The Evolvement of the Renographic Curve Pattern in Early Childhood

The purpose of this study was to evaluate renographic parameters obtained from healthy renal units (RUs) in newborns and infants with unilateral kidney condition. Thirty three children including twenty newborns, referred to Technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) diuretic scintigraphy due to unilateral kidney condition entered the study. Only contralateral, healthy RUs were analyzed. Since many children returned for follow up, there were altogether 78 dynamic studies included. Kidney length was compared to ultrasound measurements. Renographic curve parameters (time to maximum counts, T max and time to half maximum counts, T½ max) were evaluated. The results showed that the kidney length measured on Tc-99m MAG3 scintigraphy correlated well with ultrasound measurements. Regarding the renographic curve parameters, in the newborn period a significantly shorter T max (mean T max 3.65±1.2 min, p=0.026) was found compared to the group of two months old infants (5.12±2.2 min). In older age groups mean T max gradually shortened again. On the contrary, T½ max was significantly longer in newborn and early infant period than in older age groups (16.7±8.2 min, p=0.018), but generally showed variable values until the age of three years. It can be concluded that it is important to be aware of possible diversities of renographic curve pattern of healthy kidneys in early childhood, especially in the elimination part. Therefore, when interpreting a dynamic renal study, one should also consider other parameters like kidney growth, morphology and differential function, which can be reliably monitored with repeated Tc-99m MAG3 scintigraphy, to discern between normal and pathologic finding

Rizični čimbenici za karcinom štitne žlijezde: što danas radimo?

Thyroid cancer (TC) is the most common endocrine cancer today. The rising incidence of the differentiated papillary type cannot be entirely explained by early and meticulous diagnosis, since a proportion of large tumors has also been reported. In this review, we present the results of numerous investigations focused on possible factors causing increased TC incidence, such as chromosomal and genetic alterations, iodine intake, TSH level, autoimmune thyroid disease, gender, estrogen, obesity, lifestyle changes, and environmental pollutants. Up to now, only childhood exposure to ionizing radiation has been fully recognized as a risk factor. There is also a possibility that yet undiscovered carcinogens, especially during intrauterine life or early childhood, might be responsible for increased TC incidence as well as epigenetic changes. Therefore, more studies are necessary in order to further investigate the potential risk factors for TC and their mechanisms of action.Etiologija karcinoma štitnjače, kao najčešćeg endokrinog karcinoma intenzivno se istražuje, budući da je njegova incidencija zadnjih desetljeća u stalnom porastu, prvenstveno na račun diferenciranog papilarnog karcinoma. Jedan od glavnih razloga porasta incidencije je zasigurno dostupna i kvalitetna dijagnostika karcinoma u ranoj fazi, međutim, uočava se i porast broja većih tumora, što upućuje na zaključak da vjerojatno postoje i drugi uzroci. U ovom radu izloženi su rezultati brojnih istraživanja usmjerenih na ispitivanje potencijalnih čimbenika rizika koji se dovode u vezu s razvojem karcinoma štitne žlijezde, kao što su kromosomske/genske alteracije, unos joda, razina TSH, autoimuna bolest štitnjače, spol, estrogeni, debljina, životne navike i čimbenici okoliša, od kojih je jedini dokazani čimbenik rizika izlaganje ionizirajućem zračenju u djetinjstvu. Potrebna su daljnja istraživanja s ciljem ispitivanja mogućih čimbenika rizika i njihovih mehanizama djelovanja kako bi se moglo učinkovitije kontrolirati i usporiti pojavnost karcinoma štitnjače

DIAGNOSTIC RELEVANCE OF NUCLEAR MEDICINE IN GASTROENTEROLOGY

Dijagnostika gastroenteroloških bolesti temelji se, uz metode kliničkog pregleda i laboratorijsku dijagnostiku, u prvom redu na endoskopskoj, ultrazvučnoj i radiološkoj obradi. Ove metode osim značenja u dijagnostici osnova su za nekirurške intervencije kod gastroenteroloških bolesnika. U dijagnostičkom smislu, iako poprilično zapostavljene pa čak i zaboravljene, određenu ulogu imaju i nuklearnomedicinske metode koje svojom neinvazivnošću i visokom dijagnostičkom točnošću mogu doprinijeti donošenju konačne dijagnoze te će u ovom preglednom radu biti ukratko i na razumljiv način opisane.Diagnostics in gastroenterology is based on endoscopy, ultrasound and radiological imaging, in addition to physical examination and laboratory testing. Besides being used as valuable diagnostic tools, these methods also represent the foundation for non-surgical interventions in gastroenterological patients. In the fi eld of diagnostic imaging, a specific role is attributed to nuclear medicine methods. Although rarely used, the latter may contribute to defi nitive diagnosis of diseases in such patients, as they are noninvasive and accurate. This review article provides a brief and comprehensible summary of nuclear medicine methods in gastroenterology

