| 1. |
- Arbeus, Mikael, et al.
(author)
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Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting
- 2021
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In: Journal of cardiac surgery. - : Wiley-Blackwell Publishing Inc.. - 0886-0440 .- 1540-8191. ; 36:10, s. 3702-3708
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Journal article (peer-reviewed)abstract
- BACKGROUND: Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up.METHODS: Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography.RESULTS: The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups).CONCLUSIONS: Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.
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| 2. |
- Bäck, Anna-Karin, 1971-, et al.
(author)
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Renography with a semiautomated algorithm for diuretic decision 7 min postradiopharmaceutical administration : a feasibility study
- 2020
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In: Nuclear medicine communications. - : Lippincott Williams & Wilkins. - 0143-3636 .- 1473-5628. ; 41:10, s. 1018-1025
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The F+10 method for diuretic renography (diuretics given 10 min after the radiopharmaceutical) could be a time-conserving method. This method involves a 30-min dynamic acquisition where diuretics are administered only when necessary by the Nuclear Medicine technologist performing the examination. The purpose of this study was to assess the method's performance and to discover the optimal threshold of residual activity for a diuretic administration 7 min into the F+10 renography by reprocessing raw data from prior performed examinations with 20-min acquisitions without diuretics.METHODS: Retrospectively, raw data from 320 original examinations of adult patients performed from 2013 to 2015 were reprocessed into 7-min series and categorized as requiring diuretic or not. The diuretic decisions made by an expert panel were used as a reference. A receiver-operating characteristic curve was drawn to assess the optimal cutoff value for the residual renal activity. Sensitivity, specificity, positive and negative predictive values, as well as the Youden J index were calculated.RESULT: The experts classified 50% (160 examinations) as in need of diuretics. The receiver-operating characteristic curve demonstrated the theoretical optimal cutoff value at 7 min to be 94% of maximum activity (sensitivity 0.93, specificity 0.81, Youden J index 0.73). A clinically acceptable threshold is suggested to be 85% (sensitivity 0.99, specificity 0.59, Youden J index 0.58).CONCLUSION: Tc-mercaptoacetyltriglycine renography with the F+10 method and the threshold 85% for diuretic decision 7 min into the renography is a feasible and acceptable method in clinical practice.
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| 3. |
- Bäck, Anna-Karin, 1971-, et al.
(author)
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Timing of diuretics in diuresis renography
- 2022
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In: Clinical and translational imaging. - : Springer. - 2281-5872 .- 2281-7565. ; 10, s. 37-43
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Research review (peer-reviewed)abstract
- Purpose: The aim of this systematic literature review was to obtain an overview of when to administer the diuretics in relation to the radiopharmaceutical during a diuresis renography.Methods: A systematic literature search was performed in three different databases (Embase, PubMed/Medline and Cochrane Library) together with an information specialist. The review question was: when should diuretics be administered in relation to the radiopharmaceutical in a diuresis renography? Studies of adults were included together with guidelines published in collaboration with an organization.Results: Seventeen articles and four guidelines were retrieved in the literature search. The F - 15 method (diuretics administered 15 min before the radiopharmaceutical) was the one that was studied and described most and was compared with other time points for diuretic administration. The retrieved articles and guidelines report of advantages with different time points for diuretics. Both F - 15 and F + 0 are reported to clarify washout in equivocal cases compared to F + 20.Conclusion: No consensus could be found for a preferred time point of diuretics administration during a diuresis renography.
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| 4. |
- Bäck, Anna-Karin, 1971-, et al.
(author)
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Troubled but in good hands : A qualitative study on patient experiences in diuresis renography examinations
- 2024
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In: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831.
