INTRODUCTION: Tc-tetrofosmin is a diagnostic radiopharmaceutical used to evaluate cardiac pathologies. Despite the lower incidence of reactions compared to other drugs, radiopharmaceuticals can still cause adverse reacti...INTRODUCTION: Tc-tetrofosmin is a diagnostic radiopharmaceutical used to evaluate cardiac pathologies. Despite the lower incidence of reactions compared to other drugs, radiopharmaceuticals can still cause adverse reactions. For this reason, pharmacovigilance plays a crucial role in detecting, understanding, evaluating and preventing them. OBJECTIVE: This study aims to review the available literature,on the safety of Tc-tetrofosmin, and to analyze spontaneous adverse drug reaction reports from the European EudraVigilance database. METHODS: A literature review was conducted according to PRISMA methodology. An analysis of spontaneous notifications was carried out in EudraVigilance, until 2022. RESULTS: The review identified a selection of 7 articles. The most reported adverse reactions were skin irritation, strange taste in the mouth and nausea. Regarding the EudraVigilance analysis, 220 notifications were identified, accounting for 477 adverse reactions. The majority belong to males (51%), between 18-64 years (45%). Health professionals were the main reporters (84%). The most prevalent System Organ Class was "general disorders and administration site conditions" (21%) and the most reported adverse reaction was pruritus (10%). Approximately 67% of reactions were considered serious, with 6 fatal cases recorded. CONCLUSION: The results demonstrated that adverse reactions associated with Tc-tetrofosmin do occur and should not be minimized. Over a period of 17 years, only 220 notifications were recorded, which may highlight potential challenges in pharmacovigilance for radiopharmaceuticals. Therefore, raising awareness about the importance of reporting adverse reactions is crucial.
Prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy has reshaped the treatment landscape for metastatic castration-resistant prostate cancer (mCRPC), offering new therapeutic possibilities beyond conv...Prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy has reshaped the treatment landscape for metastatic castration-resistant prostate cancer (mCRPC), offering new therapeutic possibilities beyond conventional approaches. Among the most promising strategies is lutetium-177 PSMA-617, which has shown significant benefits in overall survival and durable PSA responses, as demonstrated in several clinical trials. At the same time, the development of novel radionuclides such as actinium-225 has opened the door to more potent treatments capable of overcoming prior resistance, particularly in patients previously exposed to beta emitters. The use of PSMA PET imaging and the identification of predictive biomarkers have helped refine patient selection, contributing to a more personalized approach. Comparative studies with agents like cabazitaxel have further supported the safety and effectiveness of this strategy. This article provides a critical overview of clinical advances in PSMA-targeted radionuclide therapy, examines emerging combination treatments, reviews the development of alpha-emitting agents, and highlights the role of personalized dosimetry in clinical practice, underlining the growing importance of this therapeutic modality across different stages of prostate cancer.
Torres I, Ramos R, Domínguez ML
… +7 more, Rosales JJ, Roteta A, Prieto E, Sancho L, de Arcocha M, Quincoces G, en nombre del Grupo de Oncología de la SEMNIM
In this third installment of the continuing education series, the clinical and therapeutic applications of zirconium, astatine and thorium are analyzed in depth. Although they are not described as theragnostic pairs, eac...In this third installment of the continuing education series, the clinical and therapeutic applications of zirconium, astatine and thorium are analyzed in depth. Although they are not described as theragnostic pairs, each of these radionuclides plays a fundamental role in precision medicine, which is rapidly advancing within Nuclear Medicine. We begin by analyzing zirconium-89, a positron emitter whose long half-life makes it particularly suitable for labeling large molecules with slow kinetics, such as antibodies, playing a crucial role in immunotherapy. The use of astatine-211, an alpha-emitting radionuclide with a simple decay scheme and chemical behavior similar to iodine, is also discussed. Its main challenge lies in its production, as it requires cyclotrons capable of generating highly energetic alpha particle beams. Furthermore, thorium-227, a 100% alpha emitter, is reviewed. This radionuclide exhibits excellent chelation properties, enabling its conjugation with tumor-targeting molecules to produce thorium-labeled conjugates. While this technique is yielding promising preclinical results, the use of thorium faces challenges, including the potential separation of radium-223 from the molecule and the dependence of activity measurements on the time of production. Since it takes 100 days to reach equilibrium, activity assessment is based on photons emitted by its daughter radionuclides. Despite these challenges, these radionuclides are driving the evolution of precision medicine, expanding therapeutic and diagnostic possibilities within Nuclear Medicine.
