Veteran player tips the scale — V/Q SPECT-CT proves decisive in blunt chest trauma. Case report and brief literature review

A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options.A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options

Brain metastases in patient with prostate cancer found in 18F-choline PET/CT

Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumor has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in 18F-fluorocholine PET/CT scan. Brain metastases are a rare complication of prostate cancer. They are usually diagnosed in an end-stage disease when the tumour has already spread to the other organs and tissues. We present a case of a male with castration-resistant prostate cancer with bone metastases visualized in 18F-fluorocholine PET/CT scan

The diagnostic efficacy and safety of stress-only supine and prone myocardial perfusion imaging with a dedicated cardiac gamma camera in patients with suspected or known coronary artery disease

BACKGROUND: Myocardial perfusion scintigraphy remains one of the substantial noninvasive diagnostic methods in coronary artery disease. Recent technological advancement allowed to create novel semiconductor, dedicated cardiac gamma camera with better spatial resolution and higher energy resolution, resulting in the reduction of radiation burden and acquisition time. The aim of this study was to evaluate the efficacy and safety of stress-only supine and prone MPS with a cardiac gamma camera in patients with suspected or known coronary artery disease. MATERIAL AND METHODS: A total number of 203 consecutive patients with suspected or known coronary artery disease, who underwent MPS were enrolled in the study. The patients without perfusion abnormalities on stress supine and prone MPS scans had no rest MPS, in the remaining patients two-day stress-rest imaging was performed. The group of 160 patients with one-year follow up was subjected to final analysis. RESULTS: Stress-only protocol of myocardial perfusion imaging was performed in 72 patients, 88 patients underwent two-day stress and rest myocardial perfusion scintigraphy. In 46 out of 72 stress-only group of patients, prone study did not affect further proceedings. However, in over 1/3 of cases (26/72), prone scans resulted in abstaining from rest imaging. One year follow-up revealed no sudden cardiac deaths or myocardial infarctions in both (stress-only and stress-rest) groups. Revascularization was performed most often in the double-positive group — patients with significant ischaemia on myocardial perfusion images and chest pain or electrocardiographic changes or both during the stress test. In this double-positive group, all 11 patients had coronary angiography (two of them prior to myocardial perfusion scintigraphy), nine of them had subsequent revascularization. CONCLUSIONS: In patients with no significant perfusion abnormalities on stress scans omitting rest study is safe with very good one-year risk prognosis of acute cardiac events and allows to limit the radiation exposure and procedure duration. Additional prone acquisitions are valuable supplements in determining the decision of safe early completion of myocardial perfusion imaging

Long bone metastases as predictors of survival in patients with metastatic renal cancer

BACKGROUND: The aim of this study was to assess the prevalence of long bone metastases in renal cancer patients and to evaluate their utility as predictors of survival in this group. MATERIAL AND METHODS: This retrospective study included 20 patients with metastatic renal cancer and bone metastases. The patients were referred for regular bone scintigraphy in order to assess disease spread in the skeleton. The patients were divided into two groups: those with 1) metastases in the skeleton (including long bones) and those with 2) metastases in the axial skeleton only. RESULTS: Bone scintigraphy imaging was performed regularly up to 81 months from the first positive bone scan. During that time 11 deaths (8 among patients with long bone lesions) were recorded. Kaplan-Meyer curves showed that patients with long bone metastases tend to have lower survival probability in comparison to the ones with metastases in other bones. CONCLUSIONS: Bone metastases localization seems to influence survival in patients with renal cancer. Long bone-involving spread of the disease is associated with worse survival probability than the spread to the other bones

Optimal activity of [18F]FDG for Hodgkin lymphoma imaging performed on PET/CT camera with BGO crystals

Background: We aimed to find the minimum feasible activity of fluorodeoxyglucose ([18F]FDG) in positron emission tomography/computed tomography (PET/CT) of Hodgkin lymphoma patients performed on a camera with bismuth germanate (BGO) crystals. Material and methods: Ninety-one [18F]FDG PET/CT scans (each in seven Bayesian Penalized Likelihood [BPL] reconstructions with varying acquisition time per bed position — 2 min, 1.5 min, 1 min, 50 s, 40 s, 30 s, and 20 s) were independently assessed by three physicians to evaluate image quality. Mean administered activity was 3.0 ± 0.1 MBq/kg and mean uptake time was 54.0 ± 8.7 min. The series quality was subjectively marked on a 1–10 scale and then ranked 1–7 based on the mean mark. Interobserver rank correlation and intraclass correlation within each series for the three observers were calculated. Phantom studies were also performed to determine if reduced acquisition time can be directly translated into a reduced activity. Results: Time series were marked and ranked unanimously — the longer the time of acquisition the higher the mark and rank. The interobserver agreement in the ranking was excellent (100%) with a kappa coefficient of 1.00 (95% CI [0.83–1.0]). The general intraclass correlation coefficient (agreement between the marks observers gave each time series) was very high (0.945, 95% CI [0.936–0.952]) and was higher the shorter the time per bed. According to all three observers only the series with 2 min and 1.5 min acquisition time were appropriate for assessment (mean mark ≥ 7). In phantom studies there was a linear correlation between time per bed, administered activity, and number of total prompts detected by a scanner. Hence, a reduction of acquisition time of 25% (from 2 min to 1.5 min) could be directly translated into a 25% activity reduction (from 3.0 to 2.25 MBq/kg). Conclusions: In patients with HL, [18F]FDG activity can be reduced by up to 25% when using a BGO crystal camera, without substantial impact on image quality

The utility of 18F-fluorocholine PET/CT in the imaging of parathyroid adenomas

Introduction: The aim of the study was to estimate the sensitivity of 18F-FCH PET/CT in preoperative localisation of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism (PHPT). Material and methods: Sixty-five consecutive patients with PHPT, who underwent neck ultrasound (US) and  99mTc/99mTc-MIBI dual-phase parathyroid scintigraphy, were prospectively enrolled. Twenty-two patients had unsuccessful parathyroid surgery prior to the study. PET/CT scans were performed 65.0 ± 13.3 min after injection of 218.5 ± 31.9 MBq of 18F-fluorocholine (FCH). Three experienced nuclear medicine physicians assessed the detection rate of hyperfunctioning parathyroid tissue. Response to parathyroidectomy and clinical follow-up served as a reference test. Per-patient sensitivity and positive predictive value (PPV) were calculated for patients who underwent surgery. Results: 18F-FCH PET/CT was positive in 61 patients, and negative in 4. US and parathyroid scintigraphy showed positive and negative results in 20, 45 and 17, 48, respectively. US showed nodular goitre in 31 patients and chronic thyroiditis in 9 patients. Parathyroid surgery was performed in 43 (66%) patients. 18F-FCH PET/CT yielded a sensitivity of 100% (95% CI: 87.99–100) and PPV of 85.7% (95% CI: 70.77–94.06). Similar values were observed in patients with chronic thyroiditis, nodular goitre, and patients after an unsuccessful parathyroid surgery. PET/CT identified hyperparathyroidism complications (kidney stones, osteoporotic bone fractures, and brown tumours) in 11 patients. Conclusions: 18F-FCH PET/CT effectively detected hyperfunctioning parathyroid tissue and its complications. The method showed excellent sensitivity and positive predictive value, including patients with nodular goitre, chronic thyroiditis, and prior unsuccessful parathyroidectomy. PET/CT performance was superior to neck ultrasound and parathyroid scintigraphy