**6. References**


201 chloride but negative results using Ga-67 citrate, it was differentiated thyroid carcinoma or poorly differentiated adenoma (Senga et al., 1982). Carril et al. analyzed Tl-201 and I-131 in ablated thyroid cancer patients. They reported that the sensitivity and specificity were 94% and 96% for Tl-201 and 29% and 100% for I-131 (Carril et al., 1997). Nakada et al. reported that Tl-201 uptake correlated well with the proliferating cell nuclear antigen index,

I-124 is a positron emitter with a half-life of 4.18 days, produced by a cyclotron. It can be used to directly image thyroid cancer using PET scanner. Van Nostrand et al. compared I-124 PET with I-131 DxWBS in detecting residual thyroid tissue and/or metastatic lesion. They reported that I-124 PET identified as many as 50% more foci of radioiodine uptake suggestive of additional residual thyroid tissue and/or metastasis (Van Nostrand et al., 2010). They suggest that I-124 PET produced superior results because the PET scanner provides images with reduced background noise and enhanced spatial and contrast resolution compared with I-131 DxWBS. The longer half-life of I-124 is useful for dose monitoring over an extended time period (Surti et al., 2009). It can be also used for lesionspecific dosimetry. I-131 mean absorbed dose distributions can be calculated from serial I-

The I-123 DxWBS or I-131 DxWBS is sensitive and specific for treatable remnant or metastatic lesion. About 25% of RxWBS detect lesions missed by DxWBS. For this reason, following administration of a therapeutic I-131 dose, RxWBS should always be performed in patients with well differentiated thyroid cancer. The timing of RxWBS is currently still controversial. Based on several studies, the timing of post-therapeutic I-131 WBS is within 5th to 10th day, especially more opportune around 7th day after therapy. I-131 WBS with SPECT/CT may be the highly tailored approach for assessing distant metastatic lesions in patients who received a radioiodine therapy if SPECT/CT is available. RxWBS is especially likely to provide the useful information when DxWBSs are negative and the serum thyroglobulin levels are elevated. Other imaging modalities including F-18 FDG PET/CT is useful in detecting remnant thyroid tissues or metastatic thyroid cancer in patient with the elevated serum thyroglobulin level and negative iodine images. I-124 can be also useful in detection of the lesion and evaluation of lesional and whole-body dosimetry in patients with

Ain, K.B. & Shih, W.J. (1994). False-positive I-131 uptake at a tracheostomy site. Discernment

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which represents proliferative activity (Nakada et al., 1999).

124 PET image (Erdi et al., 1999; Larson & Robbins, 2002).

**4.5 I-124 PET/CT**

**5. Conclusion** 

**6. References** 

well-differentiated thyroid cancer.

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**10** 

*Japan* 

**Apoptosis Imaging in Diseased Myocardium** 

*Kanazawa University & Medical and Pharmacological Research Center Foundation,* 

In various myocardial disorders including myocardial ischemia, infarction and subsequent cardiac remodelling and heart failure, myocarditis, cardiomyopathy, cardiac allograft rejection, chemotherapy induced cardiotoxicity, both necrosis and apoptosis are considered to play an important role in the underling pathophysioloy. Molecular and cellular dysfunction has been widely investigated in cardiovascular fields using various modalities. Of particular, radionuclide imaging technique has advantage for quantitative assessment of molecular function in vivo in patients. Especially in patients with coronary artery disease, perfusion imaging agents such as 201Tl, 99mTc-MIBI and tetrofosmin with combination of stress testing and ECG-gated data acquisition have been used for the simultaneous assessment of the ventricular function and severity of myocardial perfusion abnormality including its location and size in stress and resting condition. From these data, status of myocardial ischemia or jeopardized myocardium, myocardial viability and reversibility of wall motion abnormality can be diagnosed to some extent but still insufficiently. Molecular imaging may play an important role for assessing the pathophysiology and its severity in these various cardiovascular diseases beyond perfusion imaging. This chapter focuses on the apoptosis imaging that is one of the most possible nuclear molecular imaging in-vivo at this stage, and its clinical application might permit more precise assessment of the

pathophysiology in various myocardial abnormalities beyond perfusion imaging.

Four decades ago, the term apoptosis has been introduced by Kerr et. al. as a special form of cell death different from necrosis (Kerr, et al., 1972). Necrosis is passive and unregulated form of cell death, characterized by irreversible loss of plasma membrane integrity with cell swelling and rupture after sudden severe insults which preclude adequate homeostatic energy-dependent cell functions, leading to release of intracellular contents and a subsequent inflammatory response. Apoptosis on the other hand is characterized morphologically by the condensation of nuclear chromatin, cytoplasmic condensation, cell shrinkage, followed by the nuclear and cellular fragmentation and phagocytosis of apoptotic bodies by neighboring cells in the absence of inflammation. Apoptosis is considered to be an active and highly regulated ATP dependent programmed cell daeth process and plays an important roles in embryonic developement and maintenace of postnatal tissues and contributes to both normal physiology and pathology. Dysregulation of apoptosis results in either too littel or too much cell death and implicated in various diseases. For instance, insufficient apoptosis may contribute carcinogenesis, on the otherhand, eccessive apoptosis

**1. Introduction**

Junichi Taki, Hiroshi Wakabayashi, Anri Inaki,

Ichiro Matsunari and Seigo Kinuya

