Institute for Nuclear Medicine

Vienna, Austria

Institute for Nuclear Medicine

Vienna, Austria
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Brammen L.,Medical University of Vienna | Palestro C.J.,Long Island Jewish Medical Center | Holinka J.,Medical University of Vienna | Windhager R.,Medical University of Vienna | And 2 more authors.
Nuclear Medicine Review | Year: 2017

BACKGROUND: Labeled leukocyte scintigraphy (LS) is considered a valuable tool in preoperative diagnosis of prosthetic joint infections (PJI). The aim of this study was to determine the accuracy of LS combined with bone marrow scintigraphy (BMS), as well as inflammation markers CRP and WBC, in detecting infection in patients with prosthetic joints. MATERIAL AND METHODS: This study included patients suspected of having PJI between January and September 2013 at the Vienna General Hospital who underwent imaging with 99mTc-HMPAO labeled autologous leukocytes and subsequent BMS. Diagnostic accuracy was assessed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: A total of 48 patients were included. The most common joint investigated was knee (25), followed by hip (9), shoulder (2), and elbow (1). Other parts of the body investigated included the femur (6), tibia (2), leg (2), and foot (1). The pathogens most frequently isolated included Staphylococcus epidermidis and Candida albicans. The sensitivity of LS was 60%, specificity 97%, PPV 86% and NPV 90%. Overall accuracy was calculated to be 90%. CONCLUSIONS: This study was able to demonstrate that 99mTc-HMPAO labeled autologous leukocytes in patients presenting with symptoms of PJI is accurate. In contrast, however, inflammation markers CRP and WBC are not accurate pre-diagnostic markers for PJI. © 2017 Via Medica.

Beleslin B.,University of Belgrade | Sobic-Saranovic D.,Institute for Nuclear Medicine | Sobic-Saranovic D.,University of Belgrade | Djordjevic-Dikic A.,University of Belgrade | And 8 more authors.
International Journal of Cardiology | Year: 2013

Background: Patients in chronic phase of myocardial infarction (MI) have decreased coronary flow reserve (CFR) in infarct related artery (IRA) that is proportional to the extent of microvascular/myocardial damage. We proposed a novel model for the assessment of microvascular damage and infarct size using Doppler echocardiography evaluation of CFRs of the IRA (LAD) and reference artery (RCA). Methods: Our study included 34 consecutive patients (28 men, mean age 50 ± 11 years) with first anterior STEMI and single vessel disease successfully treated with primary PCI. All patients underwent SPECT MPI for the assessment of infarct size (expressed as a percentage of myocardium with fixed perfusion abnormalities) and CFR evaluation of LAD and RCA. CFR derived percentage of microvascular damage (CFR PMD) was calculated as: CFR PMD = (CFR RCA - CFR LAD) / (CFR RCA - 1) × 100 (%). Results: CFR PMD correlated significantly with all parameters evaluating the severity of myocardial damage including: peak CK activity (r = 0.632, p < 0.001), WMSI (r = 0.857, p < 0.001), ejection fraction (r = - 0.820, p < 0.001), left ventricular end diastolic (r = 0.757, p < 0.001) and end systolic volume (r = 0.794, p < 0.001). Most importantly, CFR PMD (22 ± 17%) correlated significantly with infarct size by SPECT MPI (21 ± 17%) (r = 0.874, p < 0.001). Conclusions: CFR PMD derived from the proposed model was significantly related to echocardiographic and enzymatic parameters of infarct size, as well as to myocardial damage assessed by SPECT MPI in patients with successfully reperfused first anterior STEMI. © 2012 Elsevier Ireland Ltd. All rights reserved.

Milovanovic J.,University of Belgrade | Djukic V.,University of Belgrade | Milovanovic A.,University of Belgrade | Milovanovic A.,Institute for Occupational Health of Serbia Dr Dragomir Karajovic | And 9 more authors.
Auris Nasus Larynx | Year: 2013

Objective: Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment. Methods: Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO2 laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis. Results: Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor. Conclusion: Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients' surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma. © 2012 Elsevier Ireland Ltd.

