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Biomedical subjects

A Bockisch

Publications and source records attributed to A Bockisch.

At least 19 recordsLinked to original sources

[Evil radioactivity. Subjective perception of radioactivity in patients with thyroid disease prior to treatment with radioiodine].

AIM: We assess the perspective of patients with thyroid disease towards radiation and radioactivity by means of a cultural-anthropological approach based on qualitative measures and quantitative scores. From the interviews with the patients we evaluate as to how much radioactivity is accepted as an abstract term or as a benefit within the medical context. PATIENTS, METHODS: 68 patients with autonomously functioning thyroid lesions (35 women, 33 men, 32-81 years) were included in this study. All patients were interviewed in an open dialogue with the principal investigator. Patients were asked to describe their attitude towards radioactivity in general and towards radioiodine therapy in particular. Patients were asked to use a scoring system (1 = positive, 5 = negative) to quantify their attitudes. RESULTS: The responses of all patients towards radioactivity in general were heterogeneous with most responses reflecting a negative perception. Many patients expressed their associated fears about atomic energy, malignant diseases and radioactive contamination. The scoring system reflected a mostly negative opinion base. However, patients became more positive once they assumed an immediate benefit of radioactivity for the treatment of their own disease (p = 0.01). CONCLUSIONS: Knowing about significant differences in patient's perception about radioactivity in general or in the clinical context may help to optimise and tailor the initial, pre-therapeutical interview towards the patient.

Adult↗

Whole body positron emission tomography/computed tomography (PET/CT) tumour staging with integrated PET/CT colonography: technical feasibility and first experiences in patients with colorectal cancer.

AIM: The aim of this study was to implement an imaging protocol for positron emission tomography/computed tomography (PET/CT) colonography and to combine this protocol with whole body PET/CT tumour staging for a single whole body examination for routine clinical use. SUBJECTS AND METHODS: A whole body PET/CT protocol for tumour staging and a protocol for PET/CT colonography were integrated into one examination. Fourteen prospective patients with suspected colorectal cancer underwent whole body PET/CT after aqueous bowel distension and pharmacological bowel relaxation. Colonoscopy and histopathology served as the standards of reference in all patients. RESULTS: The modified PET/CT examination detected all but one lesion in the colon. One additional lesion was detected in a patient with incomplete colonoscopy due to high grade luminal stenosis. One polyp with malignant conversion was identified with the modified PET/CT protocol. PET/CT colonography proved accurate in local lymph node staging and staged nine out of 11 patients correctly. Six additional extracolonic tumour sites were detected based on the whole body staging approach. CONCLUSION: Whole body PET/CT with integrated colonography is technically feasible for whole body staging in patients with colorectal cancer. Based on these initial diagnostic experiences, this integrated protocol may be of substantial benefit in staging patients with colorectal cancer, focusing on patients with incomplete colonoscopy and those with small synchronous bowel lesions.

Aged↗

[Value of imaging for lymph node metastases from renal cell, bladder, prostate, penile, and testicular cancers].

Computed tomography (CT) imaging is the standard method for the assessment of lymph node metastases in renal cell and testicular cancer. In bladder cancer and prostate cancer the results of CT are not convincing due to a large number of false-negative findings and the prognostic relevance of undetected metastases. For both entities recent studies revealed that MR lymphography using iron oxide particles allows the detection of small metastatic lymph nodes. For penile cancer reliable results for imaging of lymph node metastases do not exist. PET imaging using [(18)F]-fluorodeoxyglucose (FDG) is the modality of choice in therapy control of seminomas but has no defined value in other urological malignancies. PET with [(11)C] choline and [(11)C] acetate offers great potential in staging and restaging of prostate cancer. Further investigations are necessary to determine the role of these new methods.

Humans↗

Development and clinical impact of thyroglobulin antibodies in patients with differentiated thyroid carcinoma during the first 3 years after thyroidectomy.

OBJECTIVE AND DESIGN: Cross-sectional studies have reported an increased prevalence of circulating thyroglobulin autoantibodies (TgAbs) in patients with differentiated thyroid carcinoma (DTC). With the advent of more sensitive assays, a longitudinal study monitoring the development of TgAb levels after ablative therapy was warranted. METHODS: One hundred and twelve consecutive patients with follicular cell-derived thyroid cancer were followed for 3 years. All patients had been thyroidectomized and received, on average, two radioiodine therapies. Residual tissue was quantified scintigraphically by 131I 24-h uptake. TgAb and thyroglobulin (Tg) serum levels were determined with a sensitive direct radioligand assay and an IRMA respectively. RESULTS: The prevalence of TgAbs at the initial examination was 29% (median 130 U/ml). During follow-up, TgAb levels rose transiently in one-tenth of the patients, but the prevalence of demonstrable TgAbs decreased to < 10% after 3 years. The median serum half-life of TgAbs in treated DTC patients was 10 weeks. At initial examination (when all patients still had residual thyroid tissue and 17 had metastases), rising TgAb levels were correlated with the inability to detect Tg in 4, 30 and 73% of the patients, when initial TgAbs were < 6, 6-50 or > 50 U/ml respectively. While the Tg recovery test was valid for all patients, an in vitro dilution assay with TgAb serum reduced Tg values by up to 32%. CONCLUSIONS: The development and course of TgAbs in DTC patients cannot be predicted by initial or residual tumour volume, TgAb or Tg levels. The presence of TgAbs, even in low concentrations, may cause Tg underestimation despite valid recovery tests in DTC patients.

