Radiotherapy for breast cancer induced long-term diminished accumulation of radiotracer on bone scan of the irradiated ribs

Radiotherapy may result in long term effects and composition alterations in bones. Bone scintigraphy after radiotherapy may demonstrate decreased skeletal uptake; however, this is a transient effect with bone scan normalized after a few years. We describe a case of a 31-year-old female patient treated for left breast cancer with chemotherapy and radiotherapy, exhibiting reduced and diffuse diphosphonate uptake in the heavily irradiated sections of left ribs, even twelve years post-treatment. Similarly, quantitative computed tomography indicated altered bone composition. To our knowledge this is the first case describing such a long radiation side effect in breast cancer treatment

Heterotopic ossification in patients previously hospitalized in an intensive care unit

BACKGROUND: Heterotopic ossification (HO) is a potential complication in patients hospitalized in an intensive care unit (ICU). In this study we examined the association of HO diagnosed with three-phase bone scan (3pBS) in association with various parameters in patients previously hospitalized in ICU. MATERIAL AND METHODS: We retrieved patient records of the last 12 years subjected to 3pBS and diagnosed with HO from the Department of Nuclear Medicine (2004 up to 2016) and searched for a name match from ICU records. RESULTS: We found 61 patients that had a positive 3pBS for HO of whom 17 patients were hospitalized in the ICU. Among the 17 patients, twelve fulfilled the study criteria and were included in the study. The mean age was 38 years and 92% were males. HO was unilateral in 7 and bilateral in 5 patients. Patients with unilateral HO had up to 2 joints with HO, while those with bilateral had up to 4 joints. HO was most frequently observed in lower limbs, with hip being the most common joint affected. In the upper limbs, HO occurred predominantly in bilateral joints with elbow being the most frequently involved joint. Patients with longer duration of ICU stay had more joints affected. CONCLUSION: HO is a potential complication in patients with ICU hospitalization. Since 3pBS is an imaging method for early detection of HO, patients hospitalized in ICU should be screened with 3pBS for appropriate management

Hybrid bone SPECT/CT reveals spleen calcification in sickle cell mutation and beta-thalassemia

We present a case of a 65 years-old male with sickle cell mutation and beta-thalassemia (Hb S/β-Thal), who had whole-body bone scan evaluation for osteomyelitis. The examination revealed high radiopharmaceutical uptake in the left abdomen. Further evaluation with hybrid single photon emission computed tomography/computed tomography (SPECT/CT) showed calcification of approximately the entire spleen, in the context of sickle cell anemia. This report highlights the role of SPECT/CT in such cases

Gender specific association of decreased bone mineral density in patients with epilepsy

Objective To evaluate whether epilepsy or certain antiepileptic drugs render patients prone to develop low bone mineral density (BMD) and osteoporosis risk. Methods Thirty-eight (27 males, 11 females) consecutive adult epileptic patients receiving antiepileptic drugs (AEDs) and 71 control individuals matched for race, gender, age and body mass index (BMI) were subjected to dual energy X-ray absorptiometry (DXA). Results The mean lumbar spine and total hip BMD values were lower in the patients compared to control group (0.90±0.24g/cm2 vs 1.04±0.14g/cm2, p<0.001 and 0.92±0.14g/cm2 vs 0.99±0.13g/cm2, p=0.02, respectively). At the same skeletal sites, male patients had significantly reduced BMD compared to control males (0.90±0.21g/cm2 vs 1.03±0.15g/cm2, p=0.004 and 0.93±0.14g/cm2 vs 1.02±0.13g/cm2, p=0.009, respectively) while there was a trend but no significant differences in females. This BMD reduction was independent of AED type. Conclusion Adult epileptic, predominantly male patients have lower BMD and could be screened with densitometry for early diagnosis and prevention of osteoporosis

Myocardial ischemia in female patients with rheumatoid arthritis assessed with single photon emission tomography-myocardial perfusion imaging

BACKGROUND: Non-specific cardiac symptoms in female patients with rheumatoid arthritis (RA) could indicate early cardiovascular disease. MATERIALS AND METHODS: Myocardial perfusion imaging (MPI), with 99mTc tetrofosmin stress–rest single photon emission computer tomography (SPECT), in 13 RA female patients with atypical cardiac symptoms, was compared to 44 weight- and age-matched females with similar cardiac complaints (control group). Smoking, hypertension, diabetes mellitus, dyslipidemia, obesity and cardiac heredity were recorded and compared between the study and control group. MPI was assessed using 17 segment polar map and with a scale of 0 to 5 scoring. RESULTS: Patients with RA demonstrated higher cardiovascular risk (46%) compared to control individuals (17%). In addition, patients with RA had more irreversible myocardial ischemic abnormalities in their MPI than the control group. Dyslipidemia and obesity was found more frequent in RA patients with MPI SSS ≥ 4. CONCLUSION: RA patients with atypical cardiac complaints are at higher risk for cardiovascular disease; early detection and monitoring of this patient group could potentially reverse or successfully manage the consequences of the upcoming cardiovascular disease

Primary plasmacytoma of the cranial vault: a case report

We report one case of a 78-year-old woman who referred to our hospital because of a progressive right hemiparesis. On clinical examination a painless large soft mass in the left parietal region was observed. CT and MRI revealed an extra-axial mass in the in the left fronto-temporo-parietal region. The lesion was totally excised despite the bleeding tendency. Histology disclosed the presence of a plasmacytoma. Postoperative, the patient developed an epidural hematoma that required immediate evacuation. On further investigation active tuberculosis was detected. On follow up examination 1 year later no tumor recurrence or evidence of multiple myeloma was detected