Contribution of ultrasound examination in the detection of neck recurrence in low-risk differentiated thyroid carcinoma patients at first follow-up visits

BACKGROUND: In the most patients with differentiated thyroid carcinoma (DTC), recurrent disease occurs in the neck region, but the usefulness of neck ultrasound (US) in its diagnosis is not clear. The aim of this study was to evaluate the significance of US in the detection of neck recurrence in low-risk DTC patients at first follow-up visits. MATERIAL AND METHODS: A total of 32 patients, who had a history of DTC and radioiodine therapy after thyroidectomy with low doses of iodine 131 (3.7 GBq), were enrolled in this study. About 6 months after first ablation, the patients underwent clinical examination, iodine 131 scanning, measurement of thyroglobulin (Tg) after T4 withdrawal, thyroid-stimulating hormone measurement, TgAb measurement, and neck sonography with US. RESULTS: Recurrence of thyroid cancer was suspected in the neck region in 17 patients (53.1%) of the study cohort. There were six groups based on the results of posttreatment serum Tg levels, 131I whole body scan (131I WBS), and US in the detection of DTC neck recurrences. Fifteen patients had negative results of three modalities (group 1); seven patients had US evidence of neck lesions but negative 131I WBS and serum Tg results(group 2); three patients had positive results of 131I WBS but negative US and serum Tg results (group 3); four patients had positive results of serum Tg results but negative US and 131I WBS results (group 4); two patients lacked 131I WBS evidence of neck lesions, but US and serum Tg suggested the diagnosis of neck recurrence (group 5), and one subject had evidence of neck recurrence in three modalities (group 6). CONCLUSION: These findings may imply that neck sonography together with determination of serum Tg levels and 131I WBS after thyroid-stimulating hormone therapy should be considered the diagnostic modality of choice for postoperative surveillance, even in low-risk DTC patients

Uptake Difference by Somatostatin Receptors in a Patient with Neuroendocrine Tumor: 99mTc-Octreotide Uptake in the Lung without Uptake in Liver Lesions

The diagnostic value of somatostatin receptor scintigraphy (SRS) in detecting tumors has been assessed in a number of studies. We present a 30-year-old female with a history of eight months cough and left shoulder pain. Radiologic evaluation showed pulmonary mass and hepatic lesions, which were pathologically diagnosed as neuroendocrine carcinoma. 99mTc-octreotide scan demonstrated that the pulmonary lesion was positive for somatostatin receptor (SSTR), while the liver metastases were SSTR negative. The present case highlights the significance of a differential uptake pattern by somatostatin receptors in SRS in patients with neuroendocrine tumor

Detection of Superior Vena Cava Obstruction on Dynamic 99mTc-DTPA Renal Transplant Scintigraphy

We present an asymptomatic patient with a history of prolonged hemodialysis through a right internal jugular vein catheter who was diagnosed with superior vena cava (SVC) obstruction on 99mTechnetium-diethylenetriaminepentaacetic acid renal transplant scintigraphy. During the angiographic phase, an unusual vascular filling pattern was detected on the anterior view of the abdomen. Angioscintigraphic imaging of the chest wall was suggestive of SVC obstruction. The SVC obstruction in our patient was related to the long-term use of an indwelling catheter in the central venous system, which is a well-known complication of such a procedure. There is also evidence of a hypercoagulable state in dialyzed uremic cases; therefore, our patient may have been more susceptible to an SVC thrombosis. Acquired compensatory dilatation of the azygos vein is rather a rare finding. To the best of our knowledge, this is the first report describing an asymptomatic patient with SVC obstruction who was diagnosed by renal scintigraphy

Unusual Neurologic Manifestations of a Patient with Cyanotic Congenital Heart Disease after Phlebotomy

Secondary erythrocytosis in cyanotic congenital heart disease (CCHD) is a compensatory response to chronic hypoxia which should be managed with caution. CCHD patients, who have compensated erythrocytosis but do not manifest significant neurologic symptoms, may experience secondary life-threatening complications such as stroke in case of inappropriate phlebotomy. This study reports a young man with CCHD who developed frequently repeated transient neurologic deficits with various presentations after one session of phlebotomy. The symptoms resolved a few days after the hematocrit (Hct) level returned to the prephlebotomy level

Is there a relationship between non-obstructive coronary artery disease or cardiac syndrome X and migraine? Αn integrated multi-disciplinary approach

Abstract Non-obstructive coronary artery disease (CAD) which is mostly called cardiac syndrome X (CSX) is noted in about 30% of men and 40%-60% of women and seems to be incremental. In addition, frequent myocardial perfusion defects with various levels of severity are often seen in this disease. Recently, we noticed that the frequency of migraine in patients with CSX was noticeably higher than in healthy people and in CAD patients. This may support the evolving story that CSX is related to migraine and to chest pain and that CSX and migraine may have a similar pathophysiology. Hence, myocardial perfusion imaging could be used as a complement any diagnostic test to support the relation between CSXand migraine

Assessment of the maximum uptake time of 99mTc-DMSA in renal scintigraphy in rat

Introduction: The optimal imaging time of a radionuclide scintigraphy is the time at which the organ of interest has the maximum uptake of the injected radionuclide. This study was performed to investigate the maximum uptake time of 99mTc-DMSA in rat renal scan. Methods: Renal scintigraphy was performed with 3 mCi of 99mTc-DMSA. Planar images were acquired every 20 minutes for 8 hours post-injection using a small-animal SPECT. Results: Activity and the count rate per pixel (CRPP) of the kidneys peaked 1 h post-injection, plateaued for about 1 h, and declined time-dependently. Kidney to background ratio (KBR) reached to 61.7% at 1 h after injection and remained almost constant afterwards. Conclusion: The kidneys had maximum emission and CRPP between 1 to 2 h after 99mTc-DMSA injection, whereas there was no significant difference between the KBRs after 1 h. Our results showed that image acquisition of 1-2 h post-injection is recommended for renal scintigraphy with DMSA in rat

Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters

Background. Bremsstrahlung (BS) imaging during radioembolization (RE) confirms the deposition of radiotracer in hepatic/ extrahepatic tumors. The aimof this study is to demonstrate 32P images and to optimize the imaging parameters. Materials and Methods. Thirty-nine patientswith variable types of hepatic tumors, treatedwith the intra-arterial injection of 32P,were included. All patients underwent BS SPECT imaging 24–72 h after tracer administration, using lowenergy high resolution (LEHR) (18 patients) or medium energy general purpose (MEGP) (21 patients) collimators. A grading scale from1 to 4 was used to express the compatibility of the 32P images with those obtained from CT/MRI. Results. Although the image quality obtained with theMEGP collimator was visually and quantitatively better thanwith theLEHR(76%concordance score versus 71%, resp.), there was no statistically significant difference between them. Conclusion.The MEGP collimator is the first choice for BS SPECT imaging. However, if the collimator change is time consuming (as in a busy center) or an MEGP collimator is not available, the LEHR collimator could be practical with acceptable images, especially in a SPECT study. In addition, BS imaging is a useful method to confirm the proper distribution of radiotherapeutic agents and has good correlation with anatomical findings

A Pooled Analysis of Diagnostic Value of 99mTc-Ubiquicidin (UBI) Scintigraphy in Detection of an Infectious Process

Purpose: Although the data are promising fromlimited studies with technetium- 99m ubiquicidin (99mTc-UBI) scintigraphy in detection of infection in humans, these studies have had a limited sample size. This study was conducted to provide a systematic review and meta-analysis of the reported diagnostic accuracy of 99mTc-UBI scintigraphy in detection of an infectious process. Materials and Methods: The PubMed/MEDLINE,Web of Science, EMBASE, and Google Scholar literature databases were systematically searched to find the relevant human studies on 99mTc-UBI scintigraphy. For each eligible study, the truepositive, false-positive, true-negative, and false-negative findings at 99mTc-UBI scintigraphy were recorded, and the overall statistical parameters were acquired. Result: Ten studies carried out from 2004 to 2010 were included in the analysis. The pooled data sensitivity was 94.5 % and with a 95% confidence interval of 91.2%Y96.8%. The pooled specificity was still as high as about 92.7%. The range of reported specificity was from 80% to 100%. The overall accuracy was 93.7% (95% CI: 91.2%Y95.7%). Conclusion: The study demonstrated that 99mTc-UBI scintigraphy can be used to identify an infectious process with admirable accuracy in early views; however, further investigations are recommended

99mTc-ECD brain perfusion SPECT imaging for the assessment of brain perfusion in cerebral palsy (CP) patients with evaluation of the effect of hyperbaric oxygen therapy

Abstract: Objective: The present study was carried out to evaluate cerebral perfusion in different types of cerebral palsy (CP) patients. For those patients who underwent hyperbaric oxygen therapy, brain perfusion before and after the therapy was compared. Methods: A total of 11 CP patients were enrolled in this study, of which 4 patients underwent oxygen therapy. Before oxygen therapy and at the end of 40 sessions of oxygen treatment, 99mTc-ECD brain perfusion single photon emission computed tomography (SPECT) was performed , and the results were compared. Results: A total of 11 CP patients, 7 females and 4 males with an age range of 5-27 years participated in the study. In brain SPECT studies, all the patients showed perfusion impairments. The region most significantly involved was the frontal lobe (54.54%), followed by the temporal lobe (27.27%), the occipital lobe (18.18%), the visual cortex (18.18%), the basal ganglia (9.09%), the parietal lobe (9.09%), and the cerebellum (9.09%). Frontal-lobe hypoperfusion was seen in all types of cerebral palsy. Two out of 4 patients (2 males and 2 females) who underwent oxygen therapy revealed certain degree of brain perfusion improvement. Conclusion: This study demonstrated decreased cerebral perfusion in different types of CP patients. The study also showed that hyperbaric oxygen therapy improved cerebral perfusion in a few CP patients. However, it could keep the physiological discussion open and strenghten a link with other areas of neurology in which this approach may have some value