INTRODUCTION: Fever can affect the identification and efficacy evaluation of tumors on the F-FDG PET/CT, and this effect can be reduced by referring to normal tissue metabolism. The aim of the study was to analyze the in...INTRODUCTION: Fever can affect the identification and efficacy evaluation of tumors on the F-FDG PET/CT, and this effect can be reduced by referring to normal tissue metabolism. The aim of the study was to analyze the influence of fever on glucose metabolism in the mediastinal blood pool, liver, spleen, and bone marrow utilizing PET/CT quantitative parameter SUV normalized by lean body mass (SUL). MATERIALS AND METHODS: 30 patients with fever of unknown origin and 24 patients for tumor screening with normal body temperature within 3 weeks, who underwent F-FDG PET/CT in our department, were analyzed retrospectively. The SUL and SUL of the mediastinal blood pool, liver, spleen, and bone marrow were respectively measured in the two groups, and the differences between the two groups were compared by independent sample t test or Wilcoxon-Mann-Whitney test. RESULTS: The SUL and SUL of the liver in the fever group were lower than those in the control group (p = 0.001, 0.013). The SUL and SUL of spleen and bone marrow in the fever group were higher than in the control group (all p < 0.05). The SUL of the mediastinal blood pool in the fever group was lower than that in the control group (p = 0.007), but there was no significant difference in SUL of the mediastinal between the fever group and the control group (t = 1.181, p = 0.221). CONCLUSION: The fever can affect the glucose metabolism in internal organs. But there was no significant difference in the SUL of mediastinal blood pool. Perhaps the SUL of the blood pool can be invoked as a calibration parameter in the evaluation of efficacy in tumor patients with fever.
Campaña Díaz E, Gómez-Caminero López F, Manuel Álvarez Pérez J
… +4 more, Montes Fuentes C, Rama Alonso S, Ángel Badell Martínez J, García-Talavera San Miguel P
OBJECTIVE: To assess the usefulness of performing a dual-time-point protocol in the acquisition of F-choline (F-FCH) PET/CT in the pre-surgical localization of PHPT, and to demonstrate the impact of this imaging techniqu...OBJECTIVE: To assess the usefulness of performing a dual-time-point protocol in the acquisition of F-choline (F-FCH) PET/CT in the pre-surgical localization of PHPT, and to demonstrate the impact of this imaging technique on the management and outcome-based surgical decision making, compared to other imaging techniques. To evaluate the diagnostic performance of the test to discriminate between pathological parathyroid gland and cervical lymph node, as well as to establish its correlation with other imaging techniques (scintigraphy, ultrasound, CT and MRI). PATIENTS AND METHODS: We included 39 patients who underwent surgery for PHPT, in whom dual-time-point F-FCH PET/CT was performed. Metabolic index of parathyroid (P-SUVmax; P-SUVpeak), lymph node (N-SUVpeak), thyroid (T-SUVpeak) and mediastinum (M-SUVpeak) uptake were analyzed visually and semiquantitatively in both images. PET/CT results were correlated with Tc-MIBI scintigraphy, ultrasound, MRI and CT. RESULTS: In 36 patients (92%), PET/CT was positive, localizing 38 pathological glands. The sensitivity (S) of PET/CT was 97% and positive predictive value (PPV) 94%. In the visual analysis, dual-time-point protocol was necessary in 61% of the cases. Correlation between PET/CT with MRI was 80%, with 4D-CT 50%, and with the other techniques <50%. P-SUVmax shows correlation with adenoma weight and size, and with presurgical PTH. The best cutoff point for SUVpeak to differentiate parathyroid vs. lymph node was 2.6 in early images (S = 70%; specificity = 75%; p = 0.007) and 0.86 for SUVpeak/T-SUVpeak index (S = 73%; specificity = 69%; p = 0.001). CONCLUSION: F-FCH PET/CT is an excellent preoperative localization technique in patients with HPTP with negative, doubtful or inconclusive imaging techniques, being of vital importance in guiding minimally invasive surgery. The dual-time-point protocol was necessary in more than half of the cases (61%). The SUVpeak cut-off points to discriminate between parathyroid gland and lymph nodes were statistically significant.
