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Radionuclide-based Diagnosis and Therapy of Prostate Cancer
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Sven-Erik Strand, Mohamed Altai, Joanna Strand, David Ulmert
The radiometals 68Ga, 64Cu, 44Sc, 89Zr, and 86Y are considered as promising alternatives to 18F. They are metals and can be coupled to peptides and antibodies with different chelators. The utilization of 68Ga in oncological imaging has grown drastically due to the excellent properties of this radionuclide. Gallium-68 is a generator-eluted (68Ge→68Ga generator) short-lived (t1/2=68 min) radionuclide with high abundance of positron decay (89%) and maximum energy of 1.92 MeV. The generator system ensures direct access to 68Ga in clinical facilities for as long as one year (68Ge half-life 270.8 d). This is an advantage over 18F, which requires the availability of on-site or short-distance cyclotrons. As has been elaborated on elsewhere in this book there is a trade-off concerning particle range and spatial resolution. A good example of the physical properties concerning range and spatial resolution is given in Figure 19.6 comparing 18F and 68Ga [11]. In agreement with the positron range, the increasing relative spatial resolution is in the sequence (left to right) of 68Ga>44Sc>>64Cu>18F [12].
Monographs of fragrance chemicals and extracts that have caused contact allergy / allergic contact dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
In the evening of the day that a man, who had been exposed to silica for a long time, received an intravenous injection of Gallium 67 preserved with benzyl alcohol for a scintigraphy, he experienced severe itching and joint pains. The following day, he visited the emergency room for a rash over his entire body. The diagnosis of a severe urticarial reaction following the injection of Gallium 67 was entertained. Ten days later, the joint pains increased. They were symmetrical and involved mostly the fingers, hands, elbows, shoulders and knees. The urticarial rash soon disappeared but joint pains would persist for about 5 months. Later, an increase in circulating immune complexes was found and there was a positive prick test to benzyl alcohol 5% in phosphate-buffered saline. The authors postulated that an immune complex-mediated hypersensitivity reaction to the benzyl alcohol found in injectable Gallium 67 may explain the signs and symptoms reported by this patient (82).
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Gallium 68 PET/CT is used to stage carcinoid. Carcinoids can be negative on both 18F FDG PET/CT and 18F DOPA PET/CT. Although carcinoids can metastasise to the liver, the most appropriate test would be the Gallium 68 PET/CT rather than liver MRI as it would help to exclude disease elsewhere, for example in the enlarged right hilar and mediastinal nodes. However, these nodes may also be enlarged due to concurrent infection. Follow-up CT in this symptomatic young patient would not be appropriate.
Piflufolastat F-18 (18F-DCFPyL) for PSMA PET imaging in prostate cancer
Published in Expert Review of Anticancer Therapy, 2022
Andrew F. Voter, Rudolf A. Werner, Kenneth J. Pienta, Michael A. Gorin, Martin G. Pomper, Lilja B. Solnes, Steven P. Rowe
The biggest near-term change in use of PSMA-PET will be improved access. While 68Ga-PSMA-11 has seen use in Europe, access in the United States was limited, available only at select academic centers. Gallium-68 is challenging to produce in large quantities and has a relatively short half-life, limiting distribution options. In 2021, the FDA approved 18F-DCFPyL without location restrictions [4], as well as a commercial kit for generation of 68Ga-PSMA-11 [93]. As fluorine-18 production and distribution networks are more mature than those for gallium-68, this will greatly broaden access to these important imaging agents. Furthermore, clinical trials are currently underway for a range of other PSMA imaging agents, including PSMA-1007 [94], CTT1057 [95], and PSMA I&T [96], among others. As the underlying mechanism of action for all PSMA-targeted small-molecule agents is the same, similar overall performance is expected [97]. Nevertheless, clinical trials may reveal unique features of some of these agents. Furthermore, each radioisotope has its own set of benefits and challenges, and access to a set of clinically approved agents with a range of radioisotopes can only serve to improve access in diverse clinical settings.
Neurosarcoidosis As a Rare Differential Diagnosis for Single Or Multiple Lesions of the Nervous System
Published in British Journal of Neurosurgery, 2020
Christian Blume, Izabela Tuleta, Kay Nolte, Klaus W. Eichhorn, Mark Jakob, Hans Clusmann, Thorsten Send
In case of a suspected systemic sarcoidosis, a broad diagnostic work-up should be performed. An x-ray or a much more sensitive HRCT analysis may reveal abnormalities such as hilar and mediastinal lymphadenopathy or pulmonary infiltrates/scars.11 Pulmonary sarcoidosis, which is found in about 90% of NS patients, may be assessed by thoracic imaging, lung function and bronchoscopy.2 Bronchoalveolar lavage (BAL) with increased ratio of CD4/CD8 amounting to more than 3.5 has a sensitivity of 53% and a specificity of 94%.12 Angiotensin-converting enzyme (ACE) serum levels may be elevated in 24 to 76% of patients with NS.13 ACE elevations in bronchoalveolar lavage have higher prognostic value than those in serum.14 Other laboratory tests may show hyperglobulinemia, hypercalcemia, increased alkaline phosphatase and soluble receptor for il-2 (sil-2R) levels;15,16 these parameters are not specific for sarcoidosis and cannot serve as serological markers. Gallium-67 scanning is not specific either, but may be helpful in selecting the site for biopsy.11 Fluorodeoxyglucose positron emission tomography (FDG-PET) is characterized by a better uptake in the central nervous system and demonstrates higher sensitivity in detecting lymph node inflammation.15,17 In case of systemic sarcoidosis, a biopsy of the lymph nodes, skin or lung may be conducted. In patients without systemic disease and/or in patients needing a more definitive diagnosis of neurosarcoidosis, biopsy of a nervous system lesion may be considered.18
An ectopic Cushing’s syndrome as a cause of severe refractory hypokalemia in the ICU
Published in Acta Clinica Belgica, 2021
Othmane Mohib, Emmanuelle Papleux, Myriam Remmelink, Philippe Gottignies, David De Bels
The solitary pulmonary nodule at the right base, identified by the thoracic CT scan, was initially suspicious. An octreoscan was later proposed for ease of access, although the trend in the literature is to propose Gallium 68 Ga-DOTATATE Positron Emission Tomography (PET) with superior sensitivity [12]. This examination was negative, although approximately 80% of the typical carcinoid tumors and 60% of the atypical ones express SSTRs for immunohistochemistry and would therefore be detectable in SSTR-based imaging techniques [13–18]. Low-differentiated neuroendocrine carcinomas generally only weakly express SSTR and therefore are not evaluated routinely with imaging based on this last [19].