Center for Nuclear Medicine

Belgrade, Serbia

Center for Nuclear Medicine

Belgrade, Serbia

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Jankovic M.M.,University of Belgrade | Odalovic S.,Center for Nuclear Medicine | Popovic D.B.,University of Belgrade
2013 21st Telecommunications Forum Telfor, TELFOR 2013 - Proceedings of Papers | Year: 2013

The classification criteria for Sjögren's syndrome includes the salivary gland scintigraphy (SGS) as one of objective tests for assessment of salivary gland function. We have developed the software for the automatic calculation of commonly investigated quantitative salivary and oral indices (maximum accumulation, maximum secretion, modified secretion velocity, uptake ratio, parotid : submandibular ratio, ejection fraction, pre-stimulatory and post-stimulatory oral activity) derived from dynamic SGS. Our software enables the standardization of processing protocols in multicenter studies. © 2013 IEEE.


Akhtar M.S.,Bahawalpur Institute of Nuclear Medicine and Oncology BINO | Kousar F.,Center for Nuclear Medicine | Masood M.,Institute of Nuclear Medicine and Oncology INMOL | Fatimi S.,Bahawalpur Institute of Nuclear Medicine and Oncology BINO | Kokab,Bahawalpur Institute of Nuclear Medicine and Oncology BINO
Journal of the College of Physicians and Surgeons Pakistan | Year: 2010

Objective: To compare the results of patients with locally advanced breast cancer receiving two different regimens Fluorouracil, Doxorubicin and Cyclophosphamide (FAC) and Paclitaxel and Carboplatin. Study Design: Comparative study. Place and Duration of Study: The Oncology Department, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, from March 2007 to September 2008. Methodology: Patients with inoperable locally advanced breast cancer of stage were included. Sixteen patients were given FAC regimen and 9 patients were given Paclitaxel and Carboplatin, each combination was cycled after 21 days for four times. Before enrollment, detailed medical histories, physical examinations and performance status assessments were done as well as postchemotherapy evaluation with regular follow-up visits was done. Complete Response (CR, ↓100%) is defined as the disappearance of all known disease parameter i.e. disappearance in detectable tumour size, node free disease and surgery is possible. Paratial Response (PR, ↓ > 50%) was defined by 50% or greater decrease in the sum of the areas of bidimensionally measured lesions i.e. change of N2 to N1 or no status and some surgical procedure is possible to downstage the disease. Minor Response (MR) was defined as a decrease in the tumour insuffieceint to quality for partial responce. Static disease or no evaluable reflected no significant change in disease and no evidence of new disease. Progression of disease (> 25%) was defined as a 25% or greater increase in the area of any lesion > 2 cm or in the sum of the products of the individual lesions or the apprearance of new malignant lesions, surgery not possible. Results: Twenty five patients completed neoadjuvant chemotherapy. Sixteen (66%) patients received FAC and 9 (37%) patients received PC chemotherapy. Overall CR (breast and axilla) was 54%, PR was 16% and minor response (MR) was 8%. FAC treatment induced more emesis, mucositis, alopecia and cardiotoxicity. No death occurred. Conclusion: The Paclitaxel and Carboplatin regimen was better tolerated; both regimens were effective in improving disease and overall survival. © 2010. College of Physicians & Surgeons Pakistan.


Vrtovec B.,University of Ljubljana | Poglajen G.,University of Ljubljana | Lezaic L.,Center for Nuclear Medicine | Haddad F.,Stanford University | And 3 more authors.
Journal of Cardiac Failure | Year: 2011

Background: We investigated clinical effects of intracoronary transplantation of CD34+ cells in patients with dilated cardiomyopathy (DCM). Methods: Of 55 patients with DCM, 28 were randomized to CD34+ transplantation (SC group), and 27 patients did not receive stem cell therapy (controls). In the SC group, peripheral blood CD34+ cells were mobilized by granulocyte-colony stimulating factor and collected via apheresis. Patients underwent myocardial scintigraphy and CD34+ cells were injected in the coronary artery supplying the segments with reduced viability. Results: At baseline, the 2 groups did not differ in age, gender, left ventricular ejection fraction (LVEF), or NT-proBNP levels. At 1 year, stem cell therapy was associated with an increase in LVEF (from 25.5 ± 7.5% to 30.1 ± 6.7%; P = .03), an increase in 6-minute walk distance (from 359 ± 104 m to 485 ± 127 m; P = .001), and a decrease in NT-proBNP (from 2069 ± 1996 pg/mL to 1037 ± 950 pg/mL; P = .01). The secondary endpoint of 1-year mortality or heart transplantation was lower in patients receiving SC therapy (2/28, 7%) than in controls (8/27, 30%) (P = .03), and SC therapy was the only independent predictor of outcome on multivariable analysis (P = .04). Conclusions: Intracoronary stem cell transplantation could lead to improved ventricular remodeling, better exercise tolerance and potentially improved survival in patients with DCM. © 2011 Elsevier Inc. All rights reserved.