Vigil Díaz C, Paredes Rodríguez P, Perissinotti A
… +7 more, Fernando Guillén E, Diego Alfonso DA, Lojo Ramírez JA, Aguiar Fernández P, Camacho V, Nieves Cabrera-Martín M, por el grupo de Trabajo de Neuroimagen de la SEMNIM
The increase in the prevalence of dementia in our clinical setting poses a diagnostic challenge for the Nuclear Medicine specialist. The aim of this study is to review the modifications in the procedure and to describe t...The increase in the prevalence of dementia in our clinical setting poses a diagnostic challenge for the Nuclear Medicine specialist. The aim of this study is to review the modifications in the procedure and to describe the usefulness of the use of brain PET with F-FDG in different clinical indications, both classic and emerging ones. The SEMNIM Neuroimaging working group has considered it appropriate to update the procedures available in Spanish in order to optimize the quality of this technique and the interpretation of its findings, both for the specialist in Nuclear Medicine and the rest of the professionals involved in the diagnosis and treatment of neurodegenerative diseases.
OBJECTIVE: [F]FDG uptake in the livers and tumors of children is lower than that of adults. The brain exhibits intense physiological [F]FDG uptake. In childhood, the ratio of brain weight to body height and the ratio of...OBJECTIVE: [F]FDG uptake in the livers and tumors of children is lower than that of adults. The brain exhibits intense physiological [F]FDG uptake. In childhood, the ratio of brain weight to body height and the ratio of brain weight to body weight are higher than those of adults. We hypothesized that in children, most of the [F]FDG would be retained in the brain, resulting in less [F]FDG activity reaching other organs and tumor tissues. METHODS: The [F]FDG PET/CT images of 56 pediatric and 24 adult patients were evaluated retrospectively. Patients were divided into four age groups: 1) 3-7 years old, 2) 8-12 years old, 3) 13-17 years old, and 4) over 18 years old. Accumulated [F]FDG activity in the brain, liver, and whole body (WB) was calculated using the manually drawn volumes of interest for all patients using NUKDOS software. Also, SUV normalized to total body weight (SUVbw) and SUV normalized to lean body mass (SUVlbm) of the liver were calculated using the NUKDOS software. RESULTS: The mean [F]FDG accumulation ratio of brain-to-WB was significantly higher in patients aged 3-7 years and 8-12 years than in adults. Brain/WB [F]FDG activity ratio was lower in the 13-17 age group compared to the 3-7 age group (P = .0001). The accumulated [F]FDG activity ratio of liver-to-WB in the 3-7 age group was significantly lower than in adults when comparing the four groups (P = .0001). The mean of liver SUVbw was statistically lower in the 3-7 and 8-12 age groups than in the 13-17 and adult groups. Patients aged 3-7 years had a significantly lower mean liver SUVlbm than those in the other age groups. The mean liver SUVlbm was also significantly lower in the 8-12 years and 13-17 years age groups than in adults. There was a negative correlation between blood glucose levels and the amount of [F]FDG in the brain. However, no statistically significant correlation existed between blood glucose and age. CONCLUSION: We showed that the [F]FDG accumulation rate was higher in the brain and lower in the liver in the children when compared to adults. Our findings suggest that increased uptake of [F]FDG in children's brains may lead to reduced activity reaching other organs and tumor tissue. To improve diagnostic accuracy, adapted SUV correction protocols can be developed for pediatric populations, considering age-related changes in [F]FDG uptake ratio of the brain.
