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28 Ultrasound Fusion (SPECT/US)
https://t.me/med1917
479
2 . Insuffi cient fhSPECT resolution when relative
activity differences are small : In the thyroid
gland, areas of different activities can occur at
close proximity. Furthermore, the signal to noise
ratio in the thyroid gland is signifi cantly lower
than in an SLN. This leads, at times, to an unsatisfactory reconstruction of thyroid activity.
3 . Artifacts in dorsal thyroid gland reconstruction :
Although the activity distribution is recorded
from different directions and under different
angles, the spatial resolution of the fhSPECT
system in the depth of the tissue is insuffi cient.
This is a problem particularly for structures
located in the dorsal part of the thyroid gland.
Therefore, further optimization of fhSPECT
instrumentation is necessary to improve image
acquisition, including spatial resolution of the
distribution of radioactivity within the fi eld being
examined. A miniaturized handheld gamma camera can potentially achieve additional improvement in image acquisition. Furthermore, it would
be useful to develop a detector that simultaneously records and displays the US image as well
as the radioactivity distribution in a true real-time
fashion. Such a concept has recently been introduced as rthESA (real-time handheld emission
spot allocator) [ 29 ] .
References
1. Wendler T, Hartl A, Lasser T, Traub J, Daghighian F,
Ziegler SI, et al. Towards intra-operative 3D nuclear
imaging: reconstruction of 3D radioactive distributions using tracked gamma probes. Med Image
Comput Comput Assist Interv. 2007;10:909–17.
2. Wendler T, Herrmann K, Schnelzer A, Lasser T, Traub
J, Kutter O, et al. First demonstration of 3-D lymphatic
mapping in breast cancer using freehand SPECT. Eur
J Nucl Med Mol Imaging. 2009;37(8):1452–61.
3. Wendler T, Traub J, Freesmeyer M, Wiesner S. Inventors;
hybrides bildgebungssystem für intraoperative.
Interventionelle und diagnostische anwendungen. patent application 2012. Deutsches Patent- und Markenamt.
4. Wiesner S, Dressel P, Friebe M, Freesmeyer M, Navab
N, Wendler T, et al. Registration Free SPECT and
Ultrasound Imaging. The 23rd Conference of the
Society for Medical Innovation and Technology
(SMIT); Tel Aviv. Israel 2011.
5. Beyer T, Townsend DW, Brun T, Kinahan PE, Charron
M, Roddy R, et al. A combined PET/CT scanner for
clinical oncology. J Nucl Med. 2000;41(8):1369–79.
Epub 2000/08/17.
6. Hasegawa BH, Wong KH, Iwata K, Barber WC,
Hwang AB, Sakdinawat AE, et al. Dual-modality
imaging of cancer with SPECT/CT. Technol Cancer
Res Treat. 2002;1(6):449–58. Epub 2003/03/11.
7. Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin
Nucl Med. 2008;38(3):177–98. Epub 2008/04/09.
8. Townsend DW. Dual-modality imaging: combining
anatomy and function. J Nucl Med. 2008;49(6):938–
55. Epub 2008/05/17.
9. Bucki M, Chassat F, Galdames F, Asahi T, Pizarro D,
Lobo G. Real-time SPECT and 2D ultrasound image
registration. In: Ayache N, Ourselin S, Maeder A, editors. Medical image computing and computer-assisted
intervention – MICCAI 2007. Berlin/Heidelberg:
Springer; 2007. p. 219–26.
10. Ewertsen C. Image fusion between ultrasonography
and CT, MRI or PET/CT for image guidance and
intervention - a theoretical and clinical study. Dan
Med Bull. 2010;57(9):B4172. Epub 2010/09/08.
11. Galdames FJ, Perez CA, Estevez PA, Held CM, Jaillet
F, Lobo G, et al. Registration of renal SPECT and
2.5D US images. Comput Med Imaging Graph.
2011;35(4):302–14.
