Elektronická učebnica nukleárnej medicíny

Basic informations

Thematic area: komisia č. 3 pre obsahovú integráciu a diverzifikáciu vysokoškolského štúdia

Project name (Slovak): Elektronická učebnica nukleárnej medicíny

Project name (English): Electronic textbook of nuclear medicine

Start of project: 2014

End of project: 2015

Condition of project: Ukončený

Project number: 003UK-4/2014

Project leader: doc. MUDr. Soňa Balogová, PhD.

University: Univerzita Komenského v Bratislave

Department: Lekárska fakulta

Anotácia originálnych výsledkov riešenia projektu v slovenskom jazyku

Elektronická učebnica nukleárnej medicíny a učebné texty

anotácia: poskytnú prehľad o diagnostických a terapeutických metódach nukleárnej medicíny pre poslucháčov LF UK s možným využitím v rámci postgraduálnej výučby odboru.

Sriptá pre pregraduálnu výučbu nuklárnej medicíny

anotácia: skriptá poskytujú základný prehľad o diagnostických a terapeutických metódach nukleárnej medicíny pre poslucháčov LF UK.

Skriptá pre postgraduálnu výučbu v rámci prípravy na špecializáciu v odbore rádiológia

anotácia: skriptá poskytujú základný prehľad o diagnostických a terapeutických metódach nukleárnej medicíny absolventov lekárskych fakúlt v rámci prípravy na špecializáciu v odbore rádiológia.

Balogova, S., J. B. Zakoun, L. Michaud, A. Khalil, M. Tassart, A. Esteso, K. Kerrou, V. Huchet, M. F. Carette, J. P. Lotz, and J. N. Talbot. 2014. 'Whole-Body 18F-Fluorocholine (FCH) PET/CT and MRI of the Spine for Monitoring Patients With Castration-Resistant Prostate Cancer Metastatic to Bone: A Pilot Study', Clinical nuclear medicine.

anotácia: s príchodom inovatívnych terapeutických prístupov pri kastračne rezistentnom karcinóme prostaty sa významne zlepšilo prežívanie pacientov. Vysoko aktuálnou otázkou sa takl stalo optimálne hodnotenie terapeutického efektu týchto potenciálne toxických a nákladných terapeutických postupov. Morfologické zobrazovacie metódy neumožňujú optimálne hodnotenie progresie kastračne rezistentného karcinóme prostaty počas liečby a funkčné zobrazovacie metódy (najmä pomocou pozitrónovej emisnej tomografie) v tejto situácii poskytujú atraktívnu alternatívu.

Pre predilekčnú lokalizáciu metastáz karcinómu prostaty v skelete bola v práci porovnávaná frekvencia detekcie progresie ochorenia pomocou magnetickej rezonancie (MRI) chrbtice a pomocou pozitrónovej emisnej tomografie/počítačovej tomografie (PET/CT) s fluórcholínom (18F). Na základe výsledkov práce bolo konštatované, že výsledky MRI chrbtice a PET/CT s fluórcholínom (18F) limitovanej na oblasť chrbtice sú vysoko konkordantné. Celotelový charakter zobrazenia pomocou PET/CT s fluórcholínom (18F) však umožňuje detekciu progresie ochorenia aj v oblastiach, ktoré pri MRI chrbtice nie sú zachytené. PET/CT s fluórcholínom (18F) tak môže byť odporúčanou metódou na hodnotenie terapeutického efektu pri kastračne rezistentnom karcinóme prostaty. V tejto oblasti ide o jednu z prvých vedeckých publikácií.

Michaud, L., A. Burgess, V. Huchet, M. Lefevre, M. Tassart, J. Ohnona, K. Kerrou, S. Balogova, J. N. Talbot, and S. Perie. 2014. 'Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism?', J Clin Endocrinol Metab, 99: 4531-6.

anotácia: Pozitrónová emisná tomografia (PET) je v súčasnosti najmodernejšou a najsenzitívnejšou metódou funkčného zobrazenia metódami nukleárnej medicíny. V súčasnosti je pri lokalizácii hyperfunkčných prištítnych teliesok metódami nukleárnej medicína štandardom scintigrafia prištítnych teliesok. Technicky je však konvenčná scintigrafia v porovnaní s PET zaťažená nevýhodou horšieho priestorového rozlíšenia, čo môže najmä v komplikovaných prípadoch viesť k obmedzenej senzitívnosti scintigrafickej lokalizácie hyperfunkčných prištítnych teliesok. V práci je navrhnuté výhodné využitie PET/CT s fluórcholínom (18F) pri lokalizácii hyperfunkčných prištítnych teliesok, ktorá potenciálne môže nahradiť konvenčnú scintigrafiu prištítnych teliesok. V tejto oblasti ide o jednu z prvých vedeckých publikácií.

