In this clinical case we analyzed the need for a correct algorithm for examining patients with liver tumors when making a primary diagnosis, thus it significantly affects the prognosis and course of the disease. We demonstrate capabilities of various diagnostic methods in the differential diagnosis of focal liver lesions. Our clinical case confirms the need for optimal routing schemes for patients to specialized centers that have all necessary resources to perform all types of diagnostic methods, including nuclear medicine diagnosis, as well as the presence of a multidisciplinary team of specialists. The article is illustrated with original images of nuclear medicine studies, CT and MRI images.

In case of locally advanced soft tissue sarcomas of the extremities (STS), the large size of which does not allow resection with preservation of the limb, isolated regional perfusion (IRP) of the limb is considered as one of the effective treatment options. Aim. To evaluate the long-term outcomes of IRP with melphalan under conditions of hyperthermia for treatment of locally advanced STS of the extremities. Materials and methods. We conducted a prospective cohort clinical study that included 42 patients with STS of the extremities. All patients underwent IRP with melphalan, in one case – in combination with tumor necrosis factor alpha. Additional lymph node dissection was performed in 8 cases (19%). The 5-year overall survival was estimated by the Kaplan-Meier method. Results. The median age of the patients was 50 years (from 24 to 80 years), women predominated – 32 (76%). STS of the upper limb was diagnosed in 14 patients (33%), of the lower limb in 28 (67%). G3 grade was verified in 34 (81%) patients, in the rest – G2. Most patients had a recurrent tumor – in 34 (81%) cases. All patients received previous treatment: surgery in combination with chemotherapy and / or radiation therapy – 36 (86%), chemotherapy alone – 2 (5%), surgery alone – 4 (9%) patients. Within 5 years, tumor recurrence developed in 20 (48%) patients, amputation was performed in 10 (24%) patients, distant metastases were diagnosed in 4 (10%) patients. The mean time to relapse after IPC was 9.3 ± 3.5 months. Overall survival at 1, 2, 3, 4, and 5 years was 98%, 88%, 86%, 74%, and 67%, respectively. Conclusion. IRP under conditions of hyperthermia with melphalan is an effective method for the treatment of STS of the extremities: the overall 5-year survival rate is 67% with a low rate of amputations and metastasis.

Introduction. Oral squamous cell carcinoma is associated with a high risk of regional metastasis even in early stages (T1–2N0M0). Morphological examination reveals concealed metastases in 20 % of removed clinically unaffected lymph nodes.Objective – to evaluate the effectiveness of flow cytometry for detection of concealed metastases in sentinel lymph nodes as an indication for cervical lymph node dissection in patients with stage сT1–2N0M0 oral squamous cell carcinoma.Materials and methods. This study included 27 patients, including 13 patients (48.1 %) with stage T1N0M0 cancer and 14 patients with stage T2N0M0 cancer (51.9 %). At the first stage, all participants underwent primary tumor removal and cervical lymph node dissection with sentinel lymph node examination. After mobilization, half of these lymph nodes was used for routine morphological examination followed by immunohistochemical examination, while the second half of them was analyzed using flow cytometry. Then we compared the results obtained.Results. We examined 46 removed sentinel lymph nodes from 27 patients. Conventional histological examination revealed 4 concealed metastases (8.7 %). Polymerase chain reaction allowed us to detect another 16 metastases (37.8 %). Levels I, II, and III lymph nodes were most frequently affected. Flow cytometry demonstrated that 20 % of patients with a <4 mm invasion had concealed metastases, whereas patients with a 4 to 8 mm invasion had concealed metastases in 60 % of cases. Median follow-up time was 20.4 ± 11.7 months (range: 2.2 to 42.5 months; median 19.5 months). All participants were alive during this time. Seventeen out of 27 patients with stage T1–2N0M0 disease (63 %) were found to have concealed metastases, while the remaining ten patients (37 %) had no metastasis. One patient with stage T1N0M0 oral floor squamous cell carcinoma underwent the removal of the primary tumor and sentinel lymph node. Morphological examination and flow cytometry showed no metastatic lesions. After 14.8 months, the patient developed ipsilateral regional CN3 metastasis. The three-year progression-free survival rate was 94.7 ± 5.1 %.Conclusion. Highly sensible and rapid flow cytometry can become the method of choice in the diagnosis of metastases and deciding on cervical lymph node dissection in patients with cN0 disease. The study is still ongoing.

