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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

Rivista di Medicina Nucleare e Imaging Molecolare


A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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The Quarterly Journal of Nuclear Medicine 2003 December;47(4):292-320

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

“Pathophysiologic mapping” of venous thromboembolism: opportunities for radiolabeled peptides

Bernarducci M. P.

Society of Nuclear Medicine Radiopharmaceutical Science Council, Reston, VA, USA


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The seri­ous clin­i­cal and eco­nom­ic ­impact of ­venous throm­boem­bol­ic (VTE) dis­ease is undis­put­ed. What con­cerns prac­ti­tion­ers and research­ers ­alike is the seem­ing inabil­ity to tru­ly mit­i­gate the ram­ifi­ca­tions of VTE. Ironically, the cur­rent approach­es to the diag­nos­tic eval­u­a­tion of sus­pect­ed VTE ­patients ­tends to ­favor the appli­ca­tion of ana­tom­ic modal­ities, ­which by vir­tue of ­their prin­ci­ples of detec­tion, seem­ing­ly ­ignore the exten­sive knowl­edge ­base of VTE pathoph­y­sio­lo­gy and nat­u­ral his­to­ry. In oth­er ­words, are we seek­ing the appro­pri­ate ­types of infor­ma­tion in ­patients ­with sus­pect­ed VTE? Research in nucle­ar med­i­cine tech­niques for detect­ing VTE ­began approx­i­mate­ly 25 ­years ago. Recently, the emer­gence of the radio­lab­eled pep­tides as a clin­i­cal­ly appli­cable tech­nol­o­gy plat­form has encour­aged a dif­fer­ent way of eval­u­at­ing VTE. Many radio­lab­eled pep­tide can­di­dates are under­go­ing pre­clin­i­cal and clin­i­cal ­research. Currently, ­only one, 99mTc-apci­tide (AcuTect®), has ­been ­approved (­since 1998) for clin­i­cal use, spe­cif­i­cal­ly in the United States. Its avail­abil­ity this ­time has ­fueled ongo­ing clin­i­cal ­research to fur­ther elu­ci­date the ben­e­fits of ­this ­unique pep­tide tech­nol­o­gy. Consequen-tly, sig­nif­i­cant ­insight has ­been ­gained ­from ­large pros­pec­tive clin­i­cal ­trials. Furthermore, ­this ­insight has kin­dled increas­ing inter­est in 99mTc-apci­tide and poten­tial new ­entrants ­into ­this spe­cial “diag­nos­tic ­class”. Unlike the ­more pop­u­lar modal­ities, radio­lab­eled pep­tides cir­cum­vent ­many of the clin­i­cal and ana­tom­ic chal­leng­es to objec­tive­ly and accu­rate­ly diag­nos­ing VTE. The impor­tance of an objec­tive and accu­rate diag­no­sis is under­stood, ­because it is par­a­mount to a ­cost-effec­tive treat­ment strat­e­gy. In addi­tion to describ­ing the cur­rent activ­ities con­cern­ing the devel­op­ment for and use of radio­lab­eled pep­tides for clin­i­cal prac­tice, ­this man­u­script is intend­ed to prom­ul­gate a ­thought-pro­vok­ing argu­ment for chang­ing our cur­rent ­approach to the diag­nos­tic eval­u­a­tion of VTE. Despite tech­no­log­i­cal and med­i­cal advanc­es, we con­tin­ue to ­debate con­tro­ver­sial ­issues in VTE, ­which seem­ing­ly and argu­ably dis­pro­por­tion­ate­ly, ­focus on treat­ment (i.e., who?, ­when?, how much? and for how ­long?). Should we not ­adopt a ­more ­robust ­approach to VTE prob­lem-solv­ing, ­which ­would log­i­cal­ly ­start ­with the diag­no­sis? Perhaps the val­i­dat­ed and per­ceived advan­tag­es of the radio­lab­eled pep­tides are all the ratio­nale we ­need to ­advance ­beyond the stat­us quo? Only ­time and con­tin­ued ­research ­will ­tell.

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