Beleslin B.,Catheterization Laboratories | Beleslin B.,University of Belgrade | Dobric M.,Catheterization Laboratories | Sobic-Saranovic D.,University of Belgrade | And 23 more authors.
Journal of Nuclear Cardiology | Year: 2010

Background: In patients with previous myocardial infarction (MI), assessment of myocardial viability and physiological significance of coronary artery stenoses are essential for appropriate guidance of revascularization. The aim of the study was to evaluate the relation between fractional flow reserve (FFR) and myocardial viability as assessed by gated SPECT MIBI perfusion scintigraphy in patients with previous MI undergoing elective PCI. Methods: The study population consisted of 26 patients (mean age 55 ± 7 years; 21 male) with a previous MI and a significant coronary stenosis in a single infarct-related coronary vessel for which PCI was being performed. In all patients, FFR was evaluated before and immediately after PCI. SPECT imaging was done before and 3 ± 1 months after PCI. A region representing the MI was considered viable if MIBI uptake was -55% of the normal region. Improvement in perfusion after revascularization was considered achieved if perfusion abnormalities decreased by 5% or more and there was a decrease in segmental score of -1 in three segments in PCI-related vascular territory. Results: Extent of perfusion abnormalities decreased from 32 ± 16% to 27 ± 19% after PCI (P < .001). In patients with myocardial viability in comparison to patients with no viability, there was significant difference in FFR before PCI (.57 ± .14 vs .76 ± .12, P = .002), despite almost the same values of diameter stenosis of infarct-related artery (63 ± 8% vs 64 ± 3%, respectively, P = .572). In addition, FFR prior to PCI was related to improvement in perfusion abnormalities after revascularization (P = .047), as well as with peak activity of creatine-kinase measured during previous MI (r = .56, P = .005). Conclusion: Lower values of FFR before angioplasty are associated with myocardial viability and functional improvement as assessed by SPECT perfusion scintigraphy. © 2010 American Society of Nuclear Cardiology.

Pavlovic S.,Institute for Nuclear Medicine | Artiko V.,Institute for Nuclear Medicine | Sobic-Saranovic D.,Institute for Nuclear Medicine | Damjanovic S.,University of Belgrade | And 10 more authors.
Neoplasma | Year: 2010

Our aim was to assess clinical utility of 99mTc-EDDA/HYNIC-TOC scintigraphy for evaluation of lung lesions in patients with neuroendocrine tumors (NETs). Single photon emission computed tomography (SPECT) of the thorax and whole body scintigraphy were performed in 34 patients using 99mTc-EDDA/HYNIC-TOC. Visual assessment was complemented by semiquantitative evaluation based on tumor to non-tumor (T/NT) ratio. Clinical, laboratory, and histological findings served as the standard for comparison. Enhanced tracer uptake was observed on both SPECT and whole body scintigraphy in 29 of 34 patients (88% sensitivity). T/NT ratios were significantly higher on SPECT than whole body images (2.96±1.07 vs.1.70±0.43, p<0.01) and did not correlate with NET proliferation index Ki-67 (r= - 0.36, p=0.27). Conclusion: 99mTc-EDDA/ HYNIC-TOC scintigraphy is useful for evaluation of NET tissue in the lungs. SPECT provides better visualization of lung lesions than whole body scintigraphy. The intensity of tracer uptake, however, does not relate to the proliferation rate of NETs. 99mTc-EDDA/HYNIC-TOC scintigraphy may be helpful for selecting and monitoring treatment options, particularly when radiolabeled somatostatin analogue therapy becomes available.

Pavlovic S.,Institute for Nuclear Medicine | Sobic-Saranovic D.,Institute for Nuclear Medicine | Djordjevic-Dikic A.,University of Belgrade | Beleslin B.,University of Belgrade | And 7 more authors.
Nuclear Medicine Communications | Year: 2010