Purpose: To show the additional clinical importance of SPECT/CT method in the complex diagnosis of skeletal system.Material and methods: Patient: male, 75 years. Medical history: At the beginning of July 2021 the patient noticed the presence of blood in urine, and after that he seeked medical assistance from urologist. During medical check up — suspicion on prostate tumor. 09.07.21 PSA > 100 ng/ml. The patient was directed to N.N. Blokhin National Medical Research Center of Oncology for further examination and treatment. Whole body bone scan revealed multiple foci of increased activities of the radiopharmaceutical in the lumbar spine, sacral vertebrae and in the projection of groin and scrotum. After bone scan, SPECT/CT was performed. Metastatic lesions of bone tissue were not confirmed, however, an inguinal scrotal hernia and a nodus in the pelvic cavity (probably of a metastatic) were detected.Conclusion: The use of SPECT/CT made it possible to detect additional changes in the study area. Information about the presence of an inguinal hernia will help prevent complications.

Purpose: To develop a method for evaluation of the radiation dose of an embryo/fetus during lymphoscintigraphy (sentinel lymph node mapping) in pregnant patients with breast cancer.Material and methods: Two pregnant women (aged 43 and 30) with breast cancer stage IIA (T2N0M0), during the second trimester of pregnancy. We used a lymphotropic colloidal radiopharmaceutical labeled with 99mTc. To evaluate the radiation dose of an embryo, each patient had 6 individual dosimeters, which were placed around the abdomen using an elastic bandage at equal distances around the abdomen. Additionally, we placed the 7th dosimeter, it was placed near the injection site (under the mammary gland). After installing individual dosimeters, radiocolloid was injected into the affected mammary gland at four points (periareolar). The administered activity of radiopharmaceutical was 32.5 MBq, and 51.5 MBq. Lymphoscintigraphy was performed 1 hour after injection. First patient underwent sector resection of the left breast with SLN biopsy. The second patient underwent right mastectomy with SLN biopsy and breast reconstruction surgery using a tissue expander.Results: Based on the results of the study, the dose rate was calculated, on the basis of which the fetal radiation doses were calculated in both patients. Comparison of the mathematical data of both patients shows that, the calculated and experimental values of radiation exposure to the fetus during the radionuclide study of sentinel lymph nodes practically coincide. The obtained data shows that during pregnancy (280 days) the embryo/fetus will accumulate a natural radiation background dose of 1960 μSv, which is 2 times higher than the dose from the radionuclide study of sentinel lymph nodes. Thus these results verify the safety of SLN biopsy technology in pregnancy.Conclusion: 1. Radionuclide diagnostic studies of pregnant women determine radiation doses to the embryo/fetus that do not cause any radiation-induced effects in the prenatal period, and the probability of the occurrence of stochastic radiation-induced effects is several times lower than the incidence of endogenous cancers. 2. Radionuclide examination of sentinel lymph nodes appears to be safe for the fetus when conducted in pregnant women diagnosed with breast cancer. 3. In Russian Federation this method is used for the first time in pregnant women with diagnosed breast cancer. This technology has not been previously described in Russian literature.

he disease incidence of neuroendocrine tumors (NET) is increasing every year. Neuroendocrine tumors Grade 1 and 2 have a more favorable prognosis than Grade 3. When we are talking about NET with non-detected initial focus, the 10-year survival rate is 22 % [1]. Therefore, it is necessary to make every effort and use all technical abilities to localize the primary tumor, even in the presence of metastases, because resection of the primary tumor(s) can increase disease-free and overall survival rate. Also, the choice of chemotherapy drug or the appointment of biotherapy may depend on this. Finding tumor localization remains challenging and must involve a combination of radiological, nuclear medicine and endoscopic imaging techniques. There are many different myths about the purpose of nuclear medicine examinations and interpretation of the results in NET patients. And in this article we will try to debunk some of them, using examples from our experience in our center. We choose 111 patients with NET (histologically confimed). All patients underwent scintigraphy of neuroendocrine tumors with 99mTc-EDDA/HYNICTOC (99mTc-Tektrotyd) in the «whole body» mode and additional SPECT or SPECT/CT examination of the chest,abdomen and pelvis.

