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Saurabh Arora,Chandrasekhar Bal 대한핵의학회 2021 핵의학 분자영상 Vol.55 No.1
Purpose To compare 131I-therapy outcomes in high turnover and normal turnover Graves’ disease patients and predict optimal first 131I activity for high turnover patients. Methods Retrospective cohort design (1:2) validated by propensity score analysis. Cohort 1, high turnover (2-h RAIU/24-h RAIU ≥ 1), n = 104, and cohort 2, normal turnover (ratio < 1), n = 208, patients were compared for post 131I outcome. The cure was defined as a combined euthyroid and stable hypothyroid state following 131I treatment. Logistic regression analysis was used for identifying prognostic factors. The propensity score was applied; 77 matched pairs (1:1 ratio) of high and normal turnover patients were selected as a validation set. Results First 131I cure rates of 28% in high turnover and 66% in normal turnover groups (p = 0.001) were noted. The therapy cycles (median, 2 vs. 1) and cumulative 131I activity (median, 15 vs. 7mCi)were required to cure hyperthyroidismin cohort 1 and cohort 2, respectively. Age (> 44 years), higher grade of goitre, and 2-h RAIU (> 37%) were associated with 131I therapy failure. The high turnover patients needed a factor of 1.5–2 times more 131I activity to achieve a similar cure rate compared to the normal turnover patients. The first-dose cure rate was 31% vs. 60% by propensity score analysis (n = 154), no way different (28% vs.66%) from the whole group of 312 patients. Conclusion High turnover Graves’ disease patients, if administered standard 131I activity, the outcomes shall be poor. To improve the success rate, 131I activity should be increased by 1.5 to 2 times in the high turnover patients.
Praveen Kumar,Chandrasekhar Bal,Nishikant Avinash Damle,Sanjana Ballal,S. N. Dwivedi,Sandeep Agarwala 대한핵의학회 2019 핵의학 분자영상 Vol.53 No.3
Purpose The effective half-life of radioiodine is an important parameter for dosimetry in differentiated thyroid cancer patients, particularly in children. We determined the pre-therapy and post-therapy effective half-life in different types of lesions, i.e., remnant, node, or lung metastases. Methods Of 84 patients recruited, 27 were < 18 years (group 1) and the remaining 57 were between 18 and 21 years (group 2). A total of 114 studies were conducted and 253 lesions were analyzed. Serial whole-body scans were acquired at 24, 48, and ≥ 72 h after administration of iodine-131. Region of interests was drawn over lesions to determine counts in the lesion. Time versus counts graphs were plotted and mono-exponentially fitted to determine effective half-life. Results The post-therapy effective half-life was found to be lesser than pre-therapy effective half-life in all types of lesions and in all groups. Median effective half-life was found maximum in intact lobe, minimum in the lung, and intermediate in remnant and nodes. In the assessment of all lesions together, pre- and post-therapy median and interquartile range (IQR) effective half-life were 59.8 (37–112) h and 48.6 (35.2–70.8) h (p < 0.0001) in group 1, 73.9 (46.2–112.7) h and 60 (57.4–85.9) h (p < 0.0001) in group 2, and 68.6 (41.53–112.36) h and 54.7 (36–80.6) h (p < 0.0001) in combined group, respectively. Importantly, the pre- and post-therapy median effective half-life serially dropped after each successive cycles of iodine-131. Conclusions There was a significant difference in pre-therapy and post-therapy effective half-life in all types of lesions. These results may have implications in calculating the correct therapeutic dose in children and in young adults.
Meghana Prabhu,Deepali Jain,Siddhartha Datta Gupta,Chandrasekhar Bal,Rakesh Kumar 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.5
Thyroid carcinoma is the most common neoplasm of endocrine malignancies. Differentiated thyroid carcinoma (DTC) constitutes90% of the thyroid carcinomas, rest being medullary thyroid carcinoma (MTC), and anaplastic thyroid carcinoma (ATC). Distant metastases occur in up to 10% of patients with DTC. Metastases to axillary lymph nodes (ALN) are very rare. As perliterature, only 25 cases have been reported. We report an unusual case of 47-year-old male with Hürthle cell carcinoma of thethyroid presenting with a solitary axillary lymph node metastasis 17 years after thyroidectomy, along with review of literature.
Taywade, Sameer Kamalakar,Kumar, Rakesh,Bhethanabhotla, Sainath,Bal, Chandrasekhar The Korea Society of Nuclear Medicine 2016 핵의학 분자영상 Vol.50 No.3
Drug induced pulmonary toxicity is not uncommon with the use of various chemotherapeutic agents. Cyclophosphamide is a widely used chemotherapeutic drug in the treatment of breast cancer. Although rare, lung toxicity has been reported with cyclophosphamide use. Detection of bleomycin induced pulmonary toxicity and pattern of $^{18}F$-fluorodeoxyglucose ($^{18}F$-FDG) uptake in lungs on fluorodeoxyglucose positron emission tomography-computed tomography ($^{18}F$-FDG PET-CT) has been elicited in literature in relation to lymphoma. However, limited data is available regarding the role of $^{18}F$-FDG PET-CT in monitoring drug induced pulmonary toxicity in breast cancer. We here present two cases of cyclophosphamide induced drug toxicity. Interim $^{18}F$-FDG PET-CT demonstrated diffusely increased tracer uptake in bilateral lung fields in both these patients. Subsequently there was resolution of lung uptake on $^{18}F$-FDG PET-CT scan post completion of chemotherapy. These patients did not develop significant respiratory symptoms during chemotherapy treatment and in follow up.