Michaud, L., S. Balogova, A. Burgess, J. Ohnona, V. Huchet, K. Kerrou, M. Lefevre, M. Tassart, F. Montravers, S. Perie, and J. N. Talbot. 2015. 'A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies', Medicine (Baltimore), 2015;94(41): e1701.

anotácia: práca rozvíja poznatky z predchádzajúcej publikácie, v kotrej bolo konštatované, že uzlovité anomálie štítnej žľazy môžu byť zdrojom falošne pozitívnych nálezov pri lokalizácii hyperfunkčných prištítnych teliesok pomocou PET/CT s fluórcholínom (18F). Aj v tejto situácii bolo konštatované výhodné využitie PET/CT s fluórcholínom (18F) pri lokalizácii hyperfunkčných prištítnych teliesok, ktorá potenciálne môže nahradiť konvenčnú scintigrafiu prištítnych teliesok. V tejto oblasti ide o jednu z prvých vedeckých publikácií.

Description of original results of the project in English

Elestronic textbook and printet textbook of nuclear medicine

annotation: both will provide the overview of diagnostic and therapeutic methods of nuclear medicine for medical students and during the postgradual training in nuclear medicine.

Handbook of nuclear medicine

annotation: this handbook provides with basic overview of diagnostic and therapeutic methods of nuclear medicine for medical students

Handbook of nuclear medicine

annotation: this handbook provides with basic overview of diagnostic and therapeutic methods of nuclear medicine for physicians in training programme in radiology

annotation/abstract: Several treatments are proposed for castration-resistant prostate cancer (CRPC) at the metastatic stage. Monitoring of response using serum prostate-specific antigen (PSA) levels (sPSA) can be insufficient at this stage. Imaging has been proposed, in particular, nuclear medicine functional imaging and MRI, since response of predominant bone metastases is hardly evaluable on CT. Our aim was to evaluate in patients with CRPC with bone metastases, before and after various treatment lines, the evolution of sPSA, whole-body 18F-fluorocholine (FCH) PET/CT and spine MRI (sMRI) that has been proposed for detection of imminent malignant spinal cord compression. We retrospectively gathered a pilot series of 10 patients with CRPC metastatic to bone who had 47 PSA assays, FCH PET/CT, and spine-MRI (sMRI) performed concomitantly as routine examinations, before the beginning and at the end of 37 therapeutic intervals (TIs). Blinded reading of FCH PET/CT and sMRI was performed to evaluate visually whether or not the disease has been progressing (new lesions, greater size, or greater uptake intensity of known lesions) between the initial and the final examination of each TI.
Visual interpretations limited to spine FCH (sFCH) PET/CT and sMRI were in accordance for 34 TIs (92%): 14 progressions and 20 nonprogressions. In 2 cases, sFCH did not detect lesions visible on sMRI: one epiduritis and one 6-mm lesion. In 1 case, MRI missed a lesion in the sacrum that was detected on sFCH. When whole-body FCH (wbFCH) PET/CT was taken into account, the agreement with sMRI was limited to 29 TIs (78%). The 8 discrepant cases were all wbFCH positive and sMRI negative, that is, a significantly higher frequency of positivity for wbFCH (P < 0.008). Serum PSA levels increased by more than 25% during 21 TIs, whereas no progression was visible in 8 TIs on sMRI and in 2 TIs on wbFCH. In 5 TIs, sPSA decreased by more than 50%, and progression was never detected on imaging.

In detecting progression in patients with CRPC metastatic to bone, results of spine imaging with sMRI and sFCH PET/CT were highly correlated, whereas wbFCH PET/CT showed significantly more progression statues comparing to sMRI alone related to the exploration of other parts of the skeleton and of soft tissue.

annotation/abstract: Preoperative ultrasonography and scintigraphy using (99m)Tc-sestamibi are commonly used to localize abnormal parathyroid glands. In cases of discrepant results between scintigraphy and ultrasonography, it is important to rely on another diagnostic imaging modality. (18)F-fluorodeoxyglucose (FDG) and (11)C-methionine positron emission tomography (PET) have been studied, but are imperfect to detect abnormal parathyroid glands. Recently, first cases of abnormal parathyroid glands taking-up radiolabelled choline were discovered incidentally in men referred to (11)C-choline or (18)F-fluorocholine (FCH)-PET/CT for prostate cancer. We checked if FCH uptake was a general feature of adenomatous or hyperplastic parathyroid glands.
FCH-PET/CT was performed in 12 patients with primary (n = 8) or secondary hyperparathyroidism (1 dialyzed, 3 grafted) and with discordant or equivocal results on preoperative ultrasonography (US) and/or (123)I/(99m)Tc-sestamibi dual-phase scintigraphy. The results of the FCH-PET/CT were evaluated, with surgical exploration and histopathologic examination as the standard of truth. On a per-patient level, the detection rate of FCH-PET/CT (at least one FCH focus corresponding to an abnormal parathyroid gland in a given patient) was 11/12 = 92%. FCH-PET/CT detected 18 foci interpreted as parathyroid glands and correctly localized 17 abnormal parathyroid glands (7 adenomas and 10 hyperplasias). On a per-lesion level, FCH-PET/CT results were 17 TP, 2 false negative ie, a lesion-based sensitivity of 89%, and 1 false positive. As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localized by FCH-PET/CT with good accuracy. Furthermore, FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.