The Renal Parenchyma Evaluation: MAG3 vs. DMSA

Scintigraphy with Tc-99m dimercaptosuccinic acid (DMSA) is considered a reference method for assessment of parenchymal lesions and estimation of differential kidney function. The aim of study was to evaluate Tc-99m mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy for the same purpose. 188 patients, submitted to both studies within three months, were divided in two groups. In the first, 83 DMSA images were compared to parenchymal phase of MAG3 scintigraphy. Kidney morphology was independently evaluated by four observers. In the second group (N=105), differential function was calculated in MAG3 and DMSA studies and the respective results were compared. Findings corresponded completely in 85% of patients. There were no statistically significant differences between calculated differential function on DMSA and MAG3 images. The results showed that most of parenchymal lesions detected on DMSA scans can be identified on MAG3 parenchymal scans. Both studies can be equally used for the calculation of differential kidney function

Glomus Tumor of the Neck Detected With 99mTc EDDA HYNIC-TOC.

A 54-year-old woman was referred to thyroid evaluation because of a lump on the left side of the neck. Ultrasound exam did not show any thyroid abnormality, but highly perfused nodule at the left common carotid artery bifurcation was found. Because of the specific location, somatostatin receptor scintigraphy with Tc EDDA HYNIC-TOC was performed, starting with perfusion images and followed with SPECT/CT imaging at 2 and 4 hours. Well-perfused nodule with intensive accumulation and no other visible pathology in the body raised suspicion of a glomus tumor, consistent with MR exam performed later. Subsequent surgical removal confirmed carotid paragangliom

The Renal Parenchyma Evaluation: MAG3 vs. DMSA

Scintigraphy with Tc-99m dimercaptosuccinic acid (DMSA) is considered a reference method for assessment of parenchymal lesions and estimation of differential kidney function. The aim of study was to evaluate Tc-99m mercaptoacetyltriglycine (MAG3) dynamic renal scintigraphy for the same purpose. 188 patients, submitted to both studies within three months, were divided in two groups. In the first, 83 DMSA images were compared to parenchymal phase of MAG3 scintigraphy. Kidney morphology was independently evaluated by four observers. In the second group (N=105), differential function was calculated in MAG3 and DMSA studies and the respective results were compared. Findings corresponded completely in 85% of patients. There were no statistically significant differences between calculated differential function on DMSA and MAG3 images. The results showed that most of parenchymal lesions detected on DMSA scans can be identified on MAG3 parenchymal scans. Both studies can be equally used for the calculation of differential kidney function

The internal consistency and validity of the Vaccination Attitudes Examination Scale: A replication study

Background: Vaccinations are important preventative health behaviors. The recently developed Vaccination Attitudes Examination Scale (VAX) aims to measure the reasons behind refusal/hesitancy regarding vaccinations.  Purpose: The aim of this replication study is to conduct an independent test of the newly developed VAX scale in the U.K. We tested: (a) internal consistency (Cronbach’s alpha); (b) convergent validity by assessing its relationships with beliefs about medication, medical mistrust and perceived sensitivity to medicines; and (c) construct validity by testing how well the VAX scale discriminated between vaccinators and nonvaccinators.  Methods: A sample of 243 UK adults completed the VAX scale, the Beliefs about Medicines Questionnaire (BMQ), the Perceived Sensitivity to Medicines Scale (PSM) and the Medical Mistrust Index (MMI), in addition to demographics of age, gender, education levels and social deprivation. Participants were asked: (a) if they received an influenza vaccination in the past year; and (b) if they had a young child, had they vaccinated their young child against influenza in the past year.  Results: The VAX: (a) demonstrated high internal consistency (α=0.92); (b) was positively correlated with medical mistrust, beliefs about medicines and less strongly correlated with perceived sensitivity to medicines; and (c) successfully differentiated parental influenza vaccinators from non-vaccinators.  Conclusion: The VAX demonstrated good internal consistency, convergent and construct validity in an independent UK sample. It appears to be a useful measure to help us understand the health beliefs that promote or deter vaccination behavior

Hybrid SPECT/CT Somatostatin Receptor Imaging of Neuroendocrine Tumours

Cilj: Cilj rada bio je procijeniti doprinos jednofotonske emisijske tomografije / kompjutorizirane tomografije somatostatinskih receptora (SR SPECT/CT) s 99mTc-EDDA/HYNIC-Tyr3-oktreotidom (99mTc-Tektrotyd) u dijagnostici i procjeni proširenosti bolesti kod pacijenata oboljelih od neuroendokrinih tumora (NET-ova). Ispitanici i metode: Retrospektivno je analizirano 120 SR SPECT/CT snimanja pacijenata s patohistološki dokazanim NET-om s obzirom na vizualizaciju primarnih lezija i metastaza. U 45 pacijenata učinjena je i pozitronska emisijska tomografija 18F-fluorodeoksiglukozom (18F-FDG PET/CT) te su nalazi uspoređeni s nalazima SR SPECT/CT-a i vrijednostima kromogranina A. Rezultati: Od 120 pacijenata 47 (39 %) je na SR SPECT/CT upućeno nakon odstranjenja primarne lezije. Od preostala 73 pacijenta (61 %), u 56 (77 %) primarni je tumor bio vidljiv SR SPECT/CT-om, a u 9 (12 %) poznata lezija nije akumulirala radiofarmak. U 8 (11 %) pacijenata s NET-om nepoznatog primarnog sijela nalaz je bio negativan. Od 68 (57 %) pacijenta s dokazanim metastazama, u njih 57 (84 %) bile su vidljive SR SPECT/CT-om, a u 11 (16 %) nisu akumulirale radiofarmak. Od 45 (38 %) pacijenata kojima je učinjen i 18F-FDG PET/CT, u 27 (60 %) detekcija primarnih lezija i metastaza bila je sukladna nalazu SR SPECT/CT-a. Osjetljivost SR SPECT/CT-a bila je 77 % za primarne lezije i 84 % za metastaze, a 18F-FDG PET/CT-a 75 % za primarne lezije i 76 % za metastaze. Vrijednosti kromogranina A nisu pokazale statistički signifikantnu korelaciju s nalazima slikovne dijagnostike. Zaključci: SR SPECT/CT ima visoku osjetljivost za detekciju NET-ova. Osim toga, potvrđena je komplementarnost s 18F-FDG PET/CT-om te kod pacijenata s negativnim nalazom SR SPECT/CT-a treba učiniti 18F-FDG PET/CT i obrnuto.The aim: The aim of this study was to evaluate the significance of somatostatin receptor single-photon emission computed tomography/computed tomography (SR SPECT/CT) with 99mTc-EDDA/HYNIC-Tyr3-octreotide (99mTc-Tektrotyd) in diagnostics and staging of patients with neuroendocrine tumours. Patients and methods: We retrospectively enrolled 120 patients with histologically proven NET who underwent SR SPECT/CT between January 2013 and February 2017. The patients’ data and SR SPECT/CT findings regarding primary lesion and metastases were analysed. In 45 patients, 2-deoxy-2-18F-fluoroglucose positron emission computed tomography/computed tomography (18F-FDG PET/CT) was performed, and the findings were compared to SR SPECT/CT and chromogranin A values. Results: Out of 120 patients, 47 (39%) underwent SR SPECT/CT after surgical removal of the primary lesion. In 73 (61%) remaining patients, the primary lesion was detected on SR SPECT/CT in 56 (77%), in 9 (12%) lesion did not accumulate 99mTc-Tektrotyd. SR SPECT/CT was negative in the remaining 8 (11%) patients with unknown primary. Out of 68 patients (57%) with metastases, 57 (84%) were detected on SR SPECT/CT, while 11 did not accumulate 99mTc- Tektrotyd. 18F-FDG PET/CT was performed in 45 patients, and findings were concordant with SR SPECT/CT in 27 (60%). The the sensitivity of SR SPECT/CT was 77% for primary lesions and 84% for metastases, and sensitivity of 18F-FDG PET/CT was 75% 76%, respectively. In 70 (58%) patients with available chromogranin A no statistically significant correlation was found with imaging methods. Conclusion: In patients with NET and negative SR SPECT/CT findings, 18F-FDG PET/CT should be recommended and vice versa, because of the complementarity of these procedures