Indian Journal of Nuclear Medicine

: 2011  |  Volume : 26  |  Issue : 5  |  Page : 1--2

Research audit

Anshu Rajnish Sharma 
 Editor-in-Chief, Indian Journal of Nuclear Medicine, Consultant, Nuclear Medicine and PET-CT, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India

Correspondence Address:
Anshu Rajnish Sharma
Editor-in-Chief, Indian Journal of Nuclear Medicine, Consultant, Nuclear Medicine and PET-CT, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai

How to cite this article:
Sharma AR. Research audit.Indian J Nucl Med 2011;26:1-2

How to cite this URL:
Sharma AR. Research audit. Indian J Nucl Med [serial online] 2011 [cited 2020 Aug 4 ];26:1-2
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Traditionally nuclear medicine has been thyroid oriented practice. But we are appreciating noticeable drift from thyroid centric research. Only 7 papers submitted in endocrinology section with six emphasizing on differentiated thyroid cancer. Five studies on thyroid are of retrospective design and one on technique. Baghel NS et al has reported good correlation between 'measured' and 'predicted' 24 hours radioiodine uptake. Computation of 24 hours radioiodine uptake was done by establishing regression relation between 2 hours and 24 hours uptake values using a window based software program. Mandakini Phukan et al explored the potential of whole body FDG PET-CT as prognostic tool for metastatic differentiated thyroid cancer. Manas et al detected 19% additional occult lesions with SPECT-CT in patients with DTC as compared to planar whole body I 131 scan and could optimize the therapeutic dose of radioiodine in significant number of patient in their study group.

Clinical utility of SPECT-CT will be highlighted during the conference proceedings. Three different institutions (PGI, AIIMS and AIMS) have analyzed their findings of using SPECT-CT in bile leak in postoperative and post-trauma setting. Borde and Sundaram from AIMS, Cochin have emphasized the high negative predictive value of SPECT-CT and able to categorize amount of bile leak (mild, moderate and severe) apart from its exact localization in abdomen. Kalpa Jyoti and colleagues from AIIMS have encountered false positive results with planar biliary scintigraphy and reported its low diagnostic accuracy with respect to SPECT-CT (66% VS 97%). On ROC analysis, observer confidence of interpreting SPECT-CT is better than planar biliary scintigraphy. Study conducted by S Arun et al could distinguish localization of bile leak within liver (subcapsular or intra-parenchymal) and peri-hepatic region. As per authors this information has therapeutic implication in guiding the accurate placement of drain for drainage. Reema Goel effectively used SPECT-CT in localization of lower gastrointestinal bleeding and correctly ascertained the bleeding sites in12/43 (28%) discrepant cases. Swaroop K et al in collaboration with BRIT will be presenting their initial experience of using 14-C labeled urea capsule as a part of epidemiological studies. Pathak and colleagues from PGI conclude in their study that non-capsulated 14C-Urea Breath Test appears to be superior than the conventional capsule based protocol for the detection of H. pylori infection.

There are four submissions in nephro-urology category. Ashish Jha has validated the self designed user friendly software program for calculation of GFR based on two plasma sampling. However, this program needs to be tested in clinical environment and with other established techniques. Shefali et al has done comparative evaluation of GFR estimation techniques and derives to the unpredictable conclusion that GFR estimation by creatinine clearance method is more accurate than Gate's technique.

There are 21 papers on PET-CT accounting for 25% of total research papers to be presented in 43 rd Annual Conference of SNM, India at Chennai. Most notable point is that about third of these papers are concentrating on application of PET in neurology and neuro-oncology. Various groups are showcasing their initial experience with PET radiopharmaceuticals other than 18 F FDG like 18 F FDOPA, 11-C Methionine for neurological indications. Thapa et al have shown that uptake of Tc-99m labeled Methionine is equal to 11-C Methionine in residual/recurrent brain tumors in their preliminary study incorporating 14 patients. With this initial experience Tc-99m Methionine appears promising agent and can be used as alternative to 11-C Methionine in centers without PET-CT scanners and cyclotron. Karunanithi and colleagues at AIIMS have compared Tc-99m GHA, 18 F FDOPA, 18 F FDG and MRI in recurrent low grade gliomas and conclude that 18 F FDOPA provides the best results followed by Tc-99m GHA in detecting recurrent/residual disease in low grade gliomas. Tc-99m GHA represents the economical and effective way of determining viable disease in primary brain tumors after surgery and radiotherapy. In an another study comparing 18 F FDG and 11-C Methionine (MET) for detection of viable residual/recurrent disease in low and high grade gliomas, Romana Sehar et al describe 11-C MET to be superior than FDG.

