MARCELO TATIT SAPIENZA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Radiologia, Faculdade de Medicina - Docente
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/43 - Laboratório de Medicina Nuclear, Hospital das Clínicas, Faculdade de Medicina
Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/43 - Laboratório de Medicina Nuclear, Hospital das Clínicas, Faculdade de Medicina
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- Estimating 131I biokinetics and radiation doses to the red marrow and whole body in thyroid cancer patients: probe detection versus image quantification(2016) WILLEGAIGNON, José; PELISSONI, Rogério Alexandre; LIMA, Beatriz Christine de Godoy Diniz; SAPIENZA, Marcelo Tatit; COURA-FILHO, George Barberio; QUEIROZ, Marcelo Araújo; BUCHPIGUEL, Carlos AlbertoAbstract Objective: To compare the probe detection method with the image quantification method when estimating 131I biokinetics and radiation doses to the red marrow and whole body in the treatment of thyroid cancer patients. Materials and Methods: Fourteen patients with metastatic thyroid cancer, without metastatic bone involvement, were submitted to therapy planning in order to tailor the therapeutic amount of 131I to each individual. Whole-body scans and probe measurements were performed at 4, 24, 48, 72, and 96 h after 131I administration in order to estimate the effective half-life (Teff) and residence time of 131I in the body. Results: The mean values for Teff and residence time, respectively, were 19 ± 9 h and 28 ± 12 h for probe detection, compared with 20 ± 13 h and 29 ± 18 h for image quantification. The average dose to the red marrow and whole body, respectively, was 0.061 ± 0.041 mGy/MBq and 0.073 ± 0.040 mGy/MBq for probe detection, compared with 0.066 ± 0.055 mGy/MBq and 0.078 ± 0.056 mGy/MBq for image quantification. Statistical analysis proved that there were no significant differences between the two methods for estimating the Teff (p = 0.801), residence time (p = 0.801), dose to the red marrow (p = 0.708), and dose to the whole body (p = 0.811), even when we considered an optimized approach for calculating doses only at 4 h and 96 h after 131I administration (p > 0.914). Conclusion: There is full agreement as to the feasibility of using probe detection and image quantification when estimating 131I biokinetics and red-marrow/whole-body doses. However, because the probe detection method is inefficacious in identifying tumor sites and critical organs during radionuclide therapy and therefore liable to skew adjustment of the amount of 131I to be administered to patients under such therapy, it should be used with caution.
- EFFICACY AND SAFETY OF CREATINE SUPPLEMENTATION IN JUVENILE DERMATOMYOSITIS: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED CROSSOVER TRIAL(2016) SOLIS, Marina Yazigi; HAYASHI, Ana Paula; ARTIOLI, Guilherme Giannini; ROSCHEL, Hamilton; SAPIENZA, Marcelo Tatit; OTADUY, Maria Concepcion; PINTO, Ana Lucia De Sa; SILVA, Clovis Artur; SALLUM, Adriana Maluf Elias; PEREIRA, Rosa Maria R.; GUALANO, BrunoIntroduction: It has been suggested that creatine supplementation is safe and effective for treating idiopathic inflammatory myopathies, but no pediatric study has been conducted to date. The objective of this study was to examine the efficacy and safety of creatine supplementation in juvenile dermatomyositis (JDM) patients. Methods: In this study, JDM patients received placebo or creatine supplementation (0.1 g/kg/day) in a randomized, crossover, double-blind design. Subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle function. Secondary outcomes included body composition, aerobic conditioning, health-related quality of life, and muscle phosphocreatine (PCr) content. Safety was assessed by laboratory parameters and kidney function measurements. Results: Creatine supplementation did not affect muscle function, intramuscular PCr content, or any other secondary outcome. Kidney function was not affected, and no side effects were reported. Conclusions: Twelve weeks of creatine supplementation in JDM patients were well-tolerated and free of adverse effects, but treatment did not affect muscle function, intramuscular PCr, or any other parameter.
- Preliminary Comparison of PET/CT Studies Performed After Intravenous and Oral Administration of F-18-Fluoride(2016) ZACCHI, Samara Riguete; VALE, Romulo Hermeto Bueno do; DUARTE, Paulo Schiavom; SAPIENZA, Marcelo Tatit; BUCHPIGUEL, Carlos AlbertoA 78-year-old man with prostate cancer was referred for F-18-NaF PET/CT for assessing bone metastases. An F-18-NaF PET/CT study was performed after the intravenous administration of the radiopharmaceutical. Five days later, a second study was done after oral administration of the radiopharmaceutical as part of a research protocol.
