, paraganglioma and malignant phaeochromocytoma.[1] Therapeutic dose of 131I-MIBG ranges within 100 to 300 mCi. At such level of the activity at room temperature the self-radiolysis occurs, and the formed amount of radioiodine exceeds the level allowed by EPh.[2] In this connection, the transportation and storage of the radiopharmaceutical is carried out at dry-ice temperature or the drug is doped with radioprotectors such as benzyl alcohol or p-hydroxybenzoic acid.[3] This paper describes the preparation process of 131I-MIBG in the solid state under argon resistant to self-radiolysis.

Description: The interchange between 127I of MIBG cold molecule and 131I of sodium iodide was performed with solid phase method[4] over catalytic additives of ammonium sulphate at the temperature of 155°C under argon atmosphere.

Procedure: In serum vial ammonium sulphate (10 mg) and “cold” MIBG (2 mg) were dissolved in 2 ml of water and then 5 ml of 1 N sodium alkali solution was added. The vial was corked with a rubber plug and rolled with aluminum cap. Via a syringe 100 mCi of sodium [131I] iodide solution in 0.1 N NaOH (0.5 ml) was added into the vial. Two needles were inserted in a rubber plug, and the vial was purged with high-purity argon through these needles. The vial was heated for 30 minutes under argon at the temperature of 155°C till complete water dissection. The vial was cooled; 5 ml of water was added second time to dissolve the residue, and the procedure of heating to dryness under argon was repeated, a thin layer of residue at the bottom of the vial was formed. The residue was cooled under argon to the room temperature; the needles were removed from the rubber plug. The preparation in the form of residue under argon can be storage and carried at the room temperature.

Results: The table gives the data on radiochemical purity at different conditions for interchange reaction. What causes the decrease of radiation effect of 131I beta-radiation? First, when passing from III to II the radiation-sensitizing effect of oxygen is excluded,[5] second, when passing from II to I the interaction between water radiolysis products and the substance is excluded; and third, the residue thickness at the bottom of the vial is less than 0.3 mg/cm2 so beta particles lose most part of the energy under argon.

Conclusions: The developed method of radiopharmaceutical 131I-MIBG production enables to carry and storage it at the room temperature. The proposed composition can be changed into a drug formulation “on site” in clinics by its dilution in physiological solution immediately before treatment.

Address for correspondence:

Dr. Vitaliy Pozdeev, Branch of Karpov Institute of Physical Chemistry, Obninsk, Russian Federation. E-mail: vvp@karpovipc.ru

References

1. Grünwald F, Ezziddin S 131I.metaiodobenzylguanidine therapy of neuroblastoma and other neuroendocrine tumors. Semin Nucl Med 2010;40:153.63.

2. Iobenguane Sulfate for Radiopharmaceutical Preparation, European Pharmacopoeia. 8.0, 01; 2010. p. 2351.

3. Prabhakar G, Mathur A, Shunmugam G, Teje YD, Sachdev SS, Sivaprasad N. Efficient production of therapeutic doses of [131I]-metaiodobenzylguanidine for clinical use. Appl Radiat Isot 2011;69:63.7.

4. Mangner TJ, Anderson.Devis H, Wieland DM, Swanson DP. Nucl Med 1983;24:118.

5. Hall EJ, Giaccia AJ. Radiobiology for the Radiologist. 6th ed.. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 546.

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-11: Our Approach to Development of Safety System for Monitoring and Prevention of Unauthorized Desertion of the „Restricted Area” by Patients Treated With High Doses of Radionuclide Therapy

Milovan Matovic, Marija Jeremic, Slobodan Jankovic, Miroslav Ravlic, Marina Vlajkovic

Department of Nuclear Medicine, Clinical Center Kragujevac and Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

Background: Following radionuclide therapy, the patients usually must remain hospitalized in the special restricted access premises (“restricted area”) until radiation in their bodies drops below a certain level defined by law. Despite strict instructions given to them by physician and nurse before administration of radionuclide therapy, the patients often try to leave “restricted area”. In order to achieve prompt alarming of the personnel when such case occurs, and be able to provide adequate measures, we have developed special alarming system.