12. Péria O, Chevalier L, Francois-Joubert A, Caravel J,
Dalsoglio S, Lavallée S, et al. Using a 3D Position
Sensor for Registration of SPECT and US Images of
the Kidney. Comput Vis Virtual Real Robot Med.
1995;905:23–9.
13. Darr AM, Opfermann T, Niksch T, Driesch D,
Marlowe RJ, Freesmeyer M. Low-activity 124I-PET/
Low-dose CT versus 99mTc-pertechnetate planar
scintigraphy or 99mTc-pertechnetate single-photon
emission computed tomography of the thyroid: a pilot
comparison. Clin Nucl Med. 2013.
14. Freesmeyer M, Winkens T, Opfermann T, Elsner P,
Runnebaum I, Darr A. Real-time ultrasound and
freehand- SPECT. Experiences with sentinel lymph
node mapping. Nuklearmedizin. 2014;53(6):259–64.
15. Jung EM, Friedrich C, Hoffstetter P, Dendl LM, Klebl
F, Agha A, et al. Volume navigation with contrast
enhanced ultrasound and image fusion for percutaneous interventions: fi rst results. PLoS One. 2012;7(3).
16. Cools-Lartigue J, Meterissian S. Accuracy of axillary
ultrasound in the diagnosis of nodal metastasis in invasive
breast cancer: a review. World J Surg. 2012;36(1):46–54.
17. Rahbar H, Partridge SC, Javid SH, Lehman
CD. Imaging axillary lymph nodes in patients with
newly diagnosed breast cancer. Curr Probl Diagn
Radiol. 2012;41(5):149–58.
18. Dietlein M, Dressler J, Grunwald F, Joseph K, Leisner
B, Moser E, et al. [Guideline for in vivo- and in vitro
procedures for thyroid diseases (version 2)].
Nuklearmedizin. 2003;42(3):109–15. Leitlinie zur
Schilddrusendiagnostik (Version 2).
19. Freesmeyer M, Winkens T, Darr A. Diagnosis of
small papillary thyroid cancer via sensor-navigated
480
https://t.me/med1917
M. Freesmeyer and T. Winkens
(124)iodine PET/ultrasound ((124)I-PET/US) fusion.
J Clin Endocrinol Metab. 2015;100(1):13–4.
20. Freesmeyer M, Opfermann T, Winkens T. Hybrid
integration of real-time ultrasound and freehandSPECT: proof of concept in patients with thyroid diseases. Radiology. 2014;271:851–61.
21. Singh AK, Kruecker J, Xu S, Glossop N, Guion P,
Ullman K, et al. Initial clinical experience with realtime transrectal ultrasonography-magnetic resonance
imaging fusion-guided prostate biopsy. BJU Int.
2008;101(7):841–5. Epub 2007/12/12.
22. Xu S, Kruecker J, Turkbey B, Glossop N, Singh AK,
Choyke P, et al. Real-time MRI-TRUS fusion for
guidance of targeted prostate biopsies. Comput Aided
Surg. 2008;13(5):255–64. Epub 2008/09/30.
23. Minami Y, Kudo M, Chung H, Inoue T, Takahashi S,
Hatanaka K, et al. Percutaneous radiofrequency ablation of sonographically unidentifi able liver tumors.
Feasibility and usefulness of a novel guiding technique with an integrated system of computed tomography and sonographic images. Oncology. 2007;72
Suppl 1:111–6. Epub 2007/12/22.
24. Kaplan I, Oldenburg NE, Meskell P, Blake M, Church
P, Holupka EJ. Real time MRI-ultrasound image
guided stereotactic prostate biopsy. Magn Reson
Imaging. 2002;20(3):295–9. Epub 2002/07/16.
25. Ewertsen C, Ellegaard K, Boesen M, Torp-Pedersen
S, Bachmann Nielsen M. Comparison of two coregistration methods for real-time ultrasonography
fused with MRI: a phantom study. Ultraschall Med.
2010;31(3):296–301. Epub 2010/06/03.
