Radionuclide Imaging of Viable Myocardium: Is it Underutilized?

Coronary artery disease is the major cause of heart failure in North America. Viability assessment is important as it aims to identify patients who stand to benefit from coronary revascularization. Radionuclide modalities currently used in the assessment of viability include 201Tl SPECT, 99mTc-based SPECT imaging, and 18F-fluorodexoyglucose (18F-FDG)-PET imaging. Different advances have been made in the last year to improve the sensitivity and specificity of these modalities. In addition, the optimum amount of viable (yet dysfunctional) myocardium is important to identify in patients, as a risk–benefit ratio must be considered. Patients with predominantly viable/hibernating myocardium can benefit from revascularization from a mortality and morbidity standpoint. However, in patients with minimal viability (predominantly scarred myocardium), revascularization risk may certainly be too high to justify revascularization without expected benefit. Understanding different radionuclide modalities and new developments in the assessment of viability in ischemic heart failure patients is the focus of this discussion

Cardiac angiosarcoma: utility of [18F]fluorodeoxyglucose positron emission tomography–computed tomography in evaluation of residue, metastases, and treatment response

Handan Tokmak,1 Nurhan Demir,2 Mehmet Onur Demirkol31Department of Nuclear Medicine and Molecular Imaging, American Hospital, Nisantasi, Istanbul, 2Internal Medicine Department, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, 3Department of Nuclear Medicine and Molecular Imaging, Koç University, Istanbul, Turkey Abstract: Cardiac angiosarcomas are a rare form of malignancy. The majority of cases arise from the right atrium as mural masses. These tumors have extremely aggressive behavior, with early clinical symptoms that vary depending on location, size, and extent of the tumor. Most of these patients have a very short survival time. Surgical therapy is considered the best choice of therapy approach in cardiac angiosarcoma patients with nonmetastatic disease, even though the disease is rarely cured. Advanced diagnostic techniques facilitate accurate, noninvasive assessments of cardiac sarcomas. We report a case of a 62-year-old man with cardiac angiosarcoma who had multiple distant metastases that were revealed by [18F]fluorodeoxyglucose positron emission tomography–computed tomography imaging. Keywords: primary cardiac angiosarcoma, FDG PET/CT imaging, noninvasive assessment of cardiac sarcoma

Tc-99(m)-polyclonal IgG scintigraphy in the detection of infected hip and knee prostheses

We investigated the usefulness of Tc-99(m)-polyclonal human IgG (Tc-99(m)-HIG) scintigraphy in the diagnosis of infected hip and knee prostheses. Twenty-nine scintigraphic studies were performed in 27 patients (17 females, 10 males) with a suspected prosthetic infection. As some patients had bilateral prostheses, a total of 35 prostheses were evaluated. There were 25 hip replacements and 10 knee prostheses. The images were analysed both visually and quantitatively. The scintigraphic results were compared with the culture results of surgical specimens and also with clinical follow-up after 3 months. Increased uptake was observed in 22 prostheses, of which 12 were true-positive and 10 were false-positive results. Staphylococci were the agents most commonly isolated. In all false-positive patients, aseptic inflammation was diagnosed. Based on quantitative analysis, no statistically significant difference was found between the true-positive and false-positive cases. For the prostheses as a whole, the sensitivity, specificity, positive predictive value and negative predictive value were 100%, 41%, 54% and 100% respectively. For the hip prostheses alone, these values were 100%, 53%, 57% and 100% respectively. Taking its high sensitivity and predictive value into consideration, Tc-99(m)-HIG scintigraphy can be used as a screening test to help eliminate prosthetic infection

Tc-99(m)-tetrofosmin scintigraphy in the evaluation of palpable breast masses

Tl-201 and Tc-99(m)-MIBI have been used io evaluate palpable breast masses. The aim of this study was to evaluate the potential of Tc-99(m)-tetrofosmin as a new tumour localizing agent in patients with palpable breast masses. Nineteen palpable breast masses were evaluated in 18 patients. Each patient received 740 MBq Tc-99(m)-tetrofosmin intravenously. Ten minutes after the injection, planar breast images in the anterior, right lateral and left lateral views were obtained with the patient in the supine position. Mammography and ultrasonography were performed in all patients. Biopsy or mastectomy with axillary dissection was performed in all patients. Thirteen of 14 primary breast tumours were detected (9 invasive ductal carcinomas, 3 invasive lobular carcinomas, 1 papillary carcinoma). One patient with mucinous carcinoma did not demonstrate Tc-99(m)-tetrofosmin accumulation. Four of five patients with histopathologically proven benign lesions did not demonstrate Tc-99(m)-tetrofosmin accumulation (2 fibrocystic diseases, 2 fibroadenomas). Tc-99(m)-tetrofosmin accumulation was seen in a patient with chronic mastitis. The sensitivity and specificity of Tc-99(m)-tetrofosmin for malignant breast lesions was 92 and 80% respectively. Four of seven (57%) axillary lymph node metastases showed Tc-99(m)-tetrofosmin uptake. In conclusion, Tc-99(m)-tetrofosmin shows real promise for use in evaluating patients with palpable breast masses

Highest heterogeneity for cystic fibrosis: 36 mutations account for 75% of all CF chromosomes in Turkish patients

WOS: 000179171500005PubMed ID: 12439892We analyzed the CFTR locus in 83 Turkish cystic fibrosis patients to identify mutations, haplotypes, and the carrier frequency in the population. We detected 36 different mutations in 125 (75%) of the total 166 CF chromosomes. Seven novel mutations were identified: four missense (K68E, Q493P, E608G, and V1147I), two splice-site (406-3T > C and 3849 + 5G > A), and one deletion (CFTRdele17b,18). The data showed that the Turkish population has the highest genetic heterogeneity at the CFTR locus reported so far. The results of this thorough molecular analysis at the CFTR locus of a population not of European descent shows that CF is not uncommon in all such populations. The large number of mutations present, as well as the high heterogeneity in haplotypes associated with the mutations suggests that most of the mutations have persisted for a long time in the population. Consistently, the carrier frequency is assessed to be high, indicating that the disease in the population is ancient. (C) 2002 Wiley-Liss, Inc