Relevance: Radionuclide bone scan signs of lesions are not specific and require radiological identification. Hybrid tomographic technology is a combination of spatial distribution of radiopharmaceuticals and its anatomical binding. Thus, makes it possible to accurately identify the affected bone structure and also determine the nature of this changes (radiological anatomy). In cancer patients, SPECT/CT method allows to visualize tumor pathology in the bones, but also keeps to a minimum errors and other excessive examinations.Purpose: To demonstrate the most frequent diseases and conditions that simulate tumor lesions in bones on bone scan.Material and methods: We analyzed the results of examinations of 81 patients with various tumor diseases (2015–2020). Bone scan was performed in the whole body 3 hours later, after intravenous administration of 99mTc-phosphotech on a Symbia E, T2 (Siemens, Germany). SPECT/CT was performed after WB Bone Scan.Results: The most frequent reasons for the focal increased uptake of radiopharmaceutical were: reactive increase in metabolism and as a result additional mineral repair: deforming osteoarthritis, osteophytes; post‑traumatic and postoperative changes; fractures (osteoporosis and stress fractures); inflammatory processes; focal uptake due to the benign neoplasms of bones and dysplasia. Combination of highly sensitive but non-specific scintigraphy with highly specific computed tomography makes it especially useful in anatomically difficult areas.Conclusion: SPECT/CT reveals a direct pater of anatomical and structural abnormalities with changes in bone tissue metabolism in case of different injuries and minimizes a number of ambiguous conclusions. SPECT/CT in oncological practice greatly helps nuclear medicine physician in the differential diagnostic process and reduces time of examination for the patient.

This article describes a new affordable diagnostic method of neuroendocrine tumors, shows the basic information on it’s conduction and interpretation of the results. Scintigraphy of neuroendocrine tumors with 99m Tc-Tectro-tyd is a new alternative and more affordable diagnostic method that allows you to determine tumor receptor status, assess the prevalence of the tumor process and plan therapy. This study may also be the first step in planning radionuclide therapy for patients with neuroendocrine tumors. Also there is a short review on teranostics.

Erdheim–Chester disease (ECD) is a rare and frequently neglected disease, usually with a poor prognosis. The first two cases of ECD were reported by Austrian pathologist: Jakob Erdheim and his apprentice student William Chester in 1930. The etiology and disease incidence are unknown. One of the main components of this disorder is a chronic uncontrollable inflammation. Clinical manifestations of the disease can be very different. ECD affects predominantly adults, usually male population. There is no effective treatment developed yet. In 2016 ECD was classified as histiocytic neoplasm by the World Health Organization and was categorized as “tumors of histiocytes and dendritic cells”. More than half of patients testing positive for the BRAF mutation. There is a Erdheim–Chester Disease Global Alliance (ECDGA), which try to unite and provide with information about diagnostics and treatment of this rare disease both patients and doctors. Today, there are 571 registered patients and only one from Russia. The final diagnosis is made on the basis of histological finding such as infiltration with foamy histiocytes, signs of inflammation and Touton giant cells. Immunohistological analysis is usually CD68 and XIIIa positive. There are radiological finding indicating a possible association with the disease. There is this specific, almost pathognomonic scintigraphic picture of the skeleton, “coated” aorta, “hairy kidney” patterns on computer tomography. We demonstrate a clinical case of a patient with a newly diagnosed ECD with bone and connective tissue involvement, with manifestation of this disease more than 10 years ago. It took four months to make the final diagnosis. There were three biopsies and a wide range of other diagnostic procedures.

This article describes a new affordable diagnostic method of neuroendocrine tumors, shows the basic information on it’s conduction and interpretation of the results. Scintigraphy of neuroendocrine tumors with 99m Tc-Tectro-tyd is a new alternative and more affordable diagnostic method that allows you to determine tumor receptor status, assess the prevalence of the tumor process and plan therapy. This study may also be the first step in planning radionuclide therapy for patients with neuroendocrine tumors. Also there is a short review on teranostics.

The study objective : using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin. Materials and methods . Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary. Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7 h left rib, left iliac wing, in the left bones of cranial vault, in C 7 , Th 6 , Th 9 , Th I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th 9 , Th I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7 h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th 9 , Th I2 , L 3 vertebral bodies and in the left iliac wing. Conclusion. Conclusion . In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th 9 and Th I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L 3 vertebra. Changes in the 7 h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.

Purpose: To determine the relative efficiency of bone scan and SPECT/CT in assessing the viability of the mandibular and maxillary bone fragments in the reconstruction of revascularized autografts. Material and methods: 37 patients with vascularized autografts were examined. Bone scan and SPECT/CT were performed as monitoring methods after surgery. The viability of autotransplants was judged on the levels of accumulation of radiopharmaceutical on bone scan and SPECT/CT in a transplanted flap. Results: Bone scan gave a reliable information on the status of the autograft in 28 out of 37 cases in patients with uncomplicated postoperative course. Additionally SPECT/CT was performed. SPECT/CT showed an increased accumulation of radiopharmaceutical in all patients with uncomplicated postoperative course. If thrombosis of supplying autograft vessels were present, SPECT/CT showed no accumulation of radiopharmaceutical – 5 patients. Thus SPECT/ CT allow to obtain a reliable data in 100 % of clinical cases. Conclusion: SPECT/CT is recommended as a method of choice for early monitoring of patients undergoing reconstructive surgery with the formation of mandibular and maxillary autografts. SPECT/CT can adequately assess the effectiveness of blood flow and the viability of bone grafts.