Subjects and Methods: We developed a system which continuously monitors on-line the corridor which a patient must use in case of an attempt to leave the special restricted access premises. Our system consists of a survey meter equipped with pancake probe directed towards the corridor. The survey meter is connected to a trigger circuit which gives signal in the case when the count rate exceeds previously adjusted value. Trigger circuit is connected to the programmable siren, blinking light, alarm device unit with SIM card and IP surveillance camera. On the siren we previously recorded the voice alarm (such as “Attention, attention, this premise you should not leave! Please return, immediately”). In the case when the siren is triggered the patient will hear this message and see blinking. When the alarm device is triggered it will call responsible physician and nurse on mobile phone. The IP camera is simultaneously triggered, too, and records this event. The data about each event are accessible via LAN, Internet and mobile phone, too.

Results: We used this original safety system for more than 100 patients who received radionuclide therapy during the last few months. There were only a few interventions based on warnings produced by activation of our safety system; in all cases the personnel reacted adequately and stopped the attempts of the patients trying to leave the “restricted area”, preventing endangerment of other patients and the health of personnel.

Conclusion: From our experience gained over the past few months, this safety system for monitoring of the patients receiving high doses of radionuclide therapy ensures a high level of safety for both personnel and the patients.

Address for correspondence:

Dr. Milovan Matovic, Department of Nuclear Medicine, Clinical Center Kragujevac and Faculty of Medical Sciences, University of Kragujevac, Kragujevac , Serbia. E-mail: mmatovic1955@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-12: A Pilot Study on Post-SIRT Survival among Patients with Hepatocellular Carcinoma: A Single Institution Experience

Eric B. Cruz

St. Luke's Medical Center, Quezon City, Philippines

Objective: To evaluate the survival of patients with hepatocellular carcinoma (HCC) who underwent selective internal radiation therapy (SIRT) using Yttrium-90 SIR-Spheres microspheres at St. Luke's Medical Center in Quezon City and Bonifacio Global City from October 2009 to February 2013.

Materials and Methods: A retrospective pilot cohort study using chart review of HCC patients who underwent SIRT at St.Luke's Medical Center in Quezon City and Bonifacio Global City from October 2009 to February 2013. Kaplan-Meier survival analysis was done on 11 patients who were eligible for the study.

Results: Of the 11 included patients, five were still alive as of October 31, 2013. Kaplan-Meier analysis showed a median overall survival of 15.0 months (45.0 ± 17.43% probability), a median time to tumour progression of 11.5 months (34.6 ± 17.59% probability), and a median time to liver function deterioration of 3.88 months (45.0 ± 15.65% probability). There was a 100% survival rate during the first three months after SIRT. These results coincided with the experience of several hospitals internationally as reported in published literature.

Conclusions: Thus, current SIRT practice at St. Luke's Medical Center affords patients an improvement in survival that is at par with other centres elsewhere in the world.

Address for correspondence:

Dr. Eric B. Cruz, St. Luke's Medical Center, Quezon City, Philippines. E-mail: ericeric980@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-13: The Rare Case of Extraneural Metastasis of Cerebellar Medulloblastoma Detected by 18-F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

Lucia Kaliska, Martin Spurny, Marika Vereb, Pavol Bician

Institute of Nuclear and Molecular Medicine, Banska Bystrica, Slovakia

Background: Medulloblastoma is the most common aggressive central nervous system (CNS) tumor in children, with early dissemination throughout the CNS and rarely to extraneural tissues as well. In case of localised disease, the 5-year survival rate is approximately 80%. After primary treatment, follow-up imaging studies are indicated for early identification of recurrent disease and initiation of salvage treatment in order to prolong survival while maintaining good quality of life. 18F-FDG PET/CT as a sensitive whole body imaging modality might be useful in identification of distant metastases of medulloblastoma and also in monitoring of therapy response.