- Prediction of iodine-131 biokinetics and radiation doses from therapy on the basis of tracer studies: an important question for therapy planning in nuclear medicine(2016) WILLEGAIGNON, Jose; PELISSONI, Rogerio A.; LIMA, Beatriz C. G. D.; SAPIENZA, Marcelo T.; COURA-FILHO, George B.; BUCHPIGUEL, Carlos A.ObjectivesThis study aimed to present a comparison of iodine-131 (I-131) biokinetics and radiation doses to red-marrow (rm) and whole-body (wb), following the administration of tracer and therapeutic activities, as a means of confirming whether I-131 clearance and radiation doses for therapy procedures can be predicted by tracer activities.MethodsEleven differentiated thyroid cancer patients were followed after receiving tracer and therapeutic I-131 activity. Whole-body I-131 clearance was estimated using radiation detectors and OLINDA/EXM software was used to calculate radiation doses to rm and wb.Results and discussionTracer I-131 activity of 86 (14)MBq and therapeutic activity of 8.04 (+/- 1.18)GBq were administered to patients, thereby producing an average wb I-131 effective half-time and residence time of, respectively, 13.51 (+/- 4.05) and 23.13 (+/- 5.98)h for tracer activities and 13.32 (+/- 3.38) and 19.63 (+/- 4.77)h for therapy. Radiation doses to rm and wb were, respectively, 0.0467 (+/- 0.0208) and 0.0589 (+/- 0.0207)mGy/MBq in tracer studies and 0.0396 (+/- 0.0169) and 0.0500 (+/- 0.0163)mGy/MBq in therapy. Although the differences were not considered statistically significant between averages, those between the values of effective half-times (P=0.906), residence times (P=0.145), and radiation doses to rm (P=0.393) and to wb (P=0.272), from tracer and therapy procedures, large differences of up to 80% in wb I-131 clearance, and up to 50% in radiation doses were observed when patients were analyzed individually, thus impacting on the total amount of I-131 activity calculated to be safe for application in individual therapy.Conclusion(131)I biokinetics and radiation doses to rm and wb in therapy procedures are well predicted by diagnostic activities when average values of a group of patients are compared. Nonetheless, when patients are analyzed individually, significant differences may be encountered, thus implying that nuclear medicine therapy-planning requires due consideration of changes in individual patient-body status from initial tracer to final therapy procedures to thus provide appropriate adjustments in therapeutic activities.
- SUV Normalized by Skeletal Volume on F-18-Fluoride PET/CT Studies(2016) CARVALHO, Giovanna; MARIN, Jose Flavio Gomes; GARCEZ, Alexandre Teles; DUARTE, Paulo Schiavom; SAPIENZA, Marcelo Tatit; BUCHPIGUEL, Carlos AlbertoObjective: To propose a technique for SUV normalization on F-18-fluoride PET/CT (F-18-NaF) studies based on skeletal volume and to compare the SUVs normalized by this technique with the ones normalized by body weight. Methods: SUVs were obtained in volumes of interest (VOIs) in proximal diaphyseal regions of the right humerus (HD) and right femur (FD) in 12 selected F-18-NaF studies. The 12 studies presented both regions considered normal by visual examination on PET and CT and were performed in patients presenting body weight below 50 kg (B50) or above 90 kg (A90) (6 patients in each group). The maximum SUVs were calculated in these 2 bone regions in both groups of patients using body weight (SUV BW) and skeletal volume (SUV SV) methodologies. The total skeletal volume for each patient was estimated based on whole skeletal VOIs automatically defined on the CT component of the PET/CT study. The maximum SUVs calculated using the 2 methodologies were compared. Results: The maximum SUVs BW were statistically higher in the group A90 in both regions, with a P < 0.001 and P < 0.008 for FD and HD, respectively. The maximum SUVs SV in the 2 regions were not statistically different between the groups B50 and A90, P values of 0.27 and 0.87 for FD and HD, respectively. Conclusions: The SUVs normalized by skeletal volume present similar results in groups of patients with extremes of body weight. Therefore, this methodology could be more adequate than the one normalized by body weight to semiquantitatively analyze F-18-NaF studies.