Adolescent↗

Prognostic value of c-erbB-2 expression in papillary thyroid carcinoma.

AIMS: c-erbB-2 overexpression has been shown to be a potential marker of aggressive biological behaviour in a varity of tumours, whereas its role played in thyroid papillary thyroid carcinoma (PTC) remains unclear. Objective of the study is to determine whether c-erbB-2 overexpression correlates with the clinical course. METHODS: We have studied 32 PTC by a two-step immunocytochemical staining procedure for paraffin-embedded specimens (DAKO Hercep-Test). Semiquantitative evaluations were performed, based on the intensity of immunostaining and the percentage of tumor cells. RESULTS: 34% (11/32) of the PTC showed a membranous overexpression of the HER2/neu oncoprotein. Correlating the pathological and clinical data revealed that 81% (9/11) c-erbB-2 positive patients and only 33% (7/21) c-erbB-2 negative patients developed a tumor recurrence or a progression (p = 0.02 in Fisher's exact test). 3/11 c-erbB-2 positive patients died from PTC whereas all (21/21) c-erbB-2 negative patients are still alive (p = 0.03). CONCLUSIONS: Our results strongly suggest that c-erbB-2 oncoprotein overexpression is related to the clinical course of PTC.

Adolescent↗

Value of (124)I-PET/CT in staging of patients with differentiated thyroid cancer.

The aim of this study is to evaluate the clinical significance of (124)I positron emission tomography (PET) using a combined PET/CT tomograph in patients with differentiated thyroid carcinoma and to compare the PET/CT results with (131)I whole-body scintigraphy (WBS), dedicated PET and CT alone. Twelve thyroid cancer patients were referred for diagnostic workup and entered complete clinical evaluation, including histology, cytology, thyroglobulin level, ultrasonography, fluorine-18 fluorodeoxyglucose (FDG)-PET, FDG-PET/CT and CT. Lesion-based evaluation showed a lesion delectability of 56, 87 and 100% for CT, (124)I-PET, and combined (124)I-PET/CT imaging, respectively. Lesion delectability of (131)I-WBS was 83%. We conclude that (124)I-PET/CT imaging is a promising technique to improve treatment planning in thyroid cancer. It is particularly valuable in patients suffering from advanced differentiated thyroid cancer prior to radio-iodine therapy and in patients with suspected recurrence and potential metastatic disease.

Adult↗

[Whole-body tumor staging: MRI or FDG-PET/CT?].

Technical innovations such as the availability of movable patient platforms and the introduction of 32-channel systems have made whole-body MRI for tumor staging feasible. In addition, the development of dual-modality PET/CT systems offers the opportunity to perform anatometabolic tumor staging with whole-body coverage in a single session. Based on an increase in patient survival when applying a stage-adapted therapy in different malignant diseases the relevant question relates to the accuracies of whole-body MRI and whole-body PET/CT for TNM staging. This review article addresses whole-body tumor staging with MRI and FDG-PET/CT with special emphasis on diagnostic accuracies for staging different malignant diseases.

Aged↗

[Principles of PET/CT and clinical application].

Medicine today imposes high demands on diagnosing disease. Techniques should be preferably noninvasive, identify the disease at an early stage, and be quick and accurate. Frequently, these demands can only be met by employing various diagnostic modalities. Consequently, the integration of two imaging modalities, such as the combination of PET and CT, increases the quality of coregistration and facilitates a timely diagnosis. However, complex imaging procedures require a judicious choice of the areas of application. If, for example, both PET and CT are indicated then a combined PET/CT exam results in improved diagnosis, whereby the actual benefit will depend upon the clinical problem. Typically we expect an advantage of 10% with PET/CT compared to separate examinations with CT and PET. In addition, PET/CT allows for new indications and applications, which cannot be performed satisfactorily with independent examinations and retrospective image alignment. One example is the application of PET/CT in radiation therapy planning.

Artifacts↗

FDG-PET/CT in re-staging of patients with lymphoma.