Case Report: Herein we report a case of an 11-year-old boy with average-risk medulloblastoma in midline vermis, treated two years ago by surgery, craniospinal irradiation and radiation boost to the postrerior fossa in conjunction with chemotherapy. Three months after completion of treatment, the foci of recurrent disease were identified by MRI in left frontal lobe and in spinal canal. Postsurgery histology of left frontal lesion revealed metastasis of embryonal neuroepithelial tumor, anaplastic subtype, also neuroblastoma could not be excluded. Further radiotherapy was added and the patient was planned for 2^nd line of chemotherapy with new antiangiogenetic therapy according to MEMMAT protocol. However, two months after completion of radiotherapy the mass in left neck area have appeared. Histology from lymph node excision confirmed metastasis of immature embryonal tumor, most likely anaplastic variant of medulloblastoma. To restage the disease 18-F FDG PET/CT and 123-MIBG scans were performed.

Results: While 123-MIBG study was completely negative suggesting non-neuroblastoma origin of lesions, 18-F FDG PET/CT showed extensive metastatic disease with multiple FDG avid lesions through bone marrow and in left cervical and left supraclavicular lymph nodes. After 18-F FDG PET/CT, palliative treatment was scheduled. Follow-up 18-F FDG PET/CT examination confirmed further progression of disease on on-going therapy.

Discussion: MRI plays a major role in initial staging, grading and prognostic evaluation of medulloblastoma. 18F-FDG PET/CT is not routinely performed in re-staging of medulloblastoma, however, as in this case, it may be useful to identify distant metastatic spread and to warrant adequate therapy. 18-F FDG PET/CT might became the modality of choice in post therapeutic follow-up of high-risk medulloblastoma, but value of systematic 18F-FDG PET/CT in post therapeutic evaluation of high risk medulloblastoma has never been studied. It can be speculated, whether it can also play a role in monitoring the therapeutic response of metastatic medulloblastoma or in prediction of therapeutic failure. To our best knowledge, only one similar case was published so far.

Address for correspondence:

Dr. Lucia Kaliska, Institute of Nuclear and Molecular Medicine, Banska Bystrica, Slovakia. E-mail: lucia.kaliska@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-14: Metabolic Volumetric Parameters in Prediction of Outcome after Chemo-Radiotherapy in Nasopharyngeal Carcinoma

Archi Agrawal, Venkatesh Rangarajan, Sarbani Laskar, Harish V, Nilendu Purandare, Sneha Shah, Ashish Jha

Tata Memorial Hospital, Mumbai, Maharashtra, India

Objective: To evaluate the best metabolic volumetric parameter for prediction of response and thus outcome assessed with 18F–fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging in patients with nasopharyngeal cancer, who were treated with chemo-radiotherapy.

Materials and Methods: This was a retrospective analysis of patients with biopsy proven nasopharyngeal cancer. All patients included in the analysis underwent a pretreatment FDG PET/CT study and a second FDG PET/CT study 6-8 weeks after completion of chemo-radiotherapy. The PET/CT parameters evaluated were maximum standardized uptake value (maxSUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). The threshold for maxSUV above 2.0 was used for calculation of MTV. All these parameters were evaluated both for pretreatment and post treatment scans.

Statistical Analysis: Univariate and multivariate analysis was done using Cox regression analysis to look for association between PET parameters and disease free and overall survival.

Results: 32 patients of nasopharyngeal carcinoma were included in this study. There were 10 females and 22 males. The median follow up was 30 months (range 16-47 months). The age range was 18-68 years. All patients were treated with chemo-radiotherapy. On univariate analysis, the post treatment MTV was found to be the best and significant predictor of overall survival (OS) [hazard ratio 1.046, 95% CI 1.007-1.085, P < 0.021] and Disease free survival (DFS) [hazard ratio 1.045, 95% CI 1.006-1.087, P < 0.023]. The pretreatment MTV, TLG and post treatment TLG had no impact on overall survival and disease free survival.

Conclusion: Post treatment metabolic tumor volume is the best predictor of outcome in nasopharyngeal cancer and is an important surrogate for risk stratification.

Address for correspondence:

Dr. Archi Agrawal, Tata Memorial Hospital, Kolkata, India. E-mail: drarchi23@hotmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-15: Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-One Stop Test for Patients with Breast Cancer Recurrence

Sadaf Jabeen, Saima Riaz, Humayun Bashir, Imran Khalid Niazi

Department of Radiology and Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan

Objective: To evaluate the impact of F18-FDG PET-CT in staging of recurrent Breast cancer.