annotation/abstract: in this study we compared F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and I/Tc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted).The reference standard was based on results of surgical exploration and histopathological examination. The results of imaging modalities were evaluated, on site and by masked reading, on per-patient and per-lesion bases.In a first approach, equivocal images/foci were considered as negative. On a per-patient level, the sensitivity was for US 38%, for scintigraphy 69% by open and 94% by masked reading, and for FCH-PET/CT 88% by open and 94% by masked reading. On a per-lesion level, sensitivity was for US 42%, for scintigraphy 58% by open and 83% by masked reading, and for FCH-PET/CT 88% by open and 96% by masked reading. One ectopic adenoma was missed by the 3 imaging modalities. Considering equivocal images/foci as positive increased the accuracy of the open reading of scintigraphy or of FCH-PET/CT, but not of US. FCH-PET/CT was significantly superior to US in all approaches, whereas it was more sensitive than scintigraphy only for open reading considering equivocal images/foci as negative (P = 0.04). FCH uptake was more intense in adenomas than in hyperplastic parathyroid glands. Thyroid lesions were suspected in 9 patients. They may induce false-positive results as in one case of oncocytic thyroid adenoma, or false-negative results as in one case of intrathyroidal parathyroid adenoma. Thyroid cancer (4 cases) can be visualized with FCH as with Tc-sestaMIBI, but the intensity of uptake was moderate, similar to that of parathyroid hyperplasia.This pilot study confirmed that FCH-PET/CT is an adequate imaging tool in patients with primary or secondary hyperparathyroidism, since both adenomas and hyperplastic parathyroid glands can be detected. The sensitivity of FCH-PET/CT was better than that of US and was not inferior to that of dual-phase dual-isotope I/Tc-scintigraphy. Further studies should evaluate whether FCH could replace Tc-sestaMIBI as the functional agent for parathyroid imaging, but US would still be useful to identify thyroid lesions.

Financial grant of MŠVVandŠ SR within KEGA

	Financial grant of MŠVVandŠ SR within KEGA	Capital expenditures in €
Pumped for the entire period of the project	7 610,00	0,00

List of project outcomes for the entire solution

Publishing activity

Category code	Specific output, name (ISBN, number of pages a i.)
ADC	Balogová, Soňa (50%); Ben Zakoun, Joseh (5%); Michaud, Laure (5%); Khalil, Antoine (5%); Tassart, Marc (5%); Esteso, Adoracion (5%); Kerrou, Khaldoun (5%); Huchet, Virginie (5%); Carette, Marie France (5%); Lotz, Jean Pierre (5%); Talbot, Jean Noel (5%): Whole-body F-18-fluorocholine (FCH) PET/CT and MRI of the spine for monitoring patients with castration-resistant prostate cancer metastatic to bone. A pilot study. 2014 ISSN 0363-9762
ADC	Michaud, Laure (20%); Burgess, Alice (10%); Huchet, Virginie (10%); Lefevre, Marine (10%); Tassart, Marc (5%); Ohnona, Jessica (5%); Kerrou, Khaldoun (5%); Balogová, Soňa (20%); Talbot, Jean Noel (10%); Périé, Sophie (5%): Is 18F-fluorocholine-PET/CT a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism?. 2014 ISSN 0021-972X
ADC	Michaud L, Balogova S, Burgess A, Ohnona J, Huchet V, Kerrou K, Lefèvre M, Tassart M, Montravers F, Périé S, Talbot JN. A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies. Medicine (Baltimore). 2015;94(41)
BCI	Balogová, Soňa (100%): Úvod do štúdia nukleárnej medicíny. 2014
BCI	Balogová, Soňa (95%); Bilický, Jozef (5%): Úvod do štúdia nukleárnej medicíny pre rádiológov. 2014
ACB	Balogová, Soňa a kolektív: Základy nukleárnej medicíny, Učebnica pre poslucháčov Lekárskej fakulty UK
BCI	Balogová, Soňa a kolektív: Základy nukleárnej medicíny, Učebné texty pre poslucháčov Lekárskej fakulty UK

Other outcomes (eg e-learning, websites, virtual laboratory, training, courses, workshops and the like.)

Output name	Description of output	Link
Študijné materiály pre poslucháčov LFUK (v slovenskom jazyku)	prednášky a cvičenia z nukleárnej medicíny	http://www.fmed.uniba.sk/pracoviska/klinicke-pracoviska/klinika-nuklearnej-mediciny-lf-uk-a-ousa/ index.php?id=6387
Študijné materiály pre poslucháčov LFUK (v anglickom jazyku)	prednášky a cvičenia z nukleárnej medicíny	http://staryweb.fmed.uniba.sk/index.php?id=4029 index.php?id=6373

Final evaluation of the commission KEGA

Splnil ciele excelentne (s dosiahnutím celospoločenských prínosov).

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