Sobic-Saranovic D.P.,University of Belgrade | Sobic-Saranovic D.P.,Center for Nuclear Medicine | Bojic L.,Center for Nuclear Medicine | Grozdic-Milojevic I.T.,Center for Nuclear Medicine | And 9 more authors.
Clinical Nuclear Medicine | Year: 2013

Purpose of the Report: The aims of this study were to compare perfusion and functional parameters between early (ES) and standard (SS) post-stress gated SPECT MIBI, to validate ES against coronary angiography, and to determine whether ES parameters can predict future cardiac events. Patients and Methods: The sample included 63 patients with normal or mildly impaired left ventricular function and intermediate Duke Treadmill Score. They underwent a 2-day stress-rest gated SPECT MIBI with the poststress data acquired at 15 minutes (ES) and 60 minutes (SS) after i.v. injection of 740 MBq of 99mTc-MIBI. The ES findings were compared to SS and against coronary angiography to determine their sensitivity/specificity for detecting 970% stenosis. The information about new-onset cardiac events was collected 26 T 6 months later. Results: Perfusion parameters did not significantly differ between ES and SS. Ejection fraction was significantly lower and regional wall motion abnormalities were significantly higher on ES than SS. The corresponding perfusion and functional parameters were strongly related (linear regression slope 0.65-1.00, intercept j0.36Y8.5, R2 0.98Y0.75). ES parameters had high sensitivity (96%) and specificity (83%) for detecting 970% stenosis. Lower early stress than rest EF (95%), higher early stress than rest EDV, and early SSS 98 emerged as significant predictors of new-onset cardiac events. Conclusions: Early post-stress gated SPECT MIBI yields comparable perfusion and functional parameters as the standard post-stress protocol. ES parameters are useful for detecting the existing coronary disease and for predicting future cardiac events. ES protocol is recommended for improving patient compliance and efficiency of nuclear cardiology services.


Sobic-Saranovic D.,University of Belgrade | Sobic-Saranovic D.,Center for Nuclear Medicine | Grozdic I.,Center for Nuclear Medicine | Vucinic-Mihailovic V.,University of Belgrade | And 14 more authors.
Journal of Nuclear Medicine | Year: 2012

The purpose of this study was to assess the utility of 18F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between 18F-FDG PET/CT and multidetector CT (MDCT) findings, to compare 18F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether 18F-FDG PET/CT findings are associated with the decision to change therapy. Methods: We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for 18F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the followup (12 ± 5 mo after 18F-FDG PET/CT), the clinical status and changes in therapy were analyzed. Results: 18F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative 18F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive 18F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive 18F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy. Conclusion: Our results indicate that 18F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. 18F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy. Copyright © 2012 by the Society of Nuclear Medicine and Molecular Imaging, Inc.


Petrovic N.S.,Center for Nuclear Medicine | Grujicic D.,Institute of Neurosurgery | Artiko V.M.,Center for Nuclear Medicine | Sobic-Saranovic D.P.,Center for Nuclear Medicine | And 3 more authors.
Nuclear Medicine Communications | Year: 2010