The aim of this study was to evaluate the clinical significance of combined fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in patients with lymphoma, and to compare the FDG-PET/CT staging results with those of FDG-PET and CT alone. Twenty-seven patients were studied. Each patient had clinical follow-up for >12 months and entered complete follow-up evaluation. Patient-based evaluation showed a sensitivity of 78% for CT alone, 86% for FDG-PET alone, 93% for CT and FDG-PET read side by side, and 93% for combined FDG-PET/CT imaging. Region-based evaluation showed a sensitivity for regional lymph node involvement of 61%, 78%, 91% and 96% respectively. FDG-PET/CT imaging is superior to CT alone ( P=0.02) and has additional benefit over FDG-PET alone due to exact anatomical localisation. We conclude that FDG-PET/CT imaging is accurate in re-staging lymphoma and offers advantages over separate FDG-PET and CT imaging.

Adult↗

Combined PET/CT with iodine-124 in diagnosis of spread metastatic thyroid carcinoma: a case report.

Iodine-124 positron emission tomography (PET) is a useful 3D imaging technique for diagnosis and management of thyroid diseases. The difficulty in interpretation of the PET scans with highly selective tracers, such as iodine-124, is the lack of identifiable anatomical structures, so an accurate anatomical localization of foci presenting abnormal uptake is problematic. Consequently, a combined PET/CT scanner can resolve these difficulties by co-registering PET and CT data in a single session allowing a correlation of functional and morphologic imaging. A case is presented where iodine-124 produced by a clinical cyclotron and FDG were used to acquire images with a combined PET/CT scanner for clinical staging. On the basis of the PET/CT exams the treatment of the patient was modified.

Adenocarcinoma, Follicular↗

Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer.

OBJECTIVE: Ultrasonography is an established diagnostic modality in the follow-up of thyroid cancer. Color flow Doppler has been proposed by some authors as an additional tool for differentiating benign from malignant cervical lesions in various types of head and neck cancer. Over the last few years, a new generation of high-resolution ultrasound platforms with the "power-mode" feature has become available, that also enables the imaging of small vessel blood flow. The objective of our study was to find ways of optimizing the differentiation of benign and malignant cervical tumors in thyroid cancer follow-up by means of sonography. METHODS: Hundred and twelve cervical lesions in 90 patients with thyroid cancer were evaluated by high-end ultrasonography (Sonoline Elegra, Siemens) using a small-part transducer (7.5 L 40, Siemens). B-mode sonography was performed at a frequency of 8 MHz. The Solbiati index (SI= ratio of largest to smallest diameter), configuration, echogenicity, intranodular structures, and margins were assessed. Perinodular and intranodular blood flow was evaluated by color flow Doppler (PRF 1250 Hz for conventional color flow Doppler, 868 Hz for power-mode Doppler). Possible malignancy was validated by histology, cytology, scintigraphy, and follow-up. Thirty five lesions were benign (diameter 0.4-3.0 cm) and 77 were malignant (0.4-5.4 cm). The patients were randomized into a test group and a learning group to determine the diagnostic value of various ultrasound criteria by means of statistical analysis. In the learning group, decision rules based on the dichotomized criteria were developed using a logistic regression model. Sensitivity and specificity of these decision rules were then evaluated in the test group. RESULTS: The presence of an echocomplex pattern or irregular hyperechoic small intranodular structures (criterion A) and the presence of an irregular diffuse intranodular blood flow (criterion B) are the best indicators of malignancy, whereas an SI >>2 is highly indicative of benign changes. Color flow Doppler is a useful addition to B-mode scanning for distinguishing benign and malignant neoplasms in the follow-up of thyroid cancer. Power-mode Doppler sonography significantly improves imaging of perinodular and intranodular blood flow when compared with conventional color flow Doppler. CONCLUSION: We propose the following decision rules based on a combination of the criteria above: (A) and (B) fulfilled: malignant, if SI< or =4; (B) but not (A) fulfilled: malignant, if SI< or =3; (A) but not (B) fulfilled: malignant, if SI< or =2; neither (A) nor (B) fulfilled: malignant, if SI approximately equal to 1 (sensitivity: 90%; specificity: 82%; accuracy 88%).

Adult↗

Diagnosis in medullary thyroid cancer with [18F]FDG-PET and improvement using a combined PET/CT scanner.

Today, positron emission tomography (PET) investigation using fluorodeoxyglucose (FDG) is the most sensitive and specific single modality established for localizing metastases of medullary thyroid cancer (MTC). Even at calcitonin serum levels below 20 pg/ml, tumour localization may be successful in individual cases. However, especially in such early tumour stages, the morphological correlation using PET is unsatisfactory. With the newly available fixed combination of PET and computed tomography (PET/CT), this drawback can be overcome as PET/CT allows a point-by-point correlation of pathological function with morphological structure. Conventional PET alone yielded an approx 80 % sensitivity and specificity in MTC: a result that will be surpassed by the combined PET/CT scanner.