Materials and Methods: Retrospective analysis of F18 FDG PET-CT scan acquired for staging patients with recurrence of breast cancer during period of September 2009 to December 2014.

Results: The data set included 31 (91.2%) females and 3 (8.8%) males with an average age of 52 years [±12.4 SD]. Invasive ductal carcinoma was identified in 91% and Invasive lobular cacinoma in 9% patients. Overall, PET-CT was positive in 29 (85.3%) cases. No morphological or metabolic disease was identified in 5 (14.7%) cases. Out of positive PET-CT scans 24 (70.6%) had local recurrence while distant nodal metastasis were identified in 15 (44.1%), bone metastasis in 10 (29.4%) and visceral metastasis in 14 (41.2%). Sites of nodal metastasis included, mediastinal nodes [n = 11], abdominal nodes [n = 2] and mediastinal plus abdominal nodes [n = 2] Visceral metastasis involved liver [n = 6], brain [n = 2], adrenal gland [n = 1], pulmonary nodules [n = 4] and pleural effusion [n = 1]. One had non-avid esophageal mass. 20 patients underwent biopsy after PET-CT scan. 16 (80%) were positive (true positive) for local recurrence/metastases. 3 showed non-malignant benign histopathology (false positive). One non-avid esophageal finding turned esophageal carcinoma on biopsy as second primary (false negative). Overall accuracy of restaging PET-CT scan in breast cancer was 80%. On follow-up, out of 29 patients with positive PET-CT scan 2 (5.9%) become disease free, 5 (14.7%) showed clinical improvement, 7 (20.6%) had disease progression and 7 (20.6%) had died. One developed second primary, prostate Ca. 7 (20.6%) were lost to follow-up. Seven patients with negative PET-CT scan remained disease free on follow up.

Conclusion: F18-FDG PET-CT is a useful one-stop scan for staging patients with recurrent breast cancer.

Address for correspondence:

Dr. Sadaf Jabeen, Shaukat Khanum Memorial Cancer Hospital & Reseach Center, Lahore, Pakistan. E-mail: sadaf_jabeen2001@yahoo.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-16: Positron Emission Tomography/ Computed Tomography in the Evaluation of Primary Liver Carcinoma; Local Experience

Muhammad Numair Younis, Hamid Naseer, Afshan Ashfaq, Ahmad Qureshy, Misbah Masood, Abubaker Shahid

Institute of Nuclear Medicine and Oncology, INMOL, Lahore, Pakistan

Purpose: PET-CT at INMOL hospital Lahore is available since January 2011. Patients undergo PET imaging for oncological indications, including patients of hepatoceullar carcinoma (HCC). The study is prospective observational study to evaluate the patterns of FDG PET Scans in patients of HCC and suggest possible role of PET imaging.

Materials and Methods: Patients referred for FDG PET scan, over a period of six months, bearing a confirmed diagnosis of HCC were enrolled in the study including adult population irrespective of the gender. All the patients underwent PET scan 45–60 minutes after 7-10 mci of F-18 FDG injected intravenously. The imaging was performed at GE PET Scanner hybrid with 16 slices CT. Data was analyzed using software SPSS version 17.0.

Results: Among 23 patients 84% were males and 16% were females, with 95% above 45 years. Of 23 patients, 25% patients were referred for staging of HCC before transplant surgery. 60% were referred for post TACE evaluation, suspected of recurrence. Remaining 15% patients underwent PET scan for follow up evaluation after surgery or therapies. There has been heterogeneous pattern of FDG uptake in HCC lesions ranging from minimal to high degree in reference to mediastinum activity. The Standardized Uptake Values (SUV) ranged from 0.9 to 4.9 with a mean value of 3.1. 15% patients did not show any significant FDG activity in the primary lesion however there was FDG activity in the local nodal and distant sites.

Conclusion: 0ur study suggests that a significant HCC patient population in local settings show FDG avidity. PET scan may have a role in the evaluation of such patients, prior to the local or systemic therapy and liver transplant.

Address for correspondence:

Dr. Muhammad Numair Younis, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan. E-mail: dr.numair@gmail.com

World J Nucl Med. 2015 Apr;14(Suppl 1):S68–S102.