26. Ewertsen C, Grossjohann HS, Nielsen MB. Image
fusion involving ultrasound. Ultraschall Med.
2006;27(2):128–9. Epub 2006/05/13.
27. Ewertsen C, Henriksen BM, Torp-Pedersen S,
Bachmann Nielsen M. Characterization by biopsy or
CEUS of liver lesions guided by image fusion between
ultrasonography and CT, PET/CT or MRI. Ultraschall
Med. 2011;32(2):191–7. Epub 2011/01/13.
28. Ewertsen C, Saftoiu A, Gruionu LG, Karstrup S, Nielsen
MB. Real-time image fusion involving diagnostic ultrasound. AJR Am J Roentgenol. 2013;200(3):W249–55.
29. Freesmeyer M, Winkens T, Kuhnel C. Real-time handheld emission spot allocator (rthESA) for simultaneous
fusion imaging with ultrasound. Nuklearmedizin.
2014;53(6):265–71.
Part XII
https://t.me/med1917
Examples (Conventional
Techniques and Innovations)
Case Reports
https://t.me/med1917
Christina Bluemel , Francisco Campos ,
Angela Collarino , Andreas Cramer , Stephan Dik ,
Alessandro Giordano , Hanns-Jörg Grimminger ,
Niel Groen , Ken Herrmann , Martin Horn , Georg W. Kajdi ,
Dikra Lajaab , Stefan Paepke , Jaume Pahisa ,
Pilar Paredes , Germano Perotti , Sergi Vidal- Sicart ,
Erik M. Von Meyenfeldt , and Thomas Wendler
2 9
Contents
29.1 Radioguided Localization
of Non- palpable Breast Cancer
Using Intraoperative 3D Imaging 484
29.2 Radionuclide-Guided Biopsy of a
Rib Lesion in a Patient with
Lung Cancer 486
29.3 Added Value of SPECT/CT
in Vulvar Cancer Sentinel
Lymph Node Mapping and Biopsy 489
C. Bluemel (*) • K. Herrmann • G. W. Kajdi
Department of Nuclear Medicine ,
University of Würzburg , Würzburg , Germany
F. Campos • P. Paredes • S. Vidal-Sicart (*)
Department of Nuclear Medicine ,
Hospital Clínic Barcelona , Barcelona , Spain
A. Collarino (*) • A. Giordano • G. Perotti
Institute of Nuclear Medicine ,
University Cattolica del Sacro Cuore , Rome , Italy
A. Cramer • H.-J. Grimminger
Department of Obstetrics and Gynecolog ,
Missionsärztliches Klinikum Würzburg ,
Würzburg , Germany
S. Dik
Department of Respiratory Medicine ,
Albert Schweitzer Hospital , Dordrecht , The Netherlands
S.Dik@asz.nl
e-mail:
N. Groen
Department of Nuclear Medicine , Albert Schweitzer
Hospital , Dordrecht , The Netherlands
N.Groen@asz.nl
e-mail:
29.4 Hybrid Tracer in Gynecology 490
29.5 Minimally Invasive, Image-Guided
Core Needle Biopsy of Sentinel
Lymph Nodes as Nonsurgical
Method to Detect Lymph Node
Metastases 491
References 494
M. Horn
R&D Department , SurgicEye GmbH ,
Munich , Germany
D. Lajaab • E. M. Von Meyenfeldt (*)
Department of Surgery ,
Albert Schweitzer Hospital ,
Dordrecht , The Netherlands
325161dl@student.eur.nl;
e-mail:
e.m.von.meyenfeldt@asz.nl
S. Paepke
Department of Women’s Health ,
Klinikum rechts der Isar , Munich , Germany
J. Pahisa
Department of Gynaecology ,
Hospital Clínic Barcelona , Barcelona , Spain
T. Wendler (*)
R&D Department , SurgicEye GmbH ,
Munich , Germany
Nuclear Medicine Department ,
Klinikum rechts der Isar , Munich , Germany
© Springer International Publishing Switzerland 2016
K. Herrmann et al. (eds.), Radioguided Surgery: Current Applications and Innovative
Directions in Clinical Practice, DOI 10.1007/978-3-319-26051-8_29
483
484
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C. Bluemel et al.