Angel Hemrom,Geetanjali Arora,Nishikant Avinash Damle,Chandrasekhar Bal 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.5
Purpose Neuroblastoma (NB) is childhood’s most common extracranial solid malignancy. We have compared two imaging modalities, 131I-MIBG and 18F-DOPA PET/CT, to evaluate NB. Also, feasibility of the application of standardised scoring systems, SIOPEN and Curie scoring systems, in 18F-DOPA PET/CT was explored. Methods Patients with histopathology-proven NB underwent 131I-MIBG (planar and SPECT/CT) and 18F-DOPA PET/CT scans, as per standard imaging protocols. Duration between scans ranged from 1 to 30 days (median = 8 days). Number of lesions in Curie and SIOPEN scoring systems applied on both modalities was compared. Results Forty-six patients were included (M:F = 29:17) with a median age of 36 months. Both 131I-MIBG and 18F-DOPA scans were positive in 39 patients and negative in four patients. 18F-DOPA PET/CT was positive in additional three patients, in which 131I-MIBG was negative (p = 0.25). Overall, 18F-DOPA identified significantly greater number of lesions than 131I-MIBG, especially metastatic skeletal lesions (p < 0.05). Significant difference was observed between Curie scores in the two modalities, unlike SIOPEN scores. However, when the cut-off age of 18 months was taken, no significant difference was seen in either of the scoring systems in both the scans (p > 0.05). CS and SIOPEN scores were significantly higher in bone marrow-positive patients. Conclusion 18F-DOPA PET/CT detected more lesions than 131I-MIBG but had little impact on staging of the disease. For evaluation of NB, both scans can be used interchangeably as per the availability. Furthermore, both SIOPEN and Curie scoring systems, standardised for MIBG, can also be used to semi-quantify disease extent in 18F-DOPA PET/CT.
Von Hippel-Lindau Syndrome: Demonstration of Entire Disease Spectrum with 68Ga-DOTANOC PET-CT
Punit Sharma,Varun Singh Dhull,Chandrasekhar Bal,Arun Malhotra,Rakesh Kumar 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1
Von Hippel-Lindau (VHL) syndrome is a rare neoplastic disorder characterized by central nervous system (CNS) and visceral tumors. We here present 68Ga-labelled [1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid]-1-Nal3-Octreotide positron emission tomography computed tomography findings in a 52 year old female with VHL syndrome, demonstrating both CNS and visceral tumors.
Infected Lower Limb Megaprosthesis on 68Ga-NOTA-Ubiquicidin PET/CT Imaging
Prateek Kaushik,Satya Dev Maurya,Nishikant Damle,Sanjana Ballal,Venkatesan Sampath Kumar,Chandrasekhar Bal,Madhavi Tripathi 대한핵의학회 2022 핵의학 분자영상 Vol.56 No.3
Pain after prosthesis implant is a common clinical problem which requires distinction of septic from aseptic causes since the treatment differs. Non-invasive imaging methods play an important role in the diagnosis. Radiolabelled ubiquicidin can be used for imaging infection by binding directly to bacterial cell wall. We describe a case of a 24-year-old man with right lower limb megaprosthesis which did not show any loosening on computed tomography (CT) but was accurately diagnosed as infected prosthesis with 68Ga-NOTA-ubiquicidin(29-41) acetate scan.
Sellam Karunanithi,Shambo Guha Roy,Punit Sharma,Rajni Yadav,Chandrasekhar Bal,Rakesh Kumar 대한핵의학회 2015 핵의학 분자영상 Vol.49 No.1
Recipients of renal transplant are at increased risk ofdeveloping various malignancies, especially post-transplantlymphoproliferative disorder (PTLD) and skin cancers. Neuroendocrine tumours (NET) of the gastrointestinal tracthave not been reported in this setting. Here we describe thecase of a 75-year-old male who had undergone renal transplant8 years back and now presented with significant weight lossand backache, clinically suspected as PTLD. 18FFluordeoxyglucose(18F-FDG) positron emission tomographycomputedtomography (PET-CT) showed hypermetabolic lesionsin the liver and rectum, raising the suspicion of PTLD. However, biopsy from the liver lesion showed poorly differentiatedNET. 68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-octreotide (68Ga-DOTANOC) PET-CT was then done, which confirmed theprimary lesion in the rectum with liver metastases.