P3-17: Tumour Polypeptide Specific Antigen Serology in Cancer Management

Padmamalika Hazra, Daya Hazra, Gita Jaiswal

Department of Chemistry, St. John's College, Agra, India

Aims: To delineate the value of TPS estimation in Cancer Management. TPS (Tumour polypeptide Specific Antigen (TPS) is a specific antigen recognised by the M3 mouse monoclonal, isolated by Prof Bertil Bjorklund, President, Swedish Cancer Council, in 1987 from the crude antigen mixture TPS earlier prepared by him from various tumour precipitates and studied by him using polyclonal antiserum. TPS is a Tumour antigen which unlike classical antigens reflects proliferation rather than tumour mass.It is a sensitive indicator of tumour recurrence.

Methods: As part of long term studies on in Cancers in North India 68 cases of Head and Neck Cancers were studied. This is a major problem because of widespread exposure to tobacco not merely in the form of smoking as in the West but also as tobacco chews, and tobacco containing dental powders. The Mainpuri district of Agra in the hinterland of the S N Medical College, Agra is notorious for a peculiar strong addictive blend of tobacco with other irritants and habit forming additives, called Mainpuri tobacco. This results in one of the world's highest frequency of oropharygeal cancers. These 68 subjects included 40 seen before treatment, 16 cases post treatment and 12 cases before and after treatment.

Results: A significant correlation was observed not only with anatomical stage and histological grade, but also to response to therapy, classified according to UICC/WHO criteria as Complete Remission, Partial Remission, Static disease, Progressive Disease and Recurrence.

Conclusions: It is clear that serial TPS estimation may have a major role in personalised medicine in cancers giving early warning of recurrence. Generalising , from this series as well as the data from other tumours reported by earlier workers, possible roles in cancers of proliferation related tumour markers include answering the following questions: (a) Is a particular tumour present, and if so, are metastases likely to have already occurred, (b) is the lesion diagnosed clinically or by imaging a tumour or a benign variant such as fibroadenosis in the breast or benign hyperplasia in the prostate/or a non tumour condition such as tuberculosis ubiquitous in developing countries such as India, (c) if precancerous such as leukoplakia or metaplasia, is it progressing towards cancer or has it been arrested by interventions such as antioxidants, eschewing tobacco etc., (d) whether cancer is arising in a particular individual belonging to a high risk population such as those subjects who have a Hepatitis B or a human papilloma virus infection, (e) if a cancer is it one which can be merely watched e.g., a slow growing lymphoma or an aggressive variant demanding immediate therapy, (f) if definitely cancer, what is the prognosis in terms of likely course and response to particular therapy regimes, (g) if a particular therapy or intervention regimen has been started , is the cancer responding to therapy, or should one switch to a different chemotherapy/radiotherapy/ immunotherapy, allowing an early decision rather than losing time and money and suffering avoidable toxicity by deciding months later by clinical/imaging assessment that the current regime has failed, (h) If a patient has been cured, diagnose recurrence reliably and with a lead time well ahead of the appearance of clinical lesions, and (i) if suspicious shadows are seen during followup, are they cancers or postradiation shadows or infective lesions such as tuberculosis?

Acknowledgement: Support of the Indian Council of Medical Research is gratefully acknowledged.

Address for correspondence:

Dr. Daya Hazra, Innovative Cancer Therapy and Research Foundation, S N Medical College, Agra, India. E-mail: Dr_Hazra@yahoo.com

PERMALINK

Abstracts - Scientific Poster Session 1: Thyroid

P1-01 Blood Neutrophil-to-Lymphocyte Ratio Correlates With Tumor Prognosis in Patients with Papillary Thyroid Cancer

P1-02: Enhance Retention of Radioiodine in Thyroid Cancer Cells and Non-Thyroid Cancer Cells by PAMAM-Ag+

P1-03: Thyroid Carcinoma Detected by Incidental 18F-FDG Uptake in a Patient with Progressive Cerebellar Syndrome: A Case Report

P1-04: Prognostic Value of Thyroid Volume Changes in Hyperthyroidism Response to Radioiodine Therapy (A Preliminary Report)

P1-05: Did Standard Activities of Radio-Iodine 131I Useful in the Treatment of Multiple Bone Metastasis from Differentiated Thyroid Carcinoma

P1-06: Nonthyroidal Malignancies in Patients with Differentiated Thyroid Carcinoma

P1-07: Carum Carvi Ingestion May Increase TSH Level in Patients with Thyroid Cancer

P1-08: Incidental Thyroid Carcinoma: Should Surgery or Radioiodine Therapy be the Initial Management for Graves’ Disease with Multinodular Goitre?