I wish to highlight the work carried out by Rajnish Sharma and his colleagues at INMAS, describing various pattern of cortical glucose metabolism in 117 patients with neurodegenerative dementia. Madhavi Tripathi has studied 165 patients with Parkinsonism to differentiate between Idiopathic Parkinson's disease (PD) with other atypical Parkinsonian syndromes like MSA, PSP by 'visual interpretation' and 'SPM supported reading'. Visual and 'SPM supported reading' correlated with clinical diagnosis in 93% and 83% of patients respectively. She concludes in her study that visual evaluation method is superior. Both Visual reading and SPM supported analysis should be done together for differential diagnosis of Parkinsonism in early stage, when clinical diagnosis is ambiguous. In another study, Madhavi and colleagues at INMAS, performed FDG PET in 35 patients with amnesic mild cognitive impairment (MCI) for early detection of Alzheimer's Disease (AD). Authors have reported metabolic deficits in AD territories in 7 of 35 patients (25%) using both visual and SPM based analysis of FDG Brain PET scans.

It is interesting to note that two studies from different centers have reported a high yield of FDG PET-CT in detection of unknown primary contrary to literature. Avani et al from Apollo Chennai and Ramya Soundararajan et al from AIIMS, Delhi are able to diagnose sites of unknown primaries in 33 of 47 (70%) and 27 of 57 (43%) respectively. Chavi Gupta localizes neuroendocrine primary using Ga-68 DOTANOC scan. Clinical utility of FDG PET-CT in vasucultis has been emphasized by Santosh Sampath et al.

Rashmi et al in collaboration with BRIT has evolved and validated the IRMA technique for detection of C-peptide. Shanti Bhushan et al has used dacryoscintigraphy for diagnosing functional and mechanical obstruction of nasolacrimal duct and documented improved drainage in 32 of 40 patients after silicone tube placement and dacryocystorhinostomy surgery. Pradip Chaudhari and MGR Rajan team has performed preclinical validation of trimodality (PET/SPECT/CT) animal imaging facility at ACTREC, Mumbai using various radiopharmaceuticals like 18 F FDG, 18 F FLT, 18 F MISO, 18 F FAZA, 18 F NaF, Tc99m, 177Lu and 125I labeled compounds. Balkrishnan and Poovendiran explored the feasibility of using team viewer-6 version software for SPECT and PET scan interpretation from remote location. However, they have used phantom images in their study and this software needs to be further evaluated in clinical environment to establish its clinical utility.

INMAS group under the guidance of AK Mishra will be deliberating their projects, few to mention are 'Design and Synthesis of neurocatecholamine analogue by Pooja et al, Novel bis (thiosemicarbazone) analogues as potential hypoxia agent by Nidhi Chadha, Tc99m-labeled EDTA-bis (Glutathione) for imaging GSH efflux by Harleen Khurana et al, antisense oligonucleotides targeting 5HT1A receptor mRNA by Virendra K Meena et al, evaluation of chalcone derivatives with Tc99m as potential probe for detection of β-amyloid plaques in Alzheimer's Disease by K Ganesh et al, Synthesis and biological evaluation of thiocarbamate derivatized estradiol labeled with Tc-99m by Kanchan Chouhan and estradiol conjugate with macrocyclic chelate for tumor imaging by Anupriya et al, Design and synthesis of Tc99m -anthraquinone based analogues by Swati et al, anti integrin mAbs in malignant glioma by Surbhi Prakash et al.

Laksminarayanan et al have prepared (F-18)FET in a GETracer Lab system (configured for making FDG) using 2-(O-tosyloxyethyl)-N-trityl-L-tyrosine-tert-butyl ester (TET) as precursor with > 90% labeling efficiency. Shimpi et al have suggested modification in the RPhD technique for synthesis of Lu-177- DOTA-TATE. Sonia Mahajan et al have done comparative evaluation of 11-C and Tc-99m labeled Methionine in breast cancer. Shivanand Bhushan et al has done the feasibility study for the preparation of Patient specific Unit dose of Tc99m-labelled Radiopharmaceuticals in a Sterilized disposable syringe over the fractionated vials for clinical evaluation. Ritika Uppal and her team investigate the efficacy of tripeptide RGD (Maraciclatide) to image liver tumors in HT-29 xenograft mouse models.

There may be few studies which would have missed my attention and mention. Overall, I can say that radiopharmacy is vibrant and rapidly evolving discipline with great research potential. There is maximum number of submissions in radiopharmacy category (33%). Future of molecular imaging and nuclear medicine is directly dependent upon the development new radiopharmaceuticals and bio-molecules. Our premier research institutes like BARC, BRIT, RMC, INMAS, IICB, ACTREC are committed to this cause. Nuclear Medicine community now can look beyond FDG, as availability and clinical use of these newer PET radiopharmaceuticals like 18 F FLT, 18 F DOPA, 18 F FET, 18 F MISO, 18 F FAZA and 11 C Methionine appearing practical in India in near future.

Wishing you fruitful deliberation at the conference!