2,582 research outputs found

    ENDOCRINE TUMOURS: Imaging in the follow up of differentiated thyroid cancer: current evidence and future perspectives for a risk-adapted approach

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    The clinical and epidemiological profiles of differentiated thyroid cancers (DTCs) have changed in the last three decades. Today's DTCs are more likely to be small, localized, asymptomatic papillary forms. Current practice is though moving towards more conservative approaches (e.g. lobectomy instead of total thyroidectomy, selective use of radioiodine). This evolution has been paralleled and partly driven by rapid technological advances in the field of diagnostic imaging. The challenge of contemporary DTCs follow up is to tailor a risk-of-recurrence-based management, taking into account the dynamic nature of these risks, which evolve over time, spontaneously and in response to treatments. This review provides a closer look at the evolving evidence-based views on the use and utility of imaging technology in the post-treatment staging and the short- and long-term surveillance of patients with DTCs. The studies considered range from cervical US with Doppler flow analysis to an expanding palette of increasingly sophisticated second-line studies (cross-sectional, functional, combined-modality approaches), which can be used to detect disease that has spread beyond the neck and, in some cases, shed light on its probable outcome. 

    Technetium-99m Methoxyisobutyl Isonitrile Scintigraphy of Bone Metastasis in Three Patients with Differentiated Thyroid Cancer

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    We studied the usefulness of ^Tc-methoxyisobutyl isonitrile (MIBI) scintigraphy in the detection of bone metastases and in evaluation of therapeutical response to ^I-Na in three patients with differentiated thyroid cancer. On ^Tc-MIBI scintigraphy, increased accumulations were observed in all bone metastatic lesions (14 lesions), whereas on bone scintigraphy using ^Tc-hydroxymethylene diphosphonate (^Tc-HMDP) both increased (eight lesions, 57%) and decreased (six lesions, 43%) accumulations were observed. Within two months after ^I-Na treatment, all 14 lesions were unchanged on bone scintigraphy. However, on ^Tc-MIJBI scintigraphy, disappearance of uptake (six lesions, 43%) and decreased uptake (seven lesions, 50%) were observed in 13/14 lesions (93%). Therefore, ^Tc-MIBI scintigraphy was useful not only in the detection of bone metastatic lesions but also in evaluation of the therapeutical response to ^I-Na in differentiated thyroid cancer

    Transient hypercortisolism and symptomatic hyperthyroidism associated to primary hyperparathyroidism in an elderly patient: case report and literature review.

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    Abstract Background: Primary hyperparathyroidism (PHPT) is often found on routine blood tests, at a relatively asymptomatic stage. However many studies suggest different systemic effects related to PHPT, which could be enhanced by an abnormal cortisol release due to chronic stress of hyperparathyroidism. Being PHPT frequently found in the 6th to 7th decade of life, a careful and multifaceted approach should be taken. Case presentation: We report the case of an elderly patient with symptomatic PHPT and incidental pulmonary embolism. He was treated with hydration, zoledronic acid, cinacalcet and high-dose unfractionated heparin. Parathyroid surgery was successfully performed, but patient's conditions suddenly worsened because of a transient thyrotoxicosis, probably induced by a previous exposure to iodine load and/or thyroid surgical manipulation. A short-term treatment with beta-blockers was introduced for symptomatic relief. The patient also presented a transient hypercortisolism with elevated ACTH, likