Odwracalny ubytek perfuzji miokardium u pacjenta z nieprawidłowym odejściem gałęzi okalającej od prawej zatoki wieńcowej

We present the case of a 50 year-old woman with known anomalous origin of left circumflex coronary artery from the right sinus of Valsalva, with retro-aortic course confirmed by coronary computed tomography angiography. Due to progressive dyspnoea and a suspicion of ischaemia, the patient was referred to the Nuclear Medicine department for stress-rest myocardial perfusion scintigraphy. The imaging revealed inducible perfusion deficits mainly in the lateral and infero-lateral walls involving 14% of the total left ventricular (LV) myocardium. Although the detected coronary anomaly is considered nonmalignant, the extent of inducible ischaemia exceeding 10% of the LV myocardium should be taken into consideration while managing the patient.Prezentujemy przypadek 50-letniej kobiety z nieprawidłowym odejściem gałęzi okalającej od prawej zatoki wieńcowej z zaaortalnym przebiegiem potwierdzonym w angiotomografii komputerowej tętnic wieńcowych. Z powodu postępującej duszności i podejrzenia niedokrwienia mięśnia sercowego pacjentkę skierowano do zakładu medycyny nuklearnej w celu wykonania wysiłkowo-spoczynkowej scyntygrafii perfuzyjnej serca. Badanie obrazowe uwidoczniło odwracalne zaburzenia perfuzji głównie w ścianach dolnej i dolno-bocznej obejmujące 14% mięśnia lewej komory serca. Mimo że wykryta anomalia tętnic wieńcowych jest uznawana za łagodną, to zakres odwracalnego niedokrwienia przekraczający 10% mięśnia lewej komory serca powinien być uwzględniony w trakcie postępowania z pacjentem

Advanced, lately diagnosed primary hyperparathyroidism in a patient mistakenly treated for multiple bone metastasis. A case report and review of the literature

We report a case of 66-years-old woman mistakenly diagnosed as a metasases’ dissemination on a basis of mulitifocal skeleton lesion showed by 99mTc-MDP scanning, high serum calcium level and a vague breast tumour history. Additionally she suffered had humer and femur fractures. Immobilised and diagnosed as a cancer patient, she he was referred to palliative care. In hospice for the first time the suspicion of hyperparathyroidism was raised. When 99mTc-MIBI SPECT/CT scan revealed a parathyroid adenoma, also considering her biochemical parameters, she underwent the surgery. Following this her biochemical parameters normalised. This case illustrates a pitfall, which sometimes happens in this rare disease. A review of literature is provided.We report a case of 66-years-old woman mistakenly diagnosed as a metasases’ dissemination on a basis of mulitifocal skeleton lesion showed by 99mTc-MDP scanning, high serum calcium level and a vague breast tumour history. Additionally she suffered had humer and femur fractures. Immobilised and diagnosed as a cancer patient, she he was referred to palliative care. In hospice for the first time the suspicion of hyperparathyroidism was raised. When 99mTc-MIBI SPECT/CT scan revealed a parathyroid adenoma, also considering her biochemical parameters, she underwent the surgery. Following this her biochemical parameters normalised. This case illustrates a pitfall, which sometimes happens in this rare disease. A review of literature is provided

Sentinel lymph node detection with the use of SPECT-CT in endometrial cancer – analysis of two cases

On the basis of two cases we discuss the important issues regarding the sentinel lymph node detection biopsy (SLNB) in endometrial cancer with combined cervical administration of the radiocolloid and the subserosal blue dye injection. The first patient (endometrioid adenocarcinoma G2, invasion >50% myometrium) had 4 SLNs detected. Three were both hot and blue (detected on SPECT-CT). The fourth, paraaortic SLN was blue only. None of the lymph nodes contained metatstases. The second patient (endometrioid adenocarcinoma G1, invasion >50% myometrium) had 4 SLNs detected. Three were blue (but two of them had also very low radioactivity). The fourth SLN was hot only. Blue only node contained macrometastasis. In the past patients underwent cervical amputation. Diverse distribution of each tracer confirms the advantages of the combined tracers administration in SLNB. The radiotracer is the crucial component - uptake was present in 6 of 8 SLNs. Although the blue dye is more a complimentary method, its suberosal injection significantly increases the safety of the SLNB procedure. In the first case we have detected blue only SLN in paraaortic region which otherwise would be missed using the cervical approach only. More importantly, in the second case the tracer uptake was very limited due to the previous surgery and the blue dye administration allowed correct SLNs detection (including the metastatic node). Presented clinical cases confirms that the combined cervical and subserosal tracers administration together with preoperative SPECT-CT constitute an optimal SLN detection method and correctly provides information about the regional lymph node status

Radionuclide ventriculography in contemporary cardiological practice in Poland

W niniejszej pracy opisano wentrykulografię radioizotopową pod kątem techniki wykonania i wskazań klinicznych oraz porównano prezentowane w literaturze wyniki pomiarów parametrów hemodynamicznych uzyskiwanych tą metodą i innymi metodami, takimi jak echokardiografia i rezonans magnetyczny. W pracy zamieszczono także wyniki ankiety przeprowadzonej w zakładach medycyny nuklearnej w Polsce, mającej ocenić liczbę wykonywanych wentrykulografii radioizotopowych w ostatnich kilku latach. Wyniki ankiety wskazują na niewielkie zainteresowanie tym badaniem wśród lekarzy klinicystów, pomimo jego zalet.In the paper we described radionuclide ventriculography (MUGA) with special attention to technique, clinical indications and review of papers comparing results of hemodynamic parameters obtained by MUGA and other imaging modalities, such as echocardiography and nuclear magnetic resonance. We also present the results of a questionnaire conducted in nuclear medicine departments in Poland, which was supposed to estimate the number of ventriculographies performed in recent years, proving its small popularity among physicians, despite its advantages

