Comparison of three with six regions of interest analyses in patients with idiopathic constipation undertaking colon transit scintigraphy using 67Ga-citrate

OBJECTIVE AND INTRODUCTION: Preparation of data from 6 geometric regions of interest in the colon is time consuming, and can become impractical in the environment of busy Nuclear Medicine Departments. Therefore, we have investigated and demonstrated an alternative method for obtaining the same diagnostic information from an analysis of patients with idiopathic constipation who underwent colon transit scintigraphy using 67Ga-citrate. Data analysis methods using three regions of interest are compared to the results obtained using the more time consuming 6 regions of interest method to analyze the data. MATERIALS AND METHODS: In this study, we report our results of the comparative reanalysis of data obtained by more traditional methods. We compare 3 regions of interest (ROI) which were taken from areas including the right colon, left colon and the rectosigmoid colon, with original work using our alternative 6 (ROI) diagnostic methodology. In addition, the proximal colonic emptying (PCE) was determined at 24 hr post ingestion among members of 3 identified subject groups. RESULTS: The distribution of activity as the ingested 67Ga-citrate passes through the colon constitutes an activity profile. The mean activity position in the colon can be determined from subsequent radiographic images and from this the mean clearance time can be calculated. In quantitative assessment, this represents the time at which half of activity was eliminated from colon (mean half clearance time - MCT) which did not appear different in the reanalysis. There is no significant difference in the current study in GMC 24h, GMC 48h and GMC 72h between two groups using the Man Whitney u test (p > 0.05), while in the previous work the results were statistically significant for the two later time periods GMC (GMC 48h and GMC 72h) (p = 0.016 and p = 0.027 respectively). The PCE in the group 1 was = 2.50 (0.37); group 2, 1.57 (0.47) and group 3, 2.97. The PCE was not different between the two groups (p = 0.21). CONCLUSIONS: This investigation demonstrated that the radionuclide colon transit study using 67Ga-citrate is a safe, physiologic, and quantitative method for evaluating the transit of fecal material from cecum to rectum. Although, the visual assessment of diagnosis of the subjects in the two analyses is the same, it was not completely supported by quantitative measurements. Therefore, further studies need to be done

Evaluation of feline renal perfusion with contrast-enhanced ultrasonography and scintigraphy

Contrast-enhanced ultrasound (CEUS) is an emerging technique to evaluate tissue perfusion. Promising results have been obtained in the evaluation of renal perfusion in health and disease, both in human and veterinary medicine. Renal scintigraphy using Tc-99m-Mercaptoacetyltriglycine (MAG(3)) is another non-invasive technique that can be used to evaluate renal perfusion. However, no data are available on the ability of CEUS or Tc-99m-MAG(3) scintigraphy to detect small changes in renal perfusion in cats. Therefore, both techniques were applied in a normal feline population to evaluate detection possibilities of perfusion changes by angiotensin II (AT II). Contrast-enhanced ultrasound using a bolus injection of commercially available contrast agent and renal scintigraphy using Tc-99m-MAG(3) were performed in 11 healthy cats after infusion of 0,9% NaCl (control) and AT II. Angiotensin II induced changes were noticed on several CEUS parameters. Mean peak enhancement, wash-in perfusion index and wash-out rate for the entire kidney decreased significantly after AT II infusion. Moreover, a tendency towards a lower wash-in area-under-the curve was present. Renal scintigraphy could not detect perfusion changes induced by AT II. This study shows that CEUS is able to detect changes in feline renal perfusion induced by AT II infusion

Evaluation of renal perfusion in hyperthyroid cats before and after radioiodine treatment

Background: Hyperthyroidism and chronic kidney disease (CKD) are common in elderly cats. Consequently, both diseases often occur concurrently. Furthermore, renal function is affected by thyroid status. Because changes in renal perfusion play an important role in functional renal changes in hyperthyroid cats, investigation of renal perfusion may provide novel insights. Objectives: To evaluate renal perfusion in hyperthyroid cats with contrast-enhanced ultrasound (CEUS). Animals: A total of 42 hyperthyroid cats was included and evaluated before and 1 month after radioiodine treatment. Methods: Prospective intrasubject clinical trial of contrast-enhanced ultrasound using a commercial contrast agent (SonoVue) to evaluate renal perfusion. Time-intensity curves were created, and perfusion parameters were calculated by off-line software. A linear mixed model was used to examine differences between pre-and post-treatment perfusion parameters. Results: An increase in several time-related perfusion parameters was observed after radioiodine treatment, indicating a decreased blood velocity upon resolution of the hyperthyroid state. Furthermore, a small post-treatment decrease in peak enhancement was present in the renal medulla, suggesting a lower medullary blood volume. Conclusions and Clinical Importance: Contrast-enhanced ultrasound indicated a higher cortical and medullary blood velocity and higher medullary blood volume in hyperthyroid cats before radioactive treatment in comparison with 1-month post-treatment control

Nuclear medicine: investigation of renal function in small animal medicine

Kidney function investigations in veterinary medicine are traditionally based on blood analysis (blood urea nitrogen (BUN) and serum creatinine concentration) and / or urinalysis (urine specific gravity, protein-to-creatinine ratio or fractional excretion). Morphologic information is usually obtained by abdominal radiography or ultrasonography. However, when more specific information on the functionality of the kidneys is needed, nuclear medicine offers various tracers that specifically represent glomerular filtration rate, effective renal plasma flow or functional renal mass, sometimes combining functional and morphologic data. These procedures can be based on blood sampling techniques (non-imaging methods), or data can be obtained using a gamma-camera (imaging methods). The most commonly used radionuclides for the examination of kidney function in small animal medicine are discussed in this review

