bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of Autonomy in Idiopathic Non-Toxic Goiter, Evaluated by Regional Suppressibility of 99mTc-Uptake and TSH Response to TRH
Authors: Clemmensen O. J. , Hummer L. , Dige-Petersen H. 
Published: March 2018

SummarySeventeen euthyroid patients with non-toxic goiter were studied, 7 had diffuse goiters and 10 had nodular goiters. The TSH response to TRH and the 99mTc-uptake were measured before and after T3 suppression. The uptake, measured with a gamma camera, was calculated for the whole gland and for a maximum of 6 regions within the thyroid gland.The suppressibility of 99mTc-uptake (percent change of uptake) ranged from 0 to 95%, it was significantly greater in patients with diffuse than in those with nodular goiters, and was alike in nodular and inter-nodular tissue. The patients with diffuse goiter were significantly younger than those with nodular goiter. Abolished TSH response to TRH was seen in 2 patients with negative T3 suppression tests. In another 2 patients impaired TSH response was associated with impaired suppressibility. In 13 patients with normal TRH tests, the suppression of uptake was normal in 8 and subnormal in 5.The results suggest that nodularity and functional autonomy may develop in non-toxic goiters. In some of these goiters the mass of autonomous tissue may be large enough to cause negative TRH tests, probably indicating hypersecretion of thyroid hormones, although not necessarily above the normal range.
Zur Häufigkeitsverteilung eines Index für freies Thyroxin nach Alter und Schilddrüsenstatus
Authors: Leb G. , Goebel R. 
Published: March 2018

ZusammenfassungEs wurden die FT4I von Kollektiven verglichen, die auf Grund des Radiojodtestergebnisses gebildet wurden. Eine von anderer Seite berichtete Erhöhung des FT4I bei älteren Frauen konnte nicht nachgewiesen werden. Auch die „Grauzone” zwischen Eu- und Hyperthyreosen ist nicht so breit gefunden worden, wie anderwärts berichtet, was möglicherweise mit Auswahl und Zusammensetzung der Kollektive zusammenhängt. Beim Kollektiv mit erniedrigten Speicherwerten im Radiojodtest zeigte sich ein unerwartet großer Prozentsatz von erhöhtem FT4I, wahrscheinlich also von Hyperthyreosen. Die Zahl der Hypothyreosen in diesem Kollektiv ist gegenüber den jodprämedizierten Patienten relativ gering. Fälle mit normalem Radiojodtest und pathologischem Hemmtest dürften mehrheitlich einen normalen FT4I aufweisen, also euthyreot sein, zu einem kleineren Teil aber tatsächlich an einer Hyperthyreose leiden. Bei den Fällen mit Status nach Radiojodtherapie fordert die Häufigkeit von erhöhten FT4I-Werten eine breitere Untersuchung des Verlaufs solcher Erkrankungen in Zusammenschau mit der verabreichten Dosis.
Is there a benefit of 131I-MIBG therapy in the treatment of children with stage 4 neuroblastoma?
Authors: Simon T. , Hero B. , Eschner W. , Dietlein M. , Sudbrock F. , Bongartz R. , Berthold F. , Schicha H. , Schmidt M. 
Published: March 2018

SummaryAim: 131I-meta-iodobenzylguanidine (131I-MIBG) therapy has been used in neuroblastoma treatment for many years but its value in high intensive first line treatment protocols is not exactly known. Patients, methods: Stage 4 neuroblastoma patients >1 year with 123I-MIBG positive residual disease (primary tumour and/or metastasis) after complete induction chemotherapy according to the German neuroblastoma trial NB97 were retrospectively analyzed. Results: One-hundred-eleven patients had 123I-MIBG positive residual disease after complete induction chemotherapy. Forty patients received 131I-MIBG therapy using a median activity of 0.44 GBq/kg body weight. By univariate analysis, patients who underwent 131I-MIBG therapy had a better 3-year event free survival (3-y-EFS 46±8%) and 3-year overall survival (3-y-OS 58±9%) than 71 patients without 131I-MIBG therapy (3-y-EFS 19±5%, p=0.003; 3-y-OS 43±6%, p=0.037). However, subgroup analysis of 66 patients who underwent high dose chemotherapy with autologous stem cell transplantation (ASCT) during treatment found a very similar outcome with 131I-MIBG therapy (3-y-EFS 49±9%, 3-y-OS 59±10%) and without 131I-MIBG therapy (3-y-EFS 33±9%, p=0.171; 3-y-OS 59±9%, p=0.285) due to the dominating effect of ASCT. By multivariate analysis, 131I-MIBG therapy had no impact on EFS (p=0.494) and OS (p=0.891). Only ASCT, external beam radiation therapy and MYCN amplification were important for EFS and OS. Conclusions: An independent advantage of I-131-MIBG therapy could not be proven in this retrospective analysis. The ongoing German Neuroblastoma Trial NB2004 will address the influence of 131I-MIBG therapy with emphasis on tumour dosimetry.
Prevention, screening and therapy of thyroid diseases and their cost-effectiveness
Authors: Moka D. , Schmidt M. , Theissen P. , Schicha H. , Dietlein M. 
Published: March 2018

Summary:Cost-effectiveness analyses focused on benign thyroid diseases are under-represented in the literature. The calculation of costs per additionally gained life year is difficult: The benefit of prevention is shifted into the distant future. The influence of an untreated subclinical thyroid disease on life expectancy can only be demonstrated by a long-term follow-up and by epidemiological databases. Iodine supplementation and programs for the prevention of tobacco smoking (primary prevention) are very cost-effective. Smoking increases the risk both of multinodular goiter and of Graves’ disease. Screening programs (secondary prevention) are discussed for the laboratory parameters thyrotropin (TSH), calcium and calcitonin. TSH testing seems to be very cost-effective for epidemiological considerations in a certain lifespan (newborn, pregnancy, postpartal, older persons, hospitalisation due to acute diseases) and in persons with previously elevated TPO-antibodies or TSH-values >2 mU/l, but dedicated cost-effectiveness analyses are lacking. On the other hand, the cost-effectiveness of a routine TSH testing beyond the age of 35 years has been shown by a high-quality decision analysis. Therapeutic strategies (tertiary prevention) aim at the avoidance of complications (atrial fibrillation, myocardial infarction, death for cardiac reasons) and of iatrogenic complications. Examples of a tertiary prevention are: firstly the definitive therapy of Graves’ disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), secondly the radioiodine therapy for subclinical hyperthyroidism and the radioiodine therapy of large goiters in older patients or in patients suffering from a relevant comorbidity. Cost-effectiveness analyses for different therapeutic strategies of Graves’ disease were published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%.
Time consumption and quality of an automated fusion tool for SPECT and MRI images of the brain
Authors: Platsch G. , Schwarz A. , Schmiedehausen K. , Tomandl B. , Huk W. , Rupprecht Th. , Rahn N. , Kuwert T. , Fiedler E. 
Published: March 2018

Summary:
Aim: Although the fusion of images from different modalities may improve diagnostic accuracy, it is rarely used in clinical routine work due to logistic problems. Therefore we evaluated performance and time needed for fusing MRI and SPECT images using a semiautomated dedicated software. Patients, material and Method: In 32 patients regional cerebral blood flow was measured using 99mTc ethylcystein dimer (ECD) and the three-headed SPECT camera MultiSPECT 3. MRI scans of the brain were performed using either a 0,2 T Open or a 1,5 T Sonata. Twelve of the MRI data sets were acquired using a 3D-T1w MPRAGE sequence, 20 with a 2D acquisition technique and different echo sequences. Image fusion was performed on a Syngo workstation using an entropy minimizing algorithm by an experienced user of the software. The fusion results were classified. We measured the time needed for the automated fusion procedure and in case of need that for manual realignment after automated, but insufficient fusion. Results: The mean time of the automated fusion procedure was 123 s. It was for the 2D significantly shorter than for the 3D MRI datasets. For four of the 2D data sets and two of the 3D data sets an optimal fit was reached using the automated approach. The remaining 26 data sets required manual correction. The sum of the time required for automated fusion and that needed for manual correction averaged 320 s (50-886 s). Conclusion: The fusion of 3D MRI data sets lasted significantly longer than that of the 2D MRI data. The automated fusion tool delivered in 20% an optimal fit, in 80% manual correction was necessary. Nevertheless, each of the 32 SPECT data sets could be merged in less than 15 min with the corresponding MRI data, which seems acceptable for clinical routine use.
Value of combined XCT/SPECT technology for avoiding false positive planar 123I-MIBG scintigraphy
Authors: Özer S. , Dobrozemsky G. , Kienast O. , Beheshti M. , Becherer A. , Niederle B. , Kainberger F. , Dudczak R. , Kurtaran A. 
Published: March 2018

Summary:Aim: The clinical value of combined XCT/SPECT technology in a single device in patients undergoing 123I-MIBG scintigraphy was analyzed. Methods: 31 patients (19 men, 12 women; mean age 55 years, range: 31-79 years) demonstrating focal accumulation in planar 123I-MIBG scan were further investigated with a double headed gamma camera with an X-ray tomograph mounted on the same gantry (GE Medical Systems, Millennium VG with Hawkeye, Milwaukee, USA) for anatomical definition of the focal 123I-MIBG uptake. The patients were referred to 123I-MIBG scintigraphy because of biochemically (81%) and/or clinically (19%) suspected pheochromocytoma. Results: In 23 out of 31 patients (74%) the fused images demonstrated physiological accumulation (i. e. intestinal, renal) of 123I-MIBG. In two patients (6%) suspected adrenal MIBG-accumulation was caused by inhomogeneous liver uptake. In two patients (6%) focal abdominal accumulation was correctly localised in the adrenal glands. Furthermore, the differentiation of bone metastasis from a local recurrence for phaeochromocytoma was accurately possible for two patients (6%). Adrenal lesions mimicking liver foci were correctly localised in the remaining two patients (6%). Conclusion: Our study demonstrates the clinical value of XCT/SPECT in a single device in patients demonstrating focal 123I-MIBG uptake in planar scintigraphy. The combined XCT/SPECT technology provides a higher diagnostic accuracy.
Gender dependent rate of metabolism of the opioid receptor-PET ligand [18F]fluoroethyldiprenorphine
Authors: Spilker M. E. , Sprenger T. , Hauser A. I. , Platzer S. , Boecker H. , Toelle T. R. , Wester H.-J. , Henriksen G. 
Published: March 2018

Summary:Aim: The morphinane-derivate 6-O-(2-[18F]fluoroethyl)- 6-O-desmethyldiprenorphine ([18F]FDPN) is a nonselective opioid receptor ligand currently used in positron emission tomography (PET). Correction for plasma metabolites of the arterial input function is necessary for quantitative measurements of [18F]FDPN binding. A study was undertaken to investigate if there are gender dependent differences in the rate of metabolism of [18F]FDPN. Methods: The rate of metabolism of [18F]FDPN was mathematically quantified by fitting a bi-exponential function to each individual’s dynamic metabolite data. Results: No statistically significant gender differences were found for age, weight, body mass index or dose. However, significant differences (p <0.01) in two of the four kinetic parameters describing the rate of metabolism were found between the two groups, with women metabolizing [18F]FDPN faster than men. These differences were found in the contribution of the fast and slow kinetic components of the model describing the distribution of radioactive species in plasma, indicating a higher rate of enzyme-dependent degradation of [18F]FDPN in women than in men. Conclusion: The findings reinforce the need for individualized metabolite correction during [18F]FDPN-PET scans and also indicate that in certain cases, grouping according to gender could be performed in order to minimize methodological errors of the input function prior to kinetic analyses.
Thallium-201 scan in evaluating thyroid nodules following equivocal fine-needle aspiration cytology
Authors: Lee J. K. , Liu R. S. , Wu S. Y. , Chou M. C. , Huang W. S. 
Published: March 2018

Summary:The aim of this prospective study was to evaluate the usefulness of the thallium-201 (201Tl) thyroid scan in the detection of malignancy in cold thyroid nodules whose status was equivocal following palpation fine-needle aspiration cytology (FNAC). Patients, methods: Fifty-one patients with clinically palpable solitary cold thyroid nodules classified as non-diagnostic or suspicious following biopsy underwent 201Tl thyroid scans. Each scan was performed 15 min (early scan) and 3 h (delayed scan) after an intravenous administration of 74 MBq 201Tl. Thallium uptake in the nodules was visually assessed and scored on a three point scale, with a grade of three defining malignancy. All patients underwent surgery and the histopathology of nodule tissues were compared with results of the scans. Results: Fifty-one nodules were examined. Forty were benign and 11 were malignant. For early scans, the diagnostically relevant parameters were: sensitivity (100%), specificity (75%), and accuracy (80%). Corresponding findings for the delayed scan were: 91%, 98%, and 96%. Conclusion: The 201Tl scan is useful for detecting malignancy in cold thyroid nodules classified as nondiagnostic or suspicious lesions by FNAC.
Comparison of dobutamine-stress magnetic resonance imaging and dipyridamole-Tl-201-SPECT as alternative strategies for the detection of coronary artery disease in patients not suitable for stress-echocardiography
Authors: Jochims M. , Theissen P. , Baer F. M. , Crnac J. , Voth E. , Schneider C. A. , Erdmann E. , Schicha H. , Schmidt M. 
Published: March 2018