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Diuresis renography is a nuclear medicine examination that can distinguish between obstructive and non-obstructive uropathy. Renography has been investigated before, but not from a patient perspective. The aim of this study was to gain knowledge and understanding of patient experiences with the diuresis renography process.METHODS: The study had a qualitative descriptive design; data was collected through semi-structured interviews with 17 adult patients that had recently undergone diuresis renography. The transcripts were analysed using inductive qualitative content analysis to identify their manifest and latent content.RESULTS: One main theme was identified: 'Not smooth all the way through, but still in good hands'. The participants understood the necessity of the performed renography and endured the examination despite its worrying elements. They were bothered by diuretic effects, worried about radioactivity and felt isolated during the imaging. The technologists' caring and informative approach eased their experience. The main theme was identified from three subthemes: 'I experienced inconvenience', 'I was worried' and 'I felt safe'.CONCLUSION: The participants experienced worry throughout the renography process but were still satisfied with the examination, mostly because of the technologists being involved. Communication and interaction between patient and technologist are important for creating a good experience. Improved knowledge of patient experiences during renographies could be used to develop patient information and increase technologists' awareness of factors patients may experience as troubling.IMPLICATIONS FOR PRACTICE: This study describes issues that contribute to both negative and positive experiences. Improved professional awareness and knowledge about these issues can contribute to the development of patient information and professional encounters, and may improve patients' compliance and overall experience.
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| 5. |
- Cao, Yang, Associate Professor, 1972-, et al.
(author)
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The statistical importance of P-POSSUM scores for predicting mortality after emergency laparotomy in geriatric patients
- 2020
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In: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 20:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Geriatric patients frequently undergo emergency general surgery and accrue a greater risk of postoperative complications and fatal outcomes than the general population. It is highly relevant to develop the most appropriate care measures and to guide patient-centered decision-making around end-of-life care. Portsmouth - Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) has been used to predict mortality in patients undergoing different types of surgery. In the present study, we aimed to evaluate the relative importance of the P-POSSUM score for predicting 90-day mortality in the elderly subjected to emergency laparotomy from statistical aspects.METHODS: One hundred and fifty-seven geriatric patients aged ≥65 years undergoing emergency laparotomy between January 1st, 2015 and December 31st, 2016 were included in the study. Mortality and 27 other patient characteristics were retrieved from the computerized records of Örebro University Hospital in Örebro, Sweden. Two supervised classification machine methods (logistic regression and random forest) were used to predict the 90-day mortality risk. Three scalers (Standard scaler, Robust scaler and Min-Max scaler) were used for variable engineering. The performance of the models was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Importance of the predictors were evaluated using permutation variable importance and Gini importance.RESULTS: The mean age of the included patients was 75.4 years (standard deviation =7.3 years) and the 90-day mortality rate was 29.3%. The most common indication for surgery was bowel obstruction occurring in 92 (58.6%) patients. Types of post-operative complications ranged between 7.0-36.9% with infection being the most common type. Both the logistic regression and random forest models showed satisfactory performance for predicting 90-day mortality risk in geriatric patients after emergency laparotomy, with AUCs of 0.88 and 0.93, respectively. Both models had an accuracy > 0.8 and a specificity ≥0.9. P-POSSUM had the greatest relative importance for predicting 90-day mortality in the logistic regression model and was the fifth important predictor in the random forest model. No notable change was found in sensitivity analysis using different variable engineering methods with P-POSSUM being among the five most accurate variables for mortality prediction.CONCLUSION: P-POSSUM is important for predicting 90-day mortality after emergency laparotomy in geriatric patients. The logistic regression model and random forest model may have an accuracy of > 0.8 and an AUC around 0.9 for predicting 90-day mortality. Further validation of the variables' importance and the models' robustness is needed by use of larger dataset.
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| 6. |
- Dreifaldt, Mats, 1959-, et al.
(author)
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Pedicled versus skeletonized internal thoracic artery grafts : a randomized trial
- 2021
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In: Asian cardiovascular & thoracic annals. - : Medikaru Toribyun. - 1816-5370 .- 0218-4923. ; 29:6, s. 490-497
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Concerns have been raised regarding whether skeletonization of the internal thoracic artery could damage the graft and thereby reduces its patency. The objective of this study was to compare patency rates at mid- and long-term follow-up between pedicled and skeletonized left internal thoracic artery grafts.METHODS: This randomized controlled trial included 109 patients undergoing coronary artery bypass surgery. The patients were assigned to receive either one pedicled or one skeletonized left internal thoracic artery graft to the left anterior descending artery. Follow-up was performed at 3 years with conventional angiography, and at 8 years with computed tomography angiography. Differences between patency rates were analyzed with Fisher's exact test and a generalized linear model.RESULTS: The patency rates for pedicled and skeletonized left internal thoracic artery grafts were 46/48 (95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%) versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in patency rates for pedicled and skeletonized grafts was 5.4% (95% confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a localized stenosis, were anastomosed to native coronary arteries with a stenosis less than 70%. Three patients suffered sternal wound infections (two in the pedicled group, one in the skeletonized group).CONCLUSIONS: The skeletonization technique can be used without jeopardizing the patency of the left internal thoracic artery. The most important factor in graft failure was target artery stenosis below 70%.
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| 7. |
- Dreifaldt, Mats, 1959-, et al.
(author)
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The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting : A randomized trial
- 2021
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In: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier. - 0022-5223 .- 1097-685X. ; 161:2, s. 624-630
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Journal article (peer-reviewed)abstract
- Background: In 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial.Methods: The trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed.Results: Angiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%.Conclusions: NT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.
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| 8. |
- Edin, Victor, et al.
(author)
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A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions
- 2022
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In: Brazilian Journal of Cardiovascular Surgery. - : Brazilian Society for Cardiovascular Surgery. - 0102-7638 .- 1678-9741. ; 37:1, s. 135-138
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Journal article (peer-reviewed)abstract
- The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.
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| 9. |
- Ferrari, Gabriele, 1984-, et al.
(author)
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Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts
- 2024
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In: Perfusion. - London : Sage Publications. - 0267-6591 .- 1477-111X.
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Journal article (peer-reviewed)abstract
- Introduction: Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique. Methods: This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis. Results: The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p <.01), with a subdistribution hazard ratio (SHR) of 0.16 (p =.010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p <.01) with a SHR of 0.53 (p =.017). The short-term results were similar in both groups. Conclusions: Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG. © The Author(s) 2024.
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| 10. |
- Ferrari, Gabriele, 1984-, et al.
(author)
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Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting : a systematic review and meta-analysis
- 2021
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In: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 55:4, s. 245-253
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Research review (peer-reviewed)abstract
- To investigate the results of percutaneous coronary intervention (PCI) in saphenous vein grafts after coronary artery bypass grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were searched for relevant articles published between 1 January 2000 and 29 February 2020. The PICO (population, intervention, comparison, outcome) model was applied in constructing the clinical question. Two independent researchers performed the literature search. Thirty-six articles were identified and subjected to a quality assessment. The primary outcomes of the meta-analysis were long-term in-stent restenosis and long-term major adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95% CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 ± 1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%; 95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE (15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in better outcomes at least in term of in-stent restenosis, while the benefit of using embolic protection devices was questionable. Conclusions. PCI of a stenosed or occluded saphenous vein graft is a challenge for interventional cardiologists, and is still associated with relatively high rates of restenosis, MACE, and procedural failure. All efforts to enhance the results are warranted, including improved quality of the venous grafts used during CABG.
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| 11. |
- Ferrari, Gabriele, 1984-, et al.
(author)
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Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts
- 2022
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 37:4, s. 430-438
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft.METHODS: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM).RESULTS: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains.CONCLUSION: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.
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| 12. |
- Geijer, Håkan, 1961-, et al.
(author)
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Dendrochronology with a medical X-ray photon counting computed tomography scanner
- 2024
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In: Dendrochronologia. - : Elsevier. - 1125-7865 .- 1612-0051. ; 86
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Journal article (peer-reviewed)abstract
- Dendrochronology traditionally involves invasive techniques that might harm cultural heritage artifacts. Noninvasive approaches using X-ray technology and computed tomography (CT) have emerged, but dedicated CT systems are limited in availability. This study explored the viability of using a recently developed photon counting medical CT scanner for growth ring analysis. Six wood samples from pine, oak and beech with varying growth rates were studied. Comparisons were made between traditional methods and CT scanning with measurements performed on the untreated surface, a prepared surface and on CT images. For samples with annual rings wider than 0.3-0.4 mm, CT scanning performed well, while samples with thinner rings or indistinct ring boundaries presented challenges. The combination of traditional tree-ring measurements and analyses of CT scanned images might be a superior study approach generating extra data and information.