Objectives: (i) To examine blood perfusion and metabolic activity of various brain tumours using radionuclide cerebral angiography (RCA) and single-photon emission tomography (SPET) after a single dose of 99mTc-methoxyisobutylisonitrile (MIBI). (ii) To examine if the inclusion of RCA can improve insight into the relative contribution of tumour perfusion to the uptake of MIBI shown by SPET, and to improve evaluation of tumour biology. (iii) To determine the value and the roles of MIBI in the management of brain tumour patients. Methods: Fifty adult patients (38 male, 12 female) with a total of 56 intracranial space-occupying lesions have been included prospectively, 37 of which were newly diagnosed and the remaining with signs of recurrence/rest of earlier resected and irradiated brain tumours. The control group consisted of nine volunteers with no evidence of organic cerebral disease. Scintigraphic examination consisted of a dynamic first-pass study lasting 60 s (3 s/frame) and two SPET studies (60 projections each, 25 s/projection), starting 15 min and 2 h after intravenous injection of MIBI. Regions of interest of the tumour and normal brain tissue were drawn on RCA and both early and delayed SPET slices. The following tumour/brain activity ratios have been calculated: (i) tumour perfusion index (P); (ii) early uptake index (E); (iii) delayed uptake index (D); and(iv) retention index (R). Analogous indices have been calculated from the same examinations performed in controls, reflecting maximal physiologic regional variations of perfusion and uptake in brain tissue. Results: Mean P of various brain tumours (low-grade gliomas 0.98, anaplastic gliomas 1.14, glioblastoma multiforme 1.20, metastases 1.09, lymphomas 1.08) differ little from each other and do not exceed maximal physiologic regional variations of cerebral perfusion (1.33), with the exception of meningioma (1.87, F=2.83, P=0.015). The receiver operating characteristics curve analysis of P showed that for the cut-off value of 1.45 the sensitivity for distinguishing meningioma from other tumours is 75%, specificity 87%, positive predictive value 33% and negative predictive value 97%. Mean E of malignant brain tumours (8.3, n=31, 23 primary, eight secondary), except anaplastic gliomas (3.5, n=5), differed significantly (P=0.02) from those of benign gliomas (3, n=9) but not from that of meningioma (11.9, n=4). The cut-off value for distinguishing malignant from benign lesions on the basis of E set at 4.8 resulted in sensitivity 67%, specificity 75%, accuracy 70%, positive predictive value 80% and negative predictive value 60%. D and R showed tendency of wash-out of MIBI from meningiomas, but otherwise did not improve the results substantially. Conclusion: Integrated results of RCA and SPET with 99mTc-MIBI indicate that blood perfusion, blood-tumour barrier permeability and metabolic activity of the tumour are all very important for the resultant uptake shown by SPET. If the perfusion index is less than 1.45, then meningioma can be ruled out. Early SPET is recommendable for distinguishing glioblastoma from low-grade gliomas, as a complement to standard magnetic resonance imaging and/or computed tomography. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Radovic B.,University of Belgrade | Artiko V.,University of Belgrade | Sobic-Saranovic D.,University of Belgrade | Trajkovic G.,University of Belgrade | And 3 more authors.
Neoplasma | Year: 2015

Neuroblastoma is the most common malignancy in children comprising 7.6% of all infantile cancers. MIBG scintigraphy is a mandatory neuroblastoma diagnostic test, which is among others methods, semi-quantified by the SIOPEN method. The aim of this study was to test both the skeletal and the soft tissue segments of the SIOPEN scoring method in the diagnostic milieu and to correlate them with the Curie score. Since there is little knowledge of their diagnostic power, the following variables were tested: VMA, HVA, LDH, and MYCN, ferritin, bone marrow infiltration, the INSS and the INPC classification. The cross-sectional study with repeated measurements of 143 scintigrams was performed on 76 pediatric patients with suspected or proven neuroblastoma, who had been referred to the Center for Nuclear Medicine of the Clinical Center of Serbia in the period 2007-2012. The range of the SIOPEN soft tissue scores was 0-5. The range of the SIOPEN skeletal scores was 0-57. The range of the Curie scores was 0-26. The skeletal SIOPEN scores were significantly higher in bone marrow positive children, in children with pathologically elevated urinary VMA levels and in children having a more advanced clinical stage. There was no difference in the SIOPEN soft tissue score due to higher VMA levels, or depending on the clinical stage and positive bone marrow assessment. There was no difference between the SIOPEN skeletal and soft tissue scores on one hand and the histological grade of the tumor; elevated or normal levels of HVA, LDH, NSE and ferritin, or the presence or absence of MYNC amplification in the neuroblastoma cell line, on the other hand. The results of both SIOPEN scores showed a high linear correlation with the Curie score. The conclusion is that the soft tissue segment of the SIOPEN score needs further elucidation in a more controlled milieu. Excellent correlation between all segments of the two semi-quantitative scoring methods speaks in favor of the application of the complete SIOPEN scoring system in every day mIBG scanning. © 2015, Cancer Research Institute Slovak Acad. of Sciences. All rights reserved.


Sobic-Saranovic D.P.,University of Belgrade | Sobic-Saranovic D.P.,Center for Nuclear Medicine | Grozdic I.T.,Center for Nuclear Medicine | Videnovic-Ivanov J.,Clinic for Pulmology | And 9 more authors.
Clinical Nuclear Medicine | Year: 2013

Purpose: This study aimed to compare baseline to follow-up 18F-FDG PET/CT findings after treatment for active chronic sarcoidosis and to correlate changes on 18F-FDG PET/CT with changes in clinical status. Patients and Methods: The sample included 66 patients with chronic sarcoidosis and evidence of active inflammation on baseline 18F-FDG PET/CT for which they received therapy. Of these 66 patients, 30 returned for the follow-up 18F-FDG PET/CT after 12 (5) months to evaluate response to treatment. They were also asked to indicate changes in clinical status. Baseline characteristics of patients who did and did not return for the follow-up were compared to assess selection bias. Results: SUV max was significantly decreased at the follow-up compared with baseline 18F-FDG PET/CT (8.46 [3.52] vs 4.90 [0.96]; P = 0.006), primarily in the mediastinum. Inflammatory activity appeared absent in 9 patients, decreased in 12 patients, and increased in 9 patients, with the corresponding changes in SUVmax of j80%, j41%, and +54%, respectively. The changes on 18F-FDG PET/CT were in agreement with self-perceived changes in clinical symptoms (P = 0.019). The angiotensin-converting enzyme at the follow-up was not significantly different from baseline (49.80 [19.25] vs 46.35 [25.58], P = 0.522). There was no difference in baseline characteristics of patients who did and did not return for the follow-up. Conclusions: 18F-FDG PET/CT is able to detect clinically meaningful changes in magnitude and extent of inflammatory activity in patients receiving treatment for active chronic sarcoidosis. Thus, 18F-FDG PET/CT is a valuable adjunct to clinical evaluation for monitoring the response to treatment in these patients. Copyright © 2013 by Lippincott Williams & Wilkins.