Objectives: To compare the diagnostic utility of gated single-photon emission computed tomography (SPECT) methoxy isobutyl isonitrile (MIBI) myocardial perfusion imaging and transthoracic Doppler echocardiography (TTDE) coronary flow reserve (CFR) to coronary angiography for detecting coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Method: Forty-three patients with complete LBBB and an intermediate pretest probability for CAD underwent dipyridamole stress TTDE and gated SPECT MIBI during the same session and coronary angiography within a month. The parameters of myocardial perfusion (summed stress score, summed difference scores) regional wall function (wall motion score, wall thickening score) and ejection fraction were derived using the 17-segment model and 4D-MSPECT software. TTDE variables included peak flow velocity at rest and during hyperemia in left anterior descending artery (LAD), based on which CFR was calculated (normal > 2). Results: Perfusion ischemic scores were significantly higher in group 1 with angiographic evidence of greater than 50% LAD stenosis compared with group 2 with less than 50% LAD stenosis (summed stress score 12.4 ±5.5 vs. 8.3± 3.5, P<0.05, summed difference score 3.7± 1.2 vs. 1.1± 0.3, P<0.01, respectively). Left ventricular regional wall function and ejection fraction were not different between the two groups. CFR was significantly lower in group 1 than in group 2 (1.65 ±0.21 vs. 2.31 ±0.28, P<0.001). Gated SPECT MIBI and CFR had similar sensitivity (88 vs. 88%), specificity (80 vs. 84%), and accuracy (84 vs. 86%) for detecting CAD in patients with LBBB. The agreement between the two methods was 85%. Conclusion: Our results show comparable diagnostic utility and high agreement between gated SPECT MIBI perfusion imaging and TTDE CFR assessment for detecting CAD in patients with LBBB. The advantage of gated SPECT MIBI over TTDE CFR measurements is the ability to assess the perfusion abnormalities in multiple vascular territories during the same procedure, which is convenient for detecting multi-vessel disease in patients with LBBB. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Kostic V.S.,University of Belgrade | Lukic-Jecmenica M.,University of Belgrade | Novakovic I.,University of Belgrade | Dobricic V.,University of Belgrade | And 4 more authors.
Journal of Neurology | Year: 2011

In this study we report clinical and imaging data from a multigenerational Serbian family with idiopathic basal ganglia calcification (IBGC) and exclusion of linkage to chromosome 14q, 2q37 and 8p21.1-q11.23. Fourteen out of 18 family members were personally examined and 11 of them were scanned with computed tomography (CT). CT scans revealed existence of symmetrical calcifications in six family members from three generations (four symptomatic and two asymptomatic). Age at onset of clinical symptoms varied between 22.0 and 55.4 years. The main clinical findings included parkinsonism, severe gait disturbances with freezing of gait, and dyskinesia. Hyperechogenicities identified by transcranial sonography corresponded well to the CT images of hyperintense calcifications in the same structures, whereas brain perfusion single photon emission computed tomography demonstrated predominant hypoperfusion in the frontal cortex and the basal ganglia. After exclusion of linkage to known loci, our pedigree with IBGC further demonstrates locus heterogeneity in this disorder. Analysis of clinically affected individuals supports observation that the clinical features of IBGC appear to be varied both within and between families. The age at onset of the clinical symptoms appeared to be decreasing in two observed transmissions, suggestive of possible genetic anticipation. © 2011 Springer-Verlag.

PubMed | Institute for Nuclear Medicine and University of Belgrade
Type: Journal Article | Journal: European journal of neurology | Year: 2016

Mutations in the GCH1 gene, encoding GTP cyclohydrolase 1, the enzyme critically important for dopamine production in nigrostriatal neurons, are the most common cause of dopa-responsive dystonia (DRD), characterized predominantly by limb dystonia, although parkinsonian features may also be present. It has been suggested that DRD is a neurochemical rather than neurodegenerative disorder.Transcranial brain sonography, which might be a risk marker for nigral injury, was obtained from 141 subjects divided into four groups: (i) 11 patients with genetically confirmed DRD; (ii) 55 consecutive patients with Parkinsons disease (PD); (iii) 30 patients diagnosed as isolated adult-onset focal dystonia; and (iv) 45 healthy controls (HCs).Substantia nigra hyperechogenicity was present in 63.6% of patients with DRD, which was significantly different in comparison to patients with dystonia (20%) and HCs (6.7%), but not in comparison to the PD group (87.3%). Also, values of the maximal areas of substantia nigra hyperechogenicity in patients with DRD were higher in comparison to HCs, but significantly lower than among the PD group.We suggested that the observed transcranial brain sonography features in patients with DRD might primarily be risk markers for particular clinical features (parkinsonism, dystonia) occurring in the specific genetic context (i.e. GCH1 mutations), or might reflect compensated neurodegenerative processes triggered by the long-lasting dopamine deficiency due to the profound delay in levodopa treatment in our patients with DRD.