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| 13. |
- Pettersson, Olof
(author)
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Monitoring of neuroendocrine tumor patients undergoing systemic therapies
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Monitoring of neuroendocrine tumor (NET) patients undergoing systemic therapies is troublesome as biomarkers capable of detecting tumor responses have been difficult to establish. Changes in the sum of target lesion diameters are used to evaluate the effects of therapy according to the response evaluation criteria in solid tumors (RECIST 1.1). However, as NETs tend to stabilize or increase in size when responding to therapies, monitoring based on changes in tumor diameters is often ineffective.The overall aim of these doctoral studies was to investigate novel methods for therapy monitoring in NET patients undergoing systemic therapies.In patients with pancreatic NETs (PanNETs) who underwent Peptide Receptor Radionuclide Therapy (PRRT) with 177Lu-DOTATATE at Uppsala University Hospital (n=151), we investigated if arterial-phase tumor attenuation and contrast-enhancement in the liver metastases on computed tomography (CT) changed during PRRT (Paper I).Tumor growth rate (TGR) allows for quantitative assessment of tumor dynamics expressed as percentage per month. In the same cohort as described above, TGR was calculated before and during/after PRRT (Paper II).While 68Ga-DOTA-somatotstatin analog (SSA) PET/CT is essential in the evaluation of NET patient eligibility for PRRT, temporal changes in the tumor uptake of 68Ga-DOTA-SSA have not been shown to reflect PRRT outcome. Tumor-to-blood (TBR) ratio may be closer correlated than SUV to the net influx rate (Ki). The institutional database of the University Hospital in Essen was screened for NET patients, who had undergone at least two cycles of PRRT and 68Ga-DOTA-SSA PET/CT. TBR and tumor-spleen ratio (TSR) were calculated in up to nine lesions per patient (Paper III).Data on imaging were investigated for possible associations with outcome parameters such as progression-free survival and overall survival (Papers I-III).46 PanNET patients with data on Ki-67 from at least two biopsies (Botling et al. 2019) at Uppsala University Hospital were screened for inclusion to describe TGR in PanNET patients. TGR was calculated to elucidate if changes in tumor grade may be reflected in changes in TGR. (Paper IV).In summary, the thesis investigates tools based on morphologic and functional imaging for monitoring of NET patients undergoing systemic therapies.
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| 14. |
- Piippo-Huotari, Oili, 1959-, et al.
(author)
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Patients' and radiographers' experiences of dose reducing abdominal compression in radiographic examinations : A qualitative study
- 2020
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 7:3, s. 680-689
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Journal article (peer-reviewed)abstract
- Aim: To describe patients' and radiographers' experiences of abdominal compression using conventional and patient-controlled compression methods.Design: Qualitative descriptive design.Methods: Forty-five patients who had used both a conventional and a patient-controlled compression device answered questionnaires. Five radiographers were interviewed. The data-collection took place between September 2015 and February 2017. Data were analysed by qualitative content analysis.Results: Patient-controlled compression was preferred by slightly more patients because of fear of pain due to excessively hard pressure, maintaining control over the pressure and shorter duration. It was more comfortable, and patients felt they could participate in the examinations. Conventional compression was preferred by some because of more stable pressure and uncertainty of own capacity to provide the optimal compression. Discomfort was more often mentioned concerning the conventional compression method. The radiographers experienced the patient-controlled method as less time-consuming and more comfortable, but uncertainty about correct compression technique and its effect on radiation dose and image quality was reported.