Abstract
Surgical resection comprises the standard of care
in patients with early-stage breast cancer. For
intraoperative detection of non-palpable breast
cancer, commonly wire-guided localization is
used (Hargreaves et al. J Surg Oncol 110:21–25,
2014). Alternatively, in experienced centers, a
radioguided procedure (radioguided occult
lesion localization, ROLL) is performed using
either fl uid radioactive tracers or seeds (Ahmed
and Douek Breast Cancer Res Treat 140:435–
446, 2013; Ahmed and Douek Breast 22:383–
388, 2013). For intraoperative detection of the
radioactive labeled tumor lesions, the surgeons
employ an acoustical gamma probe. In this case
we report on the feasibility and advantages of
freehand SPECT-guided lesion localization providing additional intraoperative 3D imaging.
29.1 Radioguided Localization
of Non-palpable Breast
Cancer Using Intraoperative
3D Imaging
Christina Bluemel, Andreas Cramer,
Georg W. Kajdi, Ken Herrmann,
and Hanns-Jörg Grimminger
Surgical resection comprises the standard of care in
patients with early-stage breast cancer. For intraoperative detection of non-palpable breast cancer,
commonly wire-guided localization is used [ 1 ].
Alternatively, in experienced centers, a radioguided
procedure is performed using either fl uid radioactive tracers or radioactive seeds [ 2 , 3 ]. For intraop-
erative detection of the radioactive labeled tumor
lesions, the surgeons employ an acoustical handheld gamma detection probe. In this case, we report
on the feasibility and advantages of freehand
SPECT-guided lesion localization, providing additional intraoperative 3D imaging.
We report on a 66-year-old woman with
diagnosis of a non-palpable breast cancer (T1,
6 mm; Fig. 29.1a ). Distant and lymph node (LN)
metastases were excluded by preoperative staging studies, including ultrasound of the axillary
region and abdomen, bone scintigraphy, and
chest radiography. According to the national
guidelines, the patient was referred for sentinel
lymph node (SLN) biopsy and resection of the
primary tumor [ 4 ].
The radiotracer (20 MBq,
99m
Tc-nanocolloid)
was injected in the center of the breast lesion
under ultrasound guidance using a 20-gauge needle (Fig. 29.1b ). No side effects or complications
were observed. Scintigraphic imaging started
5 min after the injection, and ventral and lateral
images were acquired (Fig. 29.2a, b ).
Consecutively, periareolar injection of 60 MBq
99m
Tc-nanocolloid was performed. Early static
(Fig. 29.2c, d ) and late static images were
acquired (Fig. 29.2e ,f), showing a SLN in the
right axillary region.
a
Fig. 29.1 Preinjection ultrasound showing the nonpalpable tumor lesion in the right breast (upper quadrant,
2 o’clock). ( a ) The distance between the skin and the
b
99m
tumor was 16 mm; ( b ) Injection of
the ventral parts of the tumor lesion using a 20G needle
( arrow )
Tc-nanocolloid in
29 Case Reports
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ace
bdf
485
Fig. 29.2 Planar scintigraphy. ( a , b ) Ventral and lateral
images showing the intratumoral injection; ( c , d ) ventral
and lateral images showing the injection site ( dotted arrow )
On the next day, the SLN biopsy was performed and LNs were sent to frozen section.
Concurrently, the primary breast tumor was
resected using guidance from both the prior wireguided localization and freehand SPECT. Before
the incision, a scan with freehand SPECT (preincision) visualized the injection site and the primary tumor in the right breast. The depth
measurement (Fig.
29.3b ) correlated with the
preoperative ultrasound images. This information can only be provided by imaging and 3D
navigation. A conventional acoustical handheld
gamma detection probe cannot assess the depth
of the tumor within the breast. The surgical site
was scanned again after the resection of the primary tumor to detect potential remaining activity,
which was excluded (Fig.
29.3c ).
and intratumoral injection ( arrow ); ( e , f ) late images show-
ing the sentinel lymph node ( red circle ) and the injection
site ( dotted arrow ).
Histopathological analysis revealed a breast
cancer of non-special subtype with peritumoral
and intratumoral ductal carcinoma in situ. The
SLNs were negative, resulting in a tumor stage of
pT1b (10 mm) N0 (0/2 SLNs), G3. The hormonal
receptor status and expression of Her2/neu were
negative. The margins were clear (R0), corresponding to the complete resection which was
confi rmed by the utilization of the freehand
SPECT scan.
In summary, intraoperative imaging using freehand SPECT is feasible, and the depth measurement can help to guide the surgeon. Therefore, we
conclude that freehand SPECT guidance is an alternative to wire-guided localization and provides the
possibility for intraoperative imaging of the specimen and assessment of the tumor margins.
486
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ac
C. Bluemel et al.
bd
Fig. 29.3 Freehand SPECT scans. ( a ) pre-incision scan
showing the injection site and the primary tumor ( arrow );
( b ) distance measurement between the skin and the
primary tumor; ( c ) post-excision scan showing only the
29.2 Radionuclide-Guided Biopsy
of a Rib Lesion in a Patient
with Lung Cancer
Dikra Lajaab, Stephan Dik, Niel Groen,
and Erik M. Von Meyenfeldt
A 62-year-old male was presented at the thoracic
oncology multidisciplinary team meeting. He was
diagnosed with lung cancer after being analyzed for
dyspnea on exertion. Workup consisted of a thoracic CT (computed tomography), which showed a
10 cm lesion in the left upper lobe, but no hilar or
mediastinal lymphadenopathy nor signs of distant
injection deposits and a successful resection of the primary; ( d ) scan of the specimen showing the intratumoral
injection deposit in a distance of 22 mm from the central
specimen margin
metastases. CT-guided percutaneous biopsy confi rmed the diagnosis of adenocarcinoma of the lung.
Further analysis using 18 F-fl uorodeoxyglucose
18
F-FDG)-positron emission tomography (PET)/CT
(
showed the FDG-avid primary lesion and no uptake
in hilar or mediastinal lymph nodes. However, PET/
CT did demonstrate an additional FDG-avid focus
located in the anterolateral portion of the left 5th rib.
Since there was no recent history of chest
trauma, a lung cancer bone metastasis was suspected (Fig. 29.4 ).
Confi rmation of the histology of the rib lesion
was of great importance. No bone metastasis
would mean that treatment with curative intent
29 Case Reports
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487
was still feasible and induction therapy and surgical resection would be warranted. Confi rmation
of a bone metastasis would imply a worse prognosis despite aggressive treatment. This information
would aid the patient and his treatment team in
choosing between a surgical approach or a more
restricted treatment plan with less morbidity.
On reexamination of the CT scan, still no bone
abnormality was found. A subsequent technetium 99 m (
99m
Tc) bone scan (SymbiaS, Siemens,
Erlangen, Germany) and single-photon emission
computed tomography (SPECT) showed high
uptake in the left 5th rib region (Fig. 29.5 ). This
made radionuclide-guided bone lesion biopsy
possible (see Chapter 22 ).
On the day of operation, our patient received
an intravenous dose of 590 MBq
oxidronate (
99m
Tc-HDP), followed by a second
99m
technetium-
bone scan in the nuclear medicine department.
During this bone scan, the location of the left
5th rib lesion was marked on the skin, using a
cobalt (Co 57 ) marker (Fig. 29.6a, b ).