P1-09: Tailoring Therapy for Benign Thyroid Disease in Private Practice

P1-10: Low Expression of Natrium lodida Symporter and Thyrotropin Receptor in Cases of Papillary Thyroid Carcinoma with Mutant B-Raf through the Role of TGF-β: It‘s Implication in the Management of Papillary Thyroid Carcinoma

P1-11: Clinical Outcome of Patients with Recurrent Well Differentiated Thyroid Carcinoma

P1-12: Salivary Gland Malignancy as a Late Complication of Radioiodine Therapy

P1-13: Prescription of Iodine-131 (131I) for Treatment of Differentiated Thyroid Carcinoma – What Changed in 10 Years: A Retrospective Analysis

P1-14: Psycho – Social Aspects of Thyroid Cancer Patients in Bangladesh

P1-15: Test of 24-Hour 131-I Uptake in Patients with Autonomous Follicular Toxic Adenoma and Multinodular Toxic Goiter with Disseminated Autonomy; Impact of the Salt lodination and the Possible Influence on the Radioiodine Therapy Planning

P1-16: Incidence of Second Primary Malignancy in Patients Treated With Ablative I131 Doses

P1-17: A Case of Basedow-Graves Thyrotoxicosis Associated With the Follicular Variant of Papillary Carcinoma

P1-18: Comparison of Post Operative 99mTc Pertechnetate Scan and Post Ablative 131I Scan for the Management of Differentiated Thyroid Carcinoma

P1-19: Do All Patients with Raised Thyroglobulin Need Treatment in TENIS Syndrome?

P1-20: Recurrent Differentiated Thyroid Cancer: Analysis of Factors and Causes

Table 1.

Table 2.

Table 3.

Table 4.

Table 5.

Table 6.

Table 7.

P1-21: Effect of Single Dose of Radioiodine Therapy on Volume Reduction of Thyroid Gland in Hyperthyroidism

P1-22: Clinical Outcome of Radioiodine Therapy in Adolescent Hyperthyroidism: Single Centre Experience

P1-23: Serum Thyroglobulin Kinetics as the Predictor of Differentiated Thyroid Carcinoma Treatment Outcome

P1-24: Correlation Between Serum Tg-on and Persistent Disease in Patients with Well Differentiated Thyroid Carcinoma

P1-25: Incremental Value of Regional Single-Photon Emission Computed Tomography-Computed Tomography While Performing Whole Body I-131 Scan of the Patients Suffering from Differentiated Thyroid Cancer - Its Impact on Clinical Decision Making

Abstracts – Scientific Poster Session 2: Personalized Medicine: Peptide Receptor Radionuclide Therapy, Prostate Cancer: P2-01 The First Meta-Iodobenzylguanidine Therapy in the Philippines

P2-02: Experience and Results of 38 Patients After 177Lu-Octreotate Therapy in the Federal Capital of Brazil

P2-03: Response Time Pattern (Delayed Response) after PRRT with [177Lu-DOTA]- D-Phe1-Tyr3-Octreotide (177Lu-DOTATOC)

P2-04: Uptake of 68Ga-DOTA-Conjugated Peptides in Uncinate Process of Pancreas - Characteristics and Clinical Significance

P2-05: 68Ga-DOTANOC PET/CT Imaging in Detection of Primary Site in Patients with Metastatic Neuroendocrine Tumours of Unknown Origin and its Impact on Clinical Decision Making: Experience from a Tertiary Care Centre in India

P2-06: Peptide Receptor Radionuclide Therapy Proves to be Safe and Immediately Efficient in Elderly Patients with Symptomatic Neuroendocrine Tumors