Trifunovic D.,University of Belgrade | Sobic-Saranovic D.,University of Belgrade | Sobic-Saranovic D.,Center for Nuclear Medicine | Beleslin B.,University of Belgrade | And 13 more authors.
International Journal of Cardiovascular Imaging | Year: 2014

Coronary microcirculatory function after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction is important determinant of infarct size (IS). Our aim was to investigate the utility of coronary flow reserve (CFR) and diastolic deceleration time (DDT) of the infarct artery (IRA) assessed by transthoracic Doppler echocardiography after pPCI for final IS prediction. In 59 patients, on the 2nd day after pPCI for acute anterior myocardial infarction, transthoracic Doppler analysis of IRA blood flow was done including measurements of CFR, baseline DDT and DDT during adenosine infusion (DDT adeno). Killip class, myocardial blush grade, resolution of ST segment elevation, peak creatine kinase-myocardial band and conventional echocardiographic parameters were determined. Single-photon emission computed tomography myocardial perfusion imaging was done 6 weeks later to define final IS (percentage of myocardium with fixed perfusion abnormality). IS significantly correlated with CFR (r = −0.686, p < 0.01), DDT (r = −0.727, p < 0.01), and DDT adeno (r = −0.780, p < 0.01). CFR and DDT adeno in multivariate analysis remained independent IS predictors after adjustment for other covariates and offered incremental prognostic value in models based on conventional clinical, angiographic, electrocardiographic and enzymatic variables. In predicting large infarction (IS > 20 %), the best cut-off for CFR was <1.73 (sensitivity 65 %, specificity 96 %) and for DDT adeno ≤720 ms (sensitivity 81 %, specificity 96 %). CFR and DDT during adenosine are independent and powerful early predictors of final IS offering incremental prognostic information over conventional parameters of myocardial and microvascular damage and tissue reperfusion. © 2014, Springer Science+Business Media Dordrecht.


PubMed | Center for Nuclear Medicine, Center for Endocrinology, Pacemaker center and Clinical Center Kragujevac
Type: Comparative Study | Journal: Journal of cardiovascular pharmacology and therapeutics | Year: 2015

The use of -blockers in the treatment of patients with coronary heart disease is associated with a decrease in the frequency of angina pectoris and mortality of patients. Due to the severity of the disease and previous cardiovascular interventions, many patients with coronary artery disease (CAD) use dual antiplatelet therapy to achieve greater inhibition of platelet aggregation. The influence of -blockers on platelet aggregation in patients using antiplatelet therapy is not well understood.To examine the effect of different -blockers on platelet aggregation in patients on dual antiplatelet therapy.The study included 331 patients who were treated at the Department of Cardiology, Clinical Center Kragujevac during 2011. Patients were divided into 4 groups depending on the type of -blockers that were used (bisoprolol, nebivolol, metoprolol, and carvedilol). Platelet aggregation was measured using the multiplate analyzer and expressed through the value of adenosine diphosphate (ADP) test (to assess the effect of clopidogrel), ASPI test (to assess the effect of acetyl salicylic acid), TRAP test (to assess baseline platelet aggregation), and the ratio of ADP/TRAP and ASPI/TRAP ASPI/TRAP (ASPI - aranchidonic acid induced aggregation, TRAP - thrombin receptor activating peptide) representing the degree of inhibition of platelet aggregation compared to the basal value. In consideration were taken the representation of demographic, clinical characteristics, laboratory parameters, and cardiovascular medications between the groups.Patients who used nebivolol had a significantly lower value of the ratio of ADP/TRAP (0.39 0.30) compared to patients who used bisoprolol (0.48 0.26; P = .038), and trend toward the lower values of ADP test (328.0 197.3 vs 403.7 213.2; P = .059), while there was no statistically significant difference in values of other laboratory parameters of platelet function between other groups.Patients with CAD on dual antiplatelet therapy who used nebivolol had significantly lower levels of residual ADP-induced platelet aggregation compared to baseline than patients who used bisoprolol.

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