The study objective : using a clinical example to demonstrate possibilities of single photon emission computerized tomography (SPECT) in combination with computed tomography (CT) in identifying latent bone metastases, taking into account the dynamics growth of serum basal calcitonin. Materials and methods . Patient S., 60 years old, visited N.N. Blokhin National Medical Research Center of Oncology for consultation on multiple lung metastases of cancer of unknown primary. Results. Taking into account basal calcitonin level, immunohistochemistry, ultrasound investigation andfine-needle aspiration biopsy of the node in the right thyroid lobe a diagnose of medullary thyroid cancer was made. CT revealed multiple metastases in both lungs. Specialist erformed thyroidectomy with central lymphadenectomy and facial neck dissection on both sides. During next four months basal calcitonin level increased twice. Control contrast CT lung screening showed the growth of previously identified metastases and the appearance of multiple new ones. Bone scan showed focuses of increased radio-pharmaceutical accumulation in the area of 7 h left rib, left iliac wing, in the left bones of cranial vault, in C 7 , Th 6 , Th 9 , Th I2 vertebrae and right foot bones. Additional examination using SPECT/CT (from the skull base to the hip joints) revealed metastases in corpuses of Th 9 , Th I2 vertebrae and the left iliac wing, and suspicion for metastasis in 7 h left rib. Magnetic resonance imaging (MRI) confirmed metastasis in Th 9 , Th I2 , L 3 vertebral bodies and in the left iliac wing. Conclusion. Conclusion . In this clinical example, SPECT/CT allowed to correctly detect metastases in both Th 9 and Th I2 vertebrae while bone scan was questionable, and MRI showed an additional damage of L 3 vertebra. Changes in the 7 h left rib could not be verified using CT, although this changes may be an emerging metastasis. Obviously, extensive use of radiation methods does not guarantee complete identification of all pathological focuses, it therefore allows assessing the prevalence of the pathological process. It is crucially important to control calcitonin level in these patients, since its rapid growth allowed suspecting additional distant metastases.

Introduction: Histiocytosis is a heterogeneous group of rare diseases of unknown etiology. LCH is characterized by an abnormal proliferation of histiocytes (activated dendric cells and macrophages). Langerhans cell histiocytosis (LCH) is the most common form of histiocytosis, it is a potentially fatal diseases. Early detection of LCH plays an important role in its prognosis and outcome. However, the role of advanced methods of nuclear medicine in diagnosis of LCH is still to be researched. We have long-term experience in observing pediatric patients with LCH. Taking into the account the difficulty of diagnostic task for bone scintigraphy in identifying lytic bone destruction, we stated the following objective of the study.Purpose: Retrospective and prospective analysis of bone scintigraphy examinations of treatment-naive pediatric patients with LCH and calculate the diagnostic efficacy of bone scintigraphy. Material and methods: We analyzed 60 examinations of treatment-naive pediatric patients with proven case of LCH (2014-2019). The scanning was performed using whole body mode, 3 hours after intravenous injection of bone-seeking radiopharmaceutical 99mTc-MDP on Symbia E, T2 (Siemens, Germany). The median age was 5.6 years.Results: During examination we visualized 88 lesions with pathological level of accumulation of radiopharmaceutical in 60 patients. 84 with high level of accumulation (>120 %); 3 with slightly increased level of accumulation (100–120 %) and 1 with lower than normal level of accumulation (<100 %). The median level of accumulation of radiopharmaceutical was 268 %. Max level of accumulation was 1422 % (patient with subtotal involvement of femoral bone). Min — 60 % (patient with lytic destruction in orbital bone). During X-Ray we found out 97 pathological focuses of bone lytic destruction. In 3 patients with polyostotic form we found extra focuses on scintigraphy, which were confirmed with following examination and X-Ray. 8 lesions were not found on scintigraphy in 8 patients.Сonclusions: We evaluated diagnostic accuracy of bone scintigraphy with 99mTc-MDP in treatment-naïve pediatric patients with proven case of LCH. Sensitivity, specificity, NPV and PPV — 91.6, 50.0, 11.1, 98.6 %, respectively.