SummaryAim: During the past decade stress-echocardiography has gained increasing popularity for detection of myocardial ischemia in patients with coronary artery disease. However, about 10% to 15% of the patients submitted for stress-echocardiography do not have an adequate acoustic window. The purpose of this study was to compare high-dose dobutamine-stress magnetic resonance imaging (dobutami-ne-MRI) with dipyridamole-Tl-201-SPECT (dipyridamole-SPECT) as alternative strategies for detection of myocardial ischemia in patients with inadequate image quality by stress-echocardiography. Patients and Methods: Of 296 patients which were consecutively submitted to stress-echocardiography 45 patients (15%) had two or more segments that could not be evaluated according to the 16-seg-ment-model of the American Society of Echocardiography. They underwent dobutamine-MRI and dipyridamole-SPECT studies, which were evaluated using a 28-segment modeli. Myocardial segments were attributed to perfusion territories of the coronary arteries. The results of ischemia detection were compared to the results of coronary angiography (stenosis >50%.) Results: In comparison to coronary angiography dobutamine-MRI yielded a sensitivity of 87%, a specificity of 86%, a positive predictive value of 93%, a negative predictive value of 75% and a diagnostic accuracy of 86%. Eor dipyridamole-SPECT results were 90%, 86%, 93%, 80% and 89%, respectively. These values were not significantly different. Conclusions: In patients not suitable for stress-echocardiography, both dobutamine-MRI and dipyridamole-SPECT are reliable strategies for detection of myocardial ischemia. Selection is dependent on the patient criteria, technical considerations, local logistics and experience of the observer.
High-activity samarium-153-EDTMP therapy followed by autologous peripheral blood stem cell support in unresectable osteosarcoma
Authors: Bielack S. , Flege S. , Eckardt J. , Sciuk J. , Jürgens H. , Schober O. , Franzius Ch. 
Published: March 2018

Summary
Purpose: Despite highly efficacious chemotherapy, patients with osteosarcomas still have a poor prognosis if adequate surgical control cannot be obtained. These patients may benefit from therapy with radiolabeled phosphonates. Patients and Methods: Six patients (three male, three female; seven to 41 years) with unresectable primary osteosarcoma (n = 3) or unresectable recurrent sites of osteosarcomas (n = 3) were treated with high-activity of Sm-153-EDTMP (150 MBq/kg BW). In all patients autologous peripheral blood stem cells had been collected before Sm-153-EDTMP therapy. Results: No immediate adverse reactions were observed in the patients. In one patient bone pain increased during the first 48 hrs after therapy. Three patients received pain relief. Autologous peripheral blood stem cell reinfusion was performed on day +12 to +27 in all patients to overcome potentially irreversible damage to the hematopoietic stem cells. In three patient external radiotherapy of the primary tumor site was performed after Sm-153-EDTMP therapy and in two of them polychemotherapy was continued. Thirty-six months later one of these patients is still free of progression. Two further patients are still alive. However, they have developed new metastases. The three patients who had no accompanying external radiotherapy, all died of disease progression five to 20 months after therapy. Conclusion: These preliminary results show that high-dose Sm-153-EDTMP therapy is feasible and warrants further evaluation of efficacy. The combination with external radiation and polychemotherapy seems to be most promising. Although osteosarcoma is believed to be relatively radioresistant, the total focal dose achieved may delay local progression or even achieve permanent local tumor control in patients with surgically inaccessible primary or relapsing tumors.
Overtherapy or undertherapy for papillary thyroid microcarcinoma?
Authors: Schober O. , Schicha H. , Dietlein M. 
Published: March 2018