MRI of the lung (3/3)-current applications and future perspectives

BACKGROUND: MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. METHODS: Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. RESULTS: In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a "buffet" of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. CONCLUSION: New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations

A new method for quantification of hepatobiliary scintigraphy using 99mTc-mebrofenin. A comparative study

A method based upon the application of mathematical techniques of deconvolution on the classical compartmental model for the quantitative study of liver function from hepatobiliary scintigraphy using 99mTc-mebrofenin data is proposed. The theory in which the method is based upon is presented and a comparison with a published methodology of obtaining the hepatic extraction after scintigraphic sudies has been performed using the results on 36 rats studies obtained with the two methods. A highly significant correlation between the two techniques was verified. The characteristics of the two methodologies, the proposed one based upon a theoretical approach and the other one on an empirical approximation are discussed. Comments are made on the interest and limitations of the presented technique that may be an useful tool for the evaluation of hepatic insufficiency

Aboralis pótgyomor prospektív randomizált összehasonlítása hagyományos orális pótgyomorral totális gastrectomia után = Prospective randomised comparison of aboral pouch with conventional oral pouch after total gastrectomy.

Prospektív randomizált vizsgálat keretében hasonlítottunk össze totális gastrectomia után két rekonstrukció típust, az aborális és az orális pótgyomrot a duodenális passzázs megtartásával. 28 beteg lépett be a tanulmányba. A betegeknél antropometriai és laborparaméterek mérése, izotópos passzázs vizsgálat, zsír és szénhidrát felszívódási vizsgálatok valamint életminőségi kérdőív kitöltése történt. Nem találtunk szignifikáns különbséget az elsődleges kimeneteli paraméterekben, és minimálisat a másodlagosakban, ezért a konklúzió, hogy a pótgyomor helye nem befolyásolja a kimenetelt. Befejeztük a korábbi aborális pouch versus Roux-Y tanulmány hosszú távú utánvizsgálatát. A fentivel azonos mérések történtek, és csak a másodlagos paraméterekben találtunk némi különbséget. A gastrointestinális hormonmérések tesztétel után különböző rekonstrukció típusoknál elvégeztünk. Szignifikáns különbségeket találtunk a cholecystokinin és somatostatin szintekben a duodenális passzázst megőrző rekonstrukciók javára. A Manometriás és Bilitec epés reflux mérések a total gastrectomián átesett betegeken még zajlanak, 14 betegnél végeztünk endoscopiát, manometriát és Bilitec vizsgálatot. | In a prospective randomised trial we compared two types of surgical reconstructions, the aboral and the oral pouch construction with preservation of the duodenal passage after total gastrectomy. 28 patients entered the study. Primarily body weight, body mass index and quality of life, secondarily serum nutritional parameters, scintigraphic small intestinal passage, lipid and carbohydrate absorption were measured. No significant differences were found in the primary outcome measures, while some differences regarding the secondary outcome. In summary the site of the reservoir does not influence the functional outcome of reconstruction after total gastrectomy. Also the long term examinations for the aboral pouch versus Roux-en-Y study was finished. The above follow-up measurements were carried, and we found some difference in secondary outcome measures only. The gastrointestinal hormone measurements following ingestion of a test food at different types of reconstructions was finished. Significant differences were found in cholecystokinin and somatostatin production in favour of reconstructions preserving the duodenal passage. The manometry and Bilitec biliary reflux studies are still going on. Upper endoscopy, esophageal manometry and 24 hour Bilitec examinations were carried out for 14 patients

Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers

PURPOSE: Currently, most centres use 2-D planar lymphoscintigraphy when performing dynamic sentinel lymph node biopsy in penile cancer patients with clinically impalpable inguinal nodes. This study aimed to investigate the role of SPECT/CT following 2-D planar lymphoscintigraphy (dynamic and static) in the detection and localization of sentinel lymph nodes in the groin. METHODS: A qualitative (visual) review was performed on planar followed by SPECT/CT lymphoscintigraphy in 115 consecutive patients (age 28-86 years) who underwent injection of (99m)Tc-nanocolloid followed by immediate acquisition of dynamic (20 min) and early static scans (5 min) initially and further delayed static (5 min) images at 120 min followed by SPECT/CT imaging. The lymph nodes detected in each groin on planar lymphoscintigraphy and SPECT/CT were compared. RESULTS: A total of 440 and 467 nodes were identified on planar scintigraphy and SPECT/CT, respectively. Overall, SPECT/CT confirmed the findings of planar imaging in 28/115 cases (24%). In the remaining 87 cases (76%), gross discrepancies were observed between planar and SPECT/CT images. SPECT/CT identified 17 instances of skin contamination (16 patients, 13%) and 36 instances of in-transit lymphatic tract activity (24 patients, 20%) that had been interpreted as tracer-avid lymph nodes on planar imaging. In addition, SPECT/CT identified 53 tracer-avid nodes in 48 patients (42%) that were not visualized on planar imaging and led to reclassification of the drainage basins (pelvic/inguinal) of 27 tracer-avid nodes. CONCLUSIONS: The addition of SPECT/CT improved the rate of detection of true tracer-avid lymph nodes and delineated their precise (3-D) anatomic localization in drainage basins

Gigantic Stomach: A Rare Manifestation of Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is characterized by degeneration and atrophy of skeletal, cardiac, and smooth muscles after a latent period of apparently normal development and function. The gastrointestinal manifestations start in the second decade of life and are mainly due to atrophy of smooth muscle layers. Refractory gastroparesis and chronic constipation can lead to severe gastric and small bowel dilatation, which can be life threatening. Here, we present a case of a 21-year-old male with a gigantic stomach secondary to DMD resolved with conservative management and no surgical intervention