Fluorodeoxyglucose F18↗

Myocardial perfusion abnormalities in patients with active acromegaly.

Cardiomyopathy is often seen in patients with a long history of acromegaly. In order to screen for perfusion abnormalities, patients with active acromegaly without evidence for coronary heart disease were examined by single photon emission computed tomography (SPECT). The study included a group of 11 strictly selected patients with active acromegaly (7 males and 4 females; age 51 +/- 12 y [mean +/- S.D.]) with elevated age-adjusted IGF-I levels (IGF-I 569 +/- 193 micro g/l; GH 31.2 +/- 56.3 micro g/l) compared to an age- and sex-matched non-acromegalic control group with comparable muscle mass index of the left ventricle (126 +/- 41 active vs. 122 +/- 33 g/m 2 control group) and body mass index (26.6 +/- 2.7 vs. 27.0 +/- 5.0 kg/m 2). To address this issue, myocardial perfusion was investigated by single photon emission computed tomography (SPECT) using a triple head gamma-camera. 70 MBq 201TlCl was injected, and post-stress (from bicycle ergometer) images were obtained. Images were interpreted quantitatively by bull's eye polary map (16 regions of the left ventricle) and were compared to the control group. In the patients with active acromegaly, the mean nuclide uptake of the 16 regions of the left ventricle after bicycle stress examination was lower than in the control group (82.99 +/- 2.85 active vs 85.48 +/- 1.29 control group, p < 0.01). Non-homogeneity of nuclide uptake was defined as the standard deviations of the 16 regions and was higher in patients with active acromegaly (11.11 +/- 2.35 active vs. 8.77 +/- 1.39 control group, p < 0.01). In conclusion, myocardial perfusion is impaired in patients with active acromegaly, thus representing an early stage of cardiac involvement in acromegaly that may be directly mediated by growth hormone excess.

Acromegaly↗

Diagnosis of labia metastasis by F-18 FDG PET and CT fusion imaging in sarcoma follow-up.

ABSTRACT A 32-year-old woman with a history of pelvic sarcoma underwent whole-body fluorine-18 fluorodeoxyglucose positron emission tomography (PET) and computed tomographic (CT) fusion imaging for restaging after primary surgery and adjuvant combined radiation and chemotherapy. Interpreting the PET images alone showed an area of focal tracer accumulation in the pelvic floor and was interpreted as being secondary to urine contamination. Image fusion with fully coregistered CT scans showed a localized site of increased uptake from a metastasis to the labia, which was confirmed by biopsy. The presented case illustrates the usefulness of combined PET/CT fusion imaging to overcome some pitfalls of PET imaging alone (eg, differentiating malignant tumor from pooling of tracer in the genitourinary tract or contamination).

Adult↗

[Continously increasing sensitivity in thyroid cancer aftercare in the course of three generations of thyroglobulin IMAs].

UNLABELLED: Aim of our study was to evaluate the increasing sensitivity within three generations of thyroglobulin (Tg) assays, which were available during the past decade, and its clinical impact for patients with differentiated thyroid carcinoma. METHODS: Determination of Tg using the IRMA introduced in 1989 (Dynotest Tg, Henning Berlin, Berlin; assay A) and 1994 (Selco Tg, Medipan Diagnostica, Selchow; assay B), as well as the IEMA available recently (Medizym Tg Rem, Medipan Diagnostica, Selchow; assay C). RESULTS: We found a close correlation between the measurable Tg values of assay A and B (r=0.985; p<0.001) as well as assay B and C (r=0.978; p<0.001). Assay B (lowest detection limit: 0.3 ng/ml) was more than twice as sensitive as assay A and did not show quite as many disturbances of recovery (in 0.5% versus 4% of our patients). Due to its strict calibration to the European reference preparation CRM 457, Tg values determined by assay C were in the mean 1.9-fold higher than by assay B. Thus, with its functional sensitivity of 0.03 ng/ml assay C is nearly 20-fold more sensitive than assay B. Whereas the proportion of measurable Tg values was only 22% in a selected group of patients (criterion of inclusion: Tg in assay B< or =1 ng/ml with TSH-suppressive conditions; n=317 serum samples from 103 patients), it was 68% in assay C, with good intraindividual reproducibility of these values in the course. CONCLUSION: The ultrasensitive assay C is especially suitable for the follow-up of treated thyroid cancer patients being considered as cured, and may shorten the time interval until the detection of a recurrence markedly: the gain of time calculated from the Tg courses in patients with a gradually progressive tumor relapse ranged from 5 to 15 months.

Biomarkers, Tumor↗