SummaryPapillary thyroid microcarcinomas £1 cm have an excellent prognosis both in terms of overall and relapse-free survival. Their high prevalence in autopsy series suggests that most papillary microcarcinomas do not progress to clinically relevant cancer. The extent of surgery is still controversial. Lobectomy or subtotal resection are standard procedures, but multifocal microcarcinomas or lymph node metastases might be overlooked. The pros and cons of completion thyroidectomy and ablative radioiodine therapy are based on limited evidence due to heterogenous inclusion criteria in published series. The retrospective data analyses included subgroups with infiltration of the thyroid capsule, lymph node metastases or multifocal microcarcinomas at the primary staging. The local relapse rate reached approximately 7% after different therapeutic regimes. Radioiodine ablation decreased the recurrence rate in some retrospective studies, but data are inconsistent. Successful radioiodine ablation is possible also after less radical surgery without complete thyroidectomy with postoperative 131I uptake of 10 to 20% or remnants of 3-8 ml. This concept was evaluated successfully in a monocentric series of patients with multifocal microcarcinomas. The therapeutic consideration should include the diameter of the carcinoma, neigh-bourhood to the thyroid capsule, histopathologic subgroups, age, familiar occurrence, patient’s informed consent and in future moleculargenetic tests, too. Therefore, limited surgical procedures for small papillary carcinomas as therapeutic standard, respectively thyroidectomy, lymph node dissection in the central compartment of the neck and ablative radioiodine therapy for individual cases are options for experienced surgeons and specialized tumour centers.
Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2)
Authors: Dressler J. , Farahati J. , Grünwald F. , Leisner B. , Moser E. , Reiners Chr. , Schicha H. , Schober O. , Dietlein M. 
Published: March 2018

SummaryThe procedure guidelines for radioiodine therapy (RIT) of differentiated thyroid cancer (version 2) are the counterpart to the procedure guidelines for 131I whole-body scintigraphy (version 2) and specify the interdisciplinary guidelines for thyroid cancer of the Deutsche Krebs-gesellschaft and the Deutsche Gesellschaft für Chirurgie concerning the nuclear medicine part. Compared with version 1 facultative options for RIT can be chosen in special cases: ablative RIT for papillary microcarcinoma ≤1 cm, ablative RIT for mixed forms of anaplastic and differentiated thyroid cancer, and RIT in patients with a measurable or increasing thyroglobulin concentration but without detectable metastases by imaging. The description of the pretherapeutic dosimetry now includes the isotopes 123I and 124I as well as a broader range of the activity of 131I. Activities of 2-5 GBq 131I are recommended for the first ablative RIT. If high accumulative activities of 131I are expected, men who have not yet finished their family planning should be advised to the option of sperm cryoconservation. An interdisciplinary consensus is necessary whether the new TNM-classification (UICC, 6th edition, 2002) will lead to modified recommendations for surgical or nuclear medicine therapy, especially for the surgical completeness and for the ablative RIT of pT1 papillary cancer.
Quantitative thyroid scintigraphy for the differentiation of Graves’ disease and hyperthyroid autoimmune thyroiditis
Authors: Sahlmann C. O. , Siefker U. , Lehmann K. , Harms E. , Conrad M. , Meller J. 
Published: March 2018

Summary
Aim: The TCTUs (global 99mTc-pertechnetate thyroid uptake under suppression) can be used as an estimate of the iodine clearance of non-TSH regulated tissue. High TCTUs levels are characteristic for Graves’ disease (GD). Decreased uptake has been described in autoimmune thyroiditis (AIT). However, systematically investigated data in a larger series of AIT-patients with subclinical or overt hyperthyroidism are not published so far. The purpose of this study is the evaluation of the TCTUs in the differentiation between AIT and GD in patients with hyperthyroidism. Methods: We determined the TCTUs in 59 patients with untreated hyperthyroid GD and in 51 patients with AIT who had subclinical or manifest hyperthyroidism without medication. Patients with GD were characterized by the presence of hyperthyroidism, decreased echogenicity of the thyroid, elevation of TSH-receptor autoantibodies (TRAb). AIT was defined by a decreased echogenicity of the thyroid, absence of elevated TSH-receptor autoantibodies (TRAb), autoantibodies against the thyroid peroxidase (anti-TPO) and spontaneous remission or development of subclinical hypothyroidism within 3 months. Results: Thyroid volumes of patients with AIT were significantly lower than those of patients with GD (p <0.05). TRAb levels were significantly higher in GD-patients (median: 19.5 U/ml; range: 15.3-35 U/ml) than in AIT-patients (median: 1.3 U/ml; range: 0-4.1 U/ml). 73% (38/59) of patients with GD had elevated anti-TPO levels. In these patients anti-TPO levels (median: 768 U/l; range: 83-6397 U/l) were not significantly different from anti-TPO levels of patients with AIT (median: 834 U/l; range: 107-8675 U/l; p = 0.17). TCTUs values of patients with AIT were significantly lower (p <0.05; median: 0.9%; range: 0.1-3.2%) than those of patients with GD (median: 5.7%; range: 1.9-28.3%). Conclusion: In our patients quantitative thyroid scintigraphy with 99mTcO4
- offered rapid and reliable differentiation between hyperthyroid GD and AIT.