BACKGROUND: Coronary artery disease is a complex, multifactorial process with high prevalence and morbidity-mortality. Single photon emission computed tomography (SPECT) myocardial perfusion imaging synchronized with the...BACKGROUND: Coronary artery disease is a complex, multifactorial process with high prevalence and morbidity-mortality. Single photon emission computed tomography (SPECT) myocardial perfusion imaging synchronized with the electrocardiogram (gated-SPECT) is a non-invasive imaging technique that has demonstrated high sensitivity and specificity for diagnosis and staging. To better predict the risk of adverse events, it is necessary to analyze the simultaneous behavior of clinical elements and diagnostic tests, a type of study that is scarce in the current literature. This research evaluated the relationship between clinical characteristics and gated-SPECT myocardial perfusion parameters with progression to cardiac death; subsequently, a model was built to predict the risk of such an outcome. METHODS: An observational, longitudinal, and retrospective study was conducted with 2 230 patients who underwent this test due to suspected coronary artery disease. Clinical characteristics, test parameters, and progression to cardiac death were collected and the relationships between them were studied. A logistic regression model was built to study the relationships between the variables and their influence on the probability of progression to cardiac death. RESULTS: Clinical characteristics associated with a higher probability of cardiac death were male sex (OR = 5.104, p = 0.004), peripheral arterial disease (OR = 7.175, p < 0.001), and diabetes mellitus (OR = 3.159, p = 0.013). The gated-SPECT parameters associated with a higher risk of this outcome were VTS ≥70 ml (OR = 12.257, p < 0.001), EF < 50% (OR = 10.757, p < 0.001), VTD ≥140 ml (OR = 8.884, p < 0.001), ventricular dilation (OR = 8.959, p < 0.001), and reversible defects (OR = 7.454, p = 0.001). Fixed defects, parietal motility abnormalities, the presence of both reversible and fixed defects, and the hyperdynamic gated state were also associated with a higher risk of cardiac death but with lower ORs. The logistic regression model showed good overall performance and high ability to determine progression to cardiac death, close to perfect predictive capacity (AUC = 0.9656).
OBJECTIVE: To analyze the prognostic value of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and other biomarkers of inflammation in patients with neuroendocrine tumors (NETs) treated with [Lu]Lu-DOTA-TAT...OBJECTIVE: To analyze the prognostic value of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and other biomarkers of inflammation in patients with neuroendocrine tumors (NETs) treated with [Lu]Lu-DOTA-TATE (Lutathera®). The prognostic value of histological characteristics of the tumor was also analyzed. PATIENTS AND METHODS: Prospective study of a cohort of patients with advanced and metastatic NETs treated with [Lu]Lu-DOTA-TATE. Before the administration of doses, NT-proBNP, hemoglobin, hematocrit, C-reactive protein, leukocytes, lymphocytes, neutrophils, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been determined. Overall survival (OS) and progression free survival (PFS) were calculated, using the Kaplan-Meier method, and curves were compared with a log-rank test. To determine the predictor variables of OS, a Cox regression model was fitted. RESULTS: 48 NET patients treated with [177Lu]Lu-DOTA-TATE. Median OS was 96 months and PFS was 29 months. Factors associated with lower OS were: NTproBNP values>300 pg/mL (HR: 10,5; p = 0,005) in the subgroup of patients with grades 2-3, in addition to inflammatory indices NLR > 2 (HR: 3,87; p = 0,049) and PLR > 300 (HR: 11,88; p = 0,01) and higher tumor grade (HR: 6,45; p = 0,011). PLR > 300 (HR: 5,506; p = 0,003) was also associated with lower PFS. In contrast, higher levels of lymphocytes (HR: 0,21; p = 0,002), hemoglobin (HR: 0,65; p = 0,041) and hematocrit (HR: 0,862; p = 0,031) were associated with higher OS, without significant changes in PFS. CONCLUSION: In patients with NETs treated with [Lu]Lu-DOTA-TATE, the determination of natriuretic factors (NT-ProBNP) and other inflammatory biomarkers may be useful as predictors of survival and prognostic factors.