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| 15. |
- Silins, Isabella, 1983-
(author)
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Improved adrenocortical PET imaging
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Adrenal tumours can either be benign or malignant, hormone secreting or not, and they can be discovered through clinical examination of the patient or by pure chance. Increased knowledge in the area, plus the widespread use of imaging techniques, have resulted in a rising number of patients with adrenal tumours that subsequently need to be diagnosed. Improved imaging is needed for primary aldosteronism (PA) and adrenocortical carcinoma (ACC) but the positron emission tomography (PET) tracer currently in use, [11C]metomidate (MTO), has many important limitations. This thesis aims to improve adrenocortical PET imaging.Methods: Paper 1 investigated the pre-clinical properties of Para-Chloro-2-[18F]fluoroethyl-etomidate (CETO), by autoradiography, binding studies, ex vivo biodistribution on rats and in vivo imaging using mice and one non-human primate (NHP). Paper II investigated the clinical properties of [18F]CETO and included patients with various kinds of adrenocortical tumours, and healthy volunteers. Metabolic and kinetic analyses were performed and three out of five healthy volunteers also underwent [15O]water PET/CT to measure adrenal blood flow. Test-retest was performed on all healthy volunteers. Paper III assessed the in vivo and in-human radiation dosimetry of [18F]CETO. Ex vivo uptake data from rats and in vivo PET/CT from NHP and humans were used to calculate residence times. Paper IV evaluated the use of the block-sequential regularized expectation maximization (BSREM) reconstruction algorithm (Q.Clear, GE Healthcare, Milwaukee, USA) for [11C]MTO PET/CT in patients with PA.Results: Papers I and II demonstrated that [18F]CETO is highly specific to the adrenal cortex both in vitro and in vivo. The non-specific binding of [18F]CETO in the liver was significantly lower than that of [11C]MTO. [18F]CETO metabolizes rapidly and the single tissue irreversible (1T1k) kinetic model provided the best fit. [15O]water PET/CT results indicated that the adrenal [18F]CETO uptake was flow limited. Several retest values, including adrenal blood flow, were lower than the test values. Paper III found that the effective dose based on human data was 18.2 μSv/MBq and that the adrenal glands were the limiting organ regardless of species used. Paper IV showed that the BSREM reconstruction algorithm improves image quality, without compromising SUVmax quantification, and a β-value between 70 and 130 was found optimal.Conclusion: [18F]CETO PET/CT is a promising method for adrenocortical imaging and is safe for clinical imaging in terms of radiation dose. [18F]CETO PET/CT should be further investigated in patients with PA or ACC, preferably in conjunction with BSREM reconstruction.
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| 16. |
- Torbrand, Christian, et al.
(author)
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Sentinel Node Identification with Hybrid Tracer-guided and Conventional Dynamic Sentinel Node Biopsy in Penile Cancer : A Prospective Study in 130 Patients from the Two National Referral Centres in Sweden
- 2022
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In: European Urology Oncology. - : European Association of Urology. - 2588-9311. ; 5:6, s. 704-711
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Journal article (peer-reviewed)abstract
- BACKGROUND: Studies suggest that a hybrid indocyanine green (ICG)-99mTc-nanocolloid tracer improves sentinel node (SN) identification compared to conventional dynamic sentinel node biopsy (DSNB).OBJECTIVE: To investigate hybrid tracer-guided SN identification in a multicentre setting and determine false-negative (FN) and complication rates.DESIGN, SETTING, AND PARTICIPANTS: A total of 130 patients with penile cancer scheduled for DSNB were prospectively included between February 2016 and December 2017 at two national Swedish referral centres. ICG-99mTc-nanocolloid hybrid tracer was used in the standard DSNB protocol.INTERVENTION: SNs were identified intraoperatively using radioguidance, fluorescence imaging, and blue dye.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The number of SNs identified by each tracer and the rates of complications and nodal recurrence during median follow-up of 34 mo were recorded. Differences in proportions between groups were compared using χ2 and McNemar's tests.RESULTS AND LIMITATIONS: Overall, 453 SNs were identified preoperatively via single-photon emission computed tomography/computed tomography. Among the 425 SNs excised, radioguidance, fluorescence, and blue dye identified 414 (97%), 363 (85%), and 349 (82%), respectively. Fluorescence imaging helped to detect six SNs that were negative using the other tracers, two of which were from the same patient and contained metastases. Histopathological examination detected 33 metastatic SNs in 20/130 patients (15%). The FN rate was 12% per groin (95% confidence interval 8-16%).CONCLUSIONS: Identification of SNs in patients with penile cancer relies mainly on radioguidance, while fluorescence (ICG) and blue dye methods for optical SN identification are comparable. However, the value of fluorescence imaging should be further evaluated in studies with long-term follow-up.PATIENT SUMMARY: In this study, we investigated addition of a dye called indocyanine green (ICG) for assessment of lymph nodes in patients with cancer of the penis. ICG did not improve the rate of detection of nodes most likely to harbour cancer because of their location in the drainage pathway for lymphatic fluid, but did help in identifying additional metastases.
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