Kossatz S.,Friedrich - Schiller University of Jena | Behe M.,Paul Scherrer Institute | Mansi R.,Institute for Nuclear Medicine | Saur D.,TU Munich | And 3 more authors.
Biomaterials | Year: 2013

Optical imaging-based diagnostics identify malignancies based on molecular changes instead of morphological criteria in a non-invasive, irradiation free process. The aim of this study was to improve imaging efficiency by the development of a new Cholecystokinin-2-receptor targeted fluorescent peptide that matches the clinical needs regarding biodistribution and pharmacokinetics while displaying superior target specificity. Furthermore we performed multifactorial imaging of Cholecystokinin-2-receptor and tumor metabolism, since simultaneous targeting of various tumor biomarkers could intensely increase tumor identification and characterization. Affinity and specificity of the fluorescent Cholecystokinin-2-receptor targeted minigastrin (dQ-MG-754) were tested invitro. We conducted invivo imaging of the dQ-MG-754 probe alone and in a multifactorial approach with a GLUT-1 targeted probe (IR800 2-DG) on subcutaneous xenograft bearing athymic nude mice up to 24h after intravenous injection (n=5/group), followed by exvivo biodistribution analysis and histological examination. We found specific, high affinity binding (Kd=1.77n. m±0.6n. m) of dQ-MG-754 to Cholecystokinin-2-receptor expressing cells and xenografts as well as favorable pharmacokinetics for fluorescence-guided endoscopy. We successfully performed multifactorial imaging for the simultaneous detection of the Cholecystokinin-2-receptor and GLUT-1 targeted probe. Prominent differences in uptake patterns of the two contrast agents could be detected. The results were validated by histological examinations. The multifactorial imaging approach presented in this study could facilitate cancer detection in diagnostic imaging and intraoperative and endoscopic applications. Especially the dQ-MG-754 probe bears great potential for translation to clinical endoscopy imaging, because it combines specific high affinity binding with renal elimination and a favorable biodistribution. © 2013 Elsevier Ltd.

Brammen L.,Medical University of Vienna | Steiner S.,University of Leipzig | Berent R.,Center for Cardiovascular Rehabilitation | Sinzinger H.,Institute for Nuclear Medicine
VASA. Zeitschrift für Gefässkrankheiten | Year: 2016

Early non-invasive imaging of atherosclerosis and in particular the detection of lesions at risk with high specificity could significantly affect cardiovascular morbidity and mortality. Conventional nuclear medicine approaches, in particular using autologous radiolabeled lipoproteins, can be related to histopathological findings; however, they fail to identify lesions at risk. Positron emission tomography (PET) tracers with much better physical properties have been examined, the most detailed information being available for F-18-deoxyglucose (FDG) and F-18-sodium fluoride (NaF). These two approaches are sensitive to different biochemical mechanisms, i.e. inflammation and microcalcification. Initial enthusiasm, in particular for F-18-FDG, has disappeared, although for F-18-NaF there is some hope, but this is not a breakthrough. No tracer is available so far that is able to identify a specific characteristic of a lesion prone to rupture. Other PET tracers in the pipeline have been examined, mainly in experimental models and only a few in patients, but they failed to contribute significantly to early lesion discovery and do not support great expectations. The key question is: Do we understand what we see? Moreover, methodological problems, a lack of standardization of imaging protocols and aspects of quantification provide a wide range for potential future improvements. While monitoring a therapeutic intervention seems to be possible for both F-18-FDG and F-18-NaF, highly specific early identification of lesions at risk by PET imaging is still far away. As of today, PET is not ready for routine clinical judgment of atherosclerotic lesions at risk to rupture. Even if all these problems can be solved, radiation exposure will still remain a concern, in particular for repeated studies.

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