There are two dosing methods for radioiodine dose administration including empirical fixed dose and calculated dose. Recent meta-analysis supported that dose calculation is better than empirical fixed dose. However, dose calculation by dosimetry or 24 hours radioiodine uptake ratio can be tedious. Pertechnetate thyroid scintigraphy is a simple nuclear imaging that can be completed on the same day and pertechnetate thyroid uptake ratio determined from the scintigraphy can be used to calculate the radioiodine dose. This research is done to measure the efficacy of the calculated dose regime. Methods: Hyperthyroidism patients referred for first radioiodine therapy were recruited. Pertechnetate thyroid scintigraphy was done and pertechnetate uptake ratio used for dose calculation. The outcome of the treatment was determined at six months. Results: A total of 95 patients were recruited. Six months after treatment, 82.1% of the calculated dose cohort achieved euthyroid or hypothyroid state. Participants with multinodular goitre had higher failure rate than those with Graves’ disease (p=0.032) although there was no difference in the median RAI dose given (p=0.866). Conclusion: This calculated dose method showed good outcome with 82.1% cure rate at six months post treatment.
Positron Emission Tomography-Computed Tomography (PET-CT) was introduced over four decades ago as an imaging tool to evaluate functional and anatomical aspects of disease such as malignancy. Besides pathological uptake, PET-CT also shows physiological uptake, especially in the gastrointestinal system, thus impacting diagnostic accuracy in these cases. There are many conditions that can attribute to increasing physiological uptake in PET-CT including microbial activity and drugs. Therefore, certain anti-spasmodic agents have been introduced to help reduce physiological uptake during scanning such as Hyoscine-n-butylbromide (Buscopan). This study aims to establish its effectiveness in reducing physiological bowel uptake on 18F-FDG PET-CT scan. Methods: 133 subjects were recruited in random for this study and divided into hyoscine (68 subjects) and control groups (65 subjects), respectively. Subjects in control group not given any anti-spasmodic medications and both groups received intravenous 18F-FDG according to body weight. PET-CT scan and images were interpreted by experienced nuclear medicine physician who scored the images according to the degree of bowel uptake and difficulty of image interpretation. Results: There were no statistical difference in bowel uptake based on SUV mean of the bowel and bowel-to-liver ratio between hyoscine and control groups. Conclusion: There was no significant effect of Hyoscine-n-butylbromide in reducing physiological bowel uptake in PET-CT scan.
Background: Positron Emission Tomography and Computed Tomography (PET-CT) imaging is shown to influence a decision change in managing non-small cell lung carcinoma (NSCLC). The introduction of such a facility in Malaysia is relatively recent, and its impact from its utility is currently being assessed.
Aim: In a tertiary referral centre possessing the only PET-CT facility in northern Peninsular Malaysia, we evaluated the potential roles of PET-CT in referred patients with non-small cell lung carcinoma.
Methodology: Sixty eligible adult cases with NSCLC, between September 2005 and December 2007, were retrospectively reviewed. Relevant data was collected using standard questionnaire for indications, staging of disease, and outcomes in terms of recurrence and response to prescribed cancer-specific therapy.
Results: The indications for PET-CT were: staging of a newly diagnosed non-small cell lung carcinoma (25.0%); post-operative restaging (21.7%); exclusion of recurrence or metastasis (18.3%); establishing diagnosis of carcinoma (13.3%); assessment of response to treatment (11.7%), and for surveillance (10.0%). The use of PET-CT was shown to induce a change in the staging, compared with non-PET conventional means in 69.2% of patients with newly diagnosed lung carcinoma (upstaged in 55.5%; downstaged in 44.5%) and in 65.0% of patients who underwent cancer-specific treatments (upstaged in 38.5%; downstaged in 61.5%). PET-CT detected recurrence in 62.5% who underwent the imaging to exclude a recurrence or metastasis.
Conclusion: PET-CT has affected the staging of a large proportion of our local Malaysian patients. Like elsewhere, the availability of such a facility is likely to have important influence in overall management of NSCLC in Malaysia.