Early biochemical and radiographic response after one cycle of [177Lu]Lu-PSMA I&T radioligand therapy in metastatic castration-resistant prostate cancer patients

Purpose The aim of this study was to investigate very early radiographic PSMA PET response after one cycle of [177Lu]Lu-PSMA I&T radioligand therapy (RLT) of metastatic castration-resistant prostate cancer (mCRPC) and to assess its role in predicting overall response and survival. Methods This retrospective study enrolled 40 mCRPC patients who were treated with a median of 3 (2–9) [177Lu]Lu-PSMA I&TRLT cycles. Biochemical response was based on the relative change of serum PSA according to PCWG3 criteria, while radiographic response referred to the relative change of PSMA-derived total viable tumor volumes expressed as total lesion PSMA (TLP). Results After one cycle of RLT, biochemical partial response (PR) was seen in 8/40 (20.0%), stable disease (SD) in 22/40 (55.0%), and progressive disease (PD) in 10/40 (25%) patients. In PSMA PET, very early molecular PR was observed in 12 (30.0%), SD in 19 (47.5%), and PD in 9 (22.5%) subjects. The PSA and TLP nadir were achieved after a median of 1 (1–5) and 2 (1–6) cycles, respectively. Nineteen (47.5%) patients showed overall biochemical PR, 11 (27.5%) had SD, and 10 (25%) experienced PD. In PSMA-directed PET, 4 patients experienced molecular complete response (CR), 24 (60.0%) had PR, 4 (10.0%) SD, and 8 (20.0%) PD. Early biochemical or radiographic response was not associated with longer overall survival (OS). Overall biochemical responders had a nearly signifcantly longer median OS (22.7 months) than non-responders (14.4 months, p=0.08). Early PSA progression was associated with shorter OS (12.2 months), compared to biochemical SD/PR (18.7 months, p=0.09). Conclusion In this retrospective cohort, there was no association between early PSMA PET radiographic response and overall survival; hence, treatment should not be prematurely discontinued. In contrast, early PSA progression after onecycle of [177Lu]Lu-PSMA I&T RLT was an indicator of overall progression and poor clinical outcome

Advantages of hybrid SPECT-CT imaging in preoperative localization of parathyroid glands in a patient with secondary hyperparathyroidism : a case report

Background: Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Patients resistant to pharmacotherapy are candidates for parathyroidectomy. Invasiveness of surgical treatment can be minimized by precise preoperative localization of parathyroid glands. Imaging modalities routinely used for this purpose are ultrasonography and MIBI-Tc99m scintigraphy. Case Report: Our case report shows advantages of co-registered computer tomography and conventional SPECT imaging (SPECT/CT) in a patient with advanced secondary hyperparathyroidism successfully treated with surgery. Results: Hybrid SPECT/CT parathyroid imaging enables better surgical planning and is superior to conventional scintigraphy

Challenging Visualization of Sentinel Lymph Nodes in Upper Urinary Tract Urothelial Carcinoma

Purpose: The purpose of this study was to assess the possibility of detecting sentinel lymph nodes (SLNs) and to perform analysis of lymphatic outflow in patients with suspicion of upper tract urothelial carcinoma (UTUC) with the use of a radioisotope-based technique. Methods: During 2018–2021, a prospective study was conducted on 19 patients with the suspicion of UTUC and for whom diagnostic ureterorenoscopy (URS) was planned. Technetium-99m (99mTc) nanocolloid radioactive tracer injection and a tumor biopsy were performed for staging procedures. Three-dimensional (3D) reconstruction and fusion of images were performed for better localization of lymph nodes (LNs). Detection of SLNs and the analysis of the radiotracer outflow was conducted with the use of single-photon emission-computed tomography/computed tomography (SPECT/CT) lymphangiography. Results: The mean age of the patients was 73.4 years; 7 (36%) were male. Pathological staging from the biopsy was T0—8 (42%), Ta—7 (36%), T1—4 (21%). SLNs were detected in two of 19 cases (10%). In one patient a single SLN (5.3%) was visualized, and in another case (5.3%), multiple (double) radioactive lymph nodes were visualized. In 17 out of the 19 (89.5%) cases, no lymphatic outflow was observed, and out of these five cases (26.3%) of gravitational leakage of injected radiotracer to the retroperitoneal space was noted. Conclusions: We demonstrated that detection of SLNs in the upper urinary tract is possible yet challenging. Radiotracer injection in the upper urinary tract during ureterorenoscopy is difficult to perform, and the expected result of injection is unsatisfactory. Lymphatic outflow from the tumor site to the first LNs in our studied group of patients is visible in 10.5% of cases. SPECT/CT lymphangiography in cases of UTUC may provide valuable information about a patient’s individual anatomy of the lymphatic system and the position of the first lymph nodes draining lymph with potential metastatic cells from the tumor