- Evaluation of MDRD4, CKD-EPI, BIS-1, and modified Cockcroft-Gault equations to estimate glomerular filtration rate in the elderly renal-transplanted recipients(2016) DAVID-NETO, Elias; TRIBONI, Ana Heloisa Kamada; RAMOS, Fernanda; AGENA, Fabiana; GALANTE, Nelson Zocoler; ALTONA, Marcelo; LEMOS, Francine Brambate Carvalhinho; SAPIENZA, Marcelo Tatit; NAHAS, William CarlosEquations to estimate glomerular filtration rate (eGFR) were developed in patients using the variables age, body weight, and serum creatinine, which may be different in the elderly. Elderly renal transplant patients (EG; n=70; mean age 65 +/- 4 y) who measured plasma Cr-51-EDTA-Clearance (mGFR) had mGFR compared to eGFR obtained by the Cockcroft-Gault corrected by body surface area (CG-BSA), the modification of diet in renal disease (MDRD-4), the Berlin Initiative Study (BIS-1), and the chronic kidney disease epidemiology collaboration (CKD-EPI). Results were validated using a cohort of 43, of the 70 elderly recipients, who performed a second Cr-51-EDTA-Clearance. Mean mGFR was 47 +/- 16 mL/min/1.73 m(2) and statistically lower than eGFR by MDRD (52 +/- 19, P=.001) and BIS-1 (51 +/- 13, P=.007) but not different from the CG-BSA (47 +/- 15) and CKD-EPI (49 +/- 18). The CKD-EPI and CG-BSA presented the lowest bias but only CKD-EPI also showed the highest 30% and 10% accuracy. The same findings were repeated in the validation set. For a cohort of elderly recipients >= 65 years (n=35, 68 +/- 3y), the CKD-EPI performed better with the lowest bias (0 +/- 12 mL/min/1.73 m(2)) and best 30% and 10% accuracy. The CKD-EPI equation is a valuable tool to monitor GFR in the elderly RTx recipients.
- Receiver operating characteristic (ROC) curve for classification of18F-NaF uptake on PET/CT(2016) VALADARES, Agnes Araujo; DUARTE, Paulo Schiavom; CARVALHO, Giovanna; ONO, Carla Rachel; COURA-FILHO, George Barberio; SADO, Heitor Naoki; SAPIENZA, Marcelo Tatit; BUCHPIGUEL, Carlos AlbertoAbstract Objective: To assess the cutoff values established by ROC curves to classify18F-NaF uptake as normal or malignant. Materials and Methods: PET/CT images were acquired 1 hour after administration of 185 MBq of18F-NaF. Volumes of interest (VOIs) were drawn on three regions of the skeleton as follows: proximal right humerus diaphysis (HD), proximal right femoral diaphysis (FD) and first vertebral body (VB1), in a total of 254 patients, totalling 762 VOIs. The uptake in the VOIs was classified as normal or malignant on the basis of the radiopharmaceutical distribution pattern and of the CT images. A total of 675 volumes were classified as normal and 52 were classified as malignant. Thirty-five VOIs classified as indeterminate or nonmalignant lesions were excluded from analysis. The standardized uptake value (SUV) measured on the VOIs were plotted on an ROC curve for each one of the three regions. The area under the ROC (AUC) as well as the best cutoff SUVs to classify the VOIs were calculated. The best cutoff values were established as the ones with higher result of the sum of sensitivity and specificity. Results: The AUCs were 0.933, 0.889 and 0.975 for UD, FD and VB1, respectively. The best SUV cutoffs were 9.0 (sensitivity: 73%; specificity: 99%), 8.4 (sensitivity: 79%; specificity: 94%) and 21.0 (sensitivity: 93%; specificity: 95%) for UD, FD and VB1, respectively. Conclusion: The best cutoff value varies according to bone region of analysis and it is not possible to establish one value for the whole body.
- Incidental diagnosis of struma ovarii through radioiodine whole-body scanning: incremental role of SPECT/CT(2016) VALE, Rômulo Hermeto Bueno do; SADO, Heitor Naoki; DANILOVIC, Débora Lucia Seguro; DUARTE, Pulo Schiavom; SAPIENZA, Marcelo Tatit
- Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil(2016) WILLEGAIGNON, Jose; BRAGA, Luis F. E. F.; SAPIENZA, Marcelo T.; COURA-FILHO, George B.; CARDONA, Marissa A. R.; ALVES, Carlos E. R.; GUTTERRES, Ricardo F.; BUCHPIGUEL, Carlos A.ObjectivesThis study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure.MethodsA screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams.Results and DiscussionA total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga-67, Tl-201, and I-131 radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities.ConclusionVariability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.