Fig. 29.4 PET/CT scan image with the large FDG-avid
primary tumor in the left upper lobe and the left 5th rib
bone lesion ( white arrow )
ab
Fig. 29.5
left 5th rib bone lesion ( white arrow )
99m
Tc-bone scan image with high uptake in the
Fig. 29.6 ( a ) Cobalt source used for localization and skin marking. ( b ) Skin marking at the scanner
488
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C. Bluemel et al.
The patient was taken to the operating room
approximately 4 hours after injection. After he
was anesthetized and draped in supine position,
the localization mark was checked with the
140 keV handheld gamma detection probe
(Eurorad, Europrobe 2, Chennevières-sur- Marne,
France). An incision was made over the skin
mark. To fi nd the exact location of the left 5th rib
bone lesion, the 140 keV gamma detection probe
was used on the rib surface (Fig. 29.7 ). The part
of rib that showed the highest rate of radioactivity
Fig. 29.7 140keV
handheld probe
localization of the left
5th rib area with the
highest uptake
(1065 counts per second (cps) vs. background
250cps) was biopsied. The outer cortex was
opened with a chisel, and the bone with high
uptake was removed with a rongeur (Fig. 29.8 ).
Decreased uptake at the biopsy site and high
activity of the biopsy material confi rmed the adequacy of the biopsy.
The postoperative chest X-ray showed no
signs of complications. The patient was discharged from hospital on the same day. No complications occurred postoperatively.
Fig. 29.8 Opening of
the outer cortex of the
left 5th rib with chisel
29 Case Reports
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489
The pathologist concluded that there were
no signs of malignancy in the biopsy. The bone
tissue showed high remodeling activity, as seen
in a posttraumatic reaction. The patient was
sent for induction chemoradiotherapy, restaging, and subsequent surgical resection of his
left upper lobe lung cancer.
Radionuclide-guided bone biopsy in this
patient proved to be an accurate way to rule out a
bone metastasis and fundamentally infl uence his
treatment plan.
29.3 Added Value of SPECT/CT
in Vulvar Cancer Sentinel
Lymph Node Mapping
and Biopsy
Angela Collarino, Germano Perotti,
and Alessandro Giordano
A 70-year-old woman was referred to our center
with bleeding ulcer, indicative of vulvar cancer,
on the left labia majora (stage FIGO T1) and clinically node negative (cNO) by preoperative ultrasound of the groin. The patient was to undergo
vulvectomy and sentinel lymph node biopsy
(SLNB) to defi ne the draining lymphatic basin at
risk for metastatic disease and to identify the
corresponding sentinel lymph node (SLN). After
the application of lidocaine spray for local anes-
99m
thesia, 74 MBq of
Tc-nanocolloid (Nanocoll®)
was injected intradermally in four peri-tumoral
sites (total volume 0.8 mL). Dynamic images (15
frames 60 s each) were acquired immediately
after injection in anterior projection with 64 × 64
matrix and zoom factor 1.33, followed by static
images in anterior and lateral projection with a
256 × 256 matrix and zoom factor 1.33. Anterior
planar image (a) showed the site of the injection
(yellow arrow) and one SLN (blue arrow) in the
left groin. Furthermore, left lateral planar image
(b) revealed another focal area of uptake (red
arrow) suggestive of another SLN (Fig.
29.9 ). A
SPECT/CT scan (128 × 128 matrix, 20 s/frame, 3°
angular steps) was performed to obtain better
anatomical localization of the SLNs. The CT scan
(c) and fused SPECT/CT image (d) showed only
one SLN localized in the left groin (blue arrow)
(Fig. 29.9 ). The other focal area of uptake seen on
lateral planar image corresponded to a contamination area (red arrow) on CT scan (e) and fused
SPECT/CT image (f) (Fig. 29.9 ). The contamina-
tion was determined by leakage of radiotracer
from the bleeding vulvar lesion. This case underlines the utility of SPECT/CT in vulvar cancer.
As reported in the current literature, SPECT/CT
in women with vulvar cancer provides anatomical
a
b
Fig. 29.9 ( a – f ) SPECT/CT in vulvar cancer sentinel lymph node mapping
c
e
d
f
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