P2-07: Complementary Role of Somatostatin Receptor Scintigraphy and Positron Emission Tomography Using F-18 Fluorodeoxyglucose in Selection of the Patients with TENIS Syndrome for peptide radio-receptor therapy

P2-08: Atypical Bronchial Carcinoid: Different Approaches

P2-09: Response of Urothelial Carcinoma to Peptide Receptor Radionuclide Therapy

P2-10: Strontium-89 Chloride in the Palliative Treatment of Patients with Painful Skeletal Metastases

P2-11: Cu-64 Prostate-Specific Membrane Antigen Positron Emission Tomography in Prostate Cancer

P2-12: Lactate Dehydrogenase as Predictive Factor of the Pain Free Syndrome Duration after Radionuclide Bone Metastases Treatment in Patients with Breast Cancer

P2-13: Therapy with 89-Sr in Painful Bone Metastasis Due to Breast Cancer

P2-14: Detection of Bladder Neck Recurrence with Ga68 Prostate-Specific Membrane Antigen Positron Emission Tomography/ Computed Tomography Scans in Post Prostatectomy Patients of Carcinoma Prostate

P2-15: 68Ga-Prostate-Specific Membrane Antigen Uptake of Pulmonary Metastases in Patients of Carcinoma Prostate: Not a Reliable Tool in Isolation

P2-16: First Experience of Ra 223 Dichloride Therapy in Latvia

P2-17: Incremental Role of 68Ga-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography Over 18 F Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in Imaging of Primary Renal Cell Carcinoma and Evaluation of Its Metastases

Abstracts - Scientific Poster Session 3: Radiopharmacy/Physics/IGDT/ Miscellaneous: P3-01 Labeled Graphene Oxide Nanostructures: Novel Therapeutic Agents

P3-02: Porphyrin Complexes of 111In: Possible Imaging/PDT Agents

P3-03: Radio Synthesis and Preclinical Dosimetric Estimation of [111In] 5, 10, 15, 20-tetra Phenyl Porphyrin Complex as a Possible Imaging/PDT Agent

P3-04: Production, Quality Control and Application of 62Zn/62Cu Radio Isotope Generator in Iran

P3-05: Production of 103Pd via (n, alpha)-Reaction and Its Separation by Spontaneous Electrodeposition

Figure 1.

Figure 2.

P3-06: Production of Glass-Based Microsphere Labeled with 90Y and 198Au for Treatment of Liver Cancer

Figure 1.

Figure 2.

P3-07: Preparation of 32P Labeled Albumin Particles for Internal Radiotherapy of Refractory Solid Tumors

P3-08: 99mTc-Colloidal Rhenium Sulphide: Influence of Different Generator's Eluates on Fluctuations in Radiochemical Purity

P3-09: Development of Radiopharmaceutical Based on Heat-Sensitive Polymer and 153Sm for Local Therapy

P3-10: Preparation of Radioresistant Therapeutic Radiopharmaceutical 131I-MIBG

P3-11: Our Approach to Development of Safety System for Monitoring and Prevention of Unauthorized Desertion of the „Restricted Area” by Patients Treated With High Doses of Radionuclide Therapy

P3-12: A Pilot Study on Post-SIRT Survival among Patients with Hepatocellular Carcinoma: A Single Institution Experience

P3-13: The Rare Case of Extraneural Metastasis of Cerebellar Medulloblastoma Detected by 18-F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography

P3-14: Metabolic Volumetric Parameters in Prediction of Outcome after Chemo-Radiotherapy in Nasopharyngeal Carcinoma

P3-15: Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-One Stop Test for Patients with Breast Cancer Recurrence

P3-16: Positron Emission Tomography/ Computed Tomography in the Evaluation of Primary Liver Carcinoma; Local Experience

P3-17: Tumour Polypeptide Specific Antigen Serology in Cancer Management

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P1-02: Enhance Retention of Radioiodine in Thyroid Cancer Cells and Non-Thyroid Cancer Cells by PAMAM-Ag⁺

P3-10: Preparation of Radioresistant Therapeutic Radiopharmaceutical ¹³¹I-MIBG