Inclusion Body Myositis: Navigating diagnostic challenges, case report

Inclusion body myositis (IBM) is a rare progressive myopathy affecting individuals older than 50 years. It is associated with significant morbidity once restricting the patient's mobility, and it has a relatively low mortality risk with respiratory muscles involvement. Muscle biopsy is the gold standard method for diagnosis. In this complex scenario, we present a case involving a 72-year-old woman admitted to our hospital with progressive weakness of lower limbs. The diagnostic process was challenging due to the case's complexity necessitating a multidisciplinary team approach. This case highlights the intricate nature of the diagnostic journey, as diagnosing IBM remains a challenge in clinical practice, requiring a high suspicion and precise application of available diagnostic tools with the guidance of a collaborative multidisciplinary approach in investigating and providing patient care. This case report contributes valuable insights to the understanding of this complex myopathy, facilitating more accurate diagnosis and enhancing patient care strategies Keywords: Sporadic inclusion body myositis; idiopathic inflammatory myopathy; rimmed vacuole

Technological Advances in SPECT and SPECT/CT Imaging

Single photon emission tomography/computed tomography (SPECT/CT) is a mature imaging technology with a dynamic role in the diagnosis and monitoring of a wide array of diseases. This paper reviews the technological advances, clinical impact, and future directions of SPECT and SPECT/CT imaging. The focus of this review is on signal amplifier devices, detector materials, camera head and collimator designs, image reconstruction techniques, and quantitative methods. Bulky photomultiplier tubes (PMTs) are being replaced by position-sensitive PMTs (PSPMTs), avalanche photodiodes (APDs), and silicon PMs to achieve higher detection efficiency and improved energy resolution and spatial resolution. Most recently, new SPECT cameras have been designed for cardiac imaging. The new design involves using specialised collimators in conjunction with conventional sodium iodide detectors (NaI(Tl)) or an L-shaped camera head, which utilises semiconductor detector materials such as CdZnTe (CZT: cadmium–zinc–telluride). The clinical benefits of the new design include shorter scanning times, improved image quality, enhanced patient comfort, reduced claustrophobic effects, and decreased overall size, particularly in specialised clinical centres. These noticeable improvements are also attributed to the implementation of resolution-recovery iterative reconstructions. Immense efforts have been made to establish SPECT and SPECT/CT imaging as quantitative tools by incorporating camera-specific modelling. Moreover, this review includes clinical examples in oncology, neurology, cardiology, musculoskeletal, and infection, demonstrating the impact of these advancements on clinical practice in radiology and molecular imaging departments

Technological Advances in SPECT and SPECT/CT Imaging

Single photon emission tomography/computed tomography (SPECT/CT) is a mature imaging technology with a dynamic role in the diagnosis and monitoring of a wide array of diseases. This paper reviews the technological advances, clinical impact, and future directions of SPECT and SPECT/CT imaging. The focus of this review is on signal amplifier devices, detector materials, camera head and collimator designs, image reconstruction techniques, and quantitative methods. Bulky photomultiplier tubes (PMTs) are being replaced by position-sensitive PMTs (PSPMTs), avalanche photodiodes (APDs), and silicon PMs to achieve higher detection efficiency and improved energy resolution and spatial resolution. Most recently, new SPECT cameras have been designed for cardiac imaging. The new design involves using specialised collimators in conjunction with conventional sodium iodide detectors (NaI(Tl)) or an L-shaped camera head, which utilises semiconductor detector materials such as CdZnTe (CZT: cadmium–zinc–telluride). The clinical benefits of the new design include shorter scanning times, improved image quality, enhanced patient comfort, reduced claustrophobic effects, and decreased overall size, particularly in specialised clinical centres. These noticeable improvements are also attributed to the implementation of resolution-recovery iterative reconstructions. Immense efforts have been made to establish SPECT and SPECT/CT imaging as quantitative tools by incorporating camera-specific modelling. Moreover, this review includes clinical examples in oncology, neurology, cardiology, musculoskeletal, and infection, demonstrating the impact of these advancements on clinical practice in radiology and molecular imaging departments

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Optimal utilization of gamma camera time in Tc-99m MDP bone scintigraphy

Thesis (MScMedSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2007.Introduction: Whole body bone scintigraphy with Tc-99m MDP is able to provide a survey of the entire skeleton. The question arises if it is mandatory to perform a whole body bone scan in all patients, irrespective of the clinical indication. The aim of this study is to determine the implications of performing limited imaging in patients who had whole body bone scan for various clinical patholgy with Tc-99m MDP, in order to determine if limited imaging would be acceptable in selected pathologies. This may enable gamma camera time to be optimally utilized in units with limited facilities. Materials and Methods: Reports of 3015 patients with various clinical pathologies who had whole body bone scans with Tc-99m MDP in our department from January 2002 to December 2004 were retrospectively reviewed. The presence of pathologic radiotracer uptake was analyzed in order to establish the pattern of distribution. Clinically significant skeletal lesions were classified according to the anatomical regions where they were located viz; skull (including the neck), axial skeleton (including the pelvis and shoulders) and limbs. Results: Our results showed that in patients with lung cancer, soft tissue sarcoma, and myeloma, there was an error in more than 25% of patients when limited imaging was performed. In patients with cancer of the breast, prostate, kidney, gastrointestinal system, and reproductive system and lymphoma there is an error in less than 5% of patients when limited imaging is employed. For iv patients with more localized musculoskeletal disorders such as suspected stress fractures, complicated joint prosthesis and avascular necrosis of the femur head, regional imaging of the area of pathology showed a percentage error of less than 6%

Differentiating acute epididymitis from testicular torsion using scrotal scintigraphy

Introduction: In patients with acute scrotal pain, differentiating acute epididymitis from testicular torsion should be made promptly and accurately, to treat the underlying cause correctly. Acute epididymitis is treated with a simple course of antibiotics while testicular torsion requires emergency surgical exploration to salvage the testis. The assessment of patients with acute scrotal pain is done mainly using color Doppler ultrasonography, which, however, requires skills and has limitations of being highly operator-dependent and uncomfortable to patients with scrotal pains because it may take too long to perform and often involves probe compression. Scrotal scintigraphy using 99m Tc-pertechnetate may provide an alternative reproducible, quick noninvasive and reliable nuclear medicine functional imaging technique that could be used in the evaluation of patients with acute scrotal pain. The aim of this study is to document our clinical experiences with the use of scrotal scintigraphy in differentiating acute epididymitis from testicular torsion in patients with acute scrotal pain. Material and Method: All scrotal scintigraphy performed in our institution between 2007 and 2015 were included in this study. Scrotal scintigraphy was performed after intravenous administration of 99m Tc-pertechnetate radiotracer and images were acquired using MEDISO dual-headed gamma camera. Acute epididymitis is diagnosed when there is increased blood flow on dynamic images and increased uptake around the region of the epididymis, while testicular torsion as decreased blood flow and photopenic area in the testis on dynamic and static images, respectively. The final diagnosis was documented based on relief of symptoms after a course of antibiotics or surgical exploration. Results: All patients were examined by urologist and only patients in whom the differentiation between acute epididymitis and torsion could not be made clinically were include in this study. A total of 21 patients were studied. There were 16 patients diagnosed with acute epididymitis and five patients with testicular torsion. Conclusion: Our study demonstrates that scrotal scintigraphy is a simple, accurate, and effective functional imaging technique that can differentiate acute epididymitis from testicular torsion in selected patients presenting with acute scrotal pain

Durable Response to Pazopanib in a Patient with Fumarate Hydratase-Mutant Tubulocystic Renal Cell Carcinoma

Tubulocystic carcinoma of the kidney (TC-RCC) is a rare renal tumor and has been recently included as a distinct entity in WHO classification of renal neoplasms. We report the case of a patient with metastatic tubulocystic RCC whose disease progressed through standard of care treatment for nonclear RCC. However, genetic analysis revealed a germline pathogenic variant of fumarate hydratase (FH) gene, and the patient had a sustained and durable response to pazopanib

Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

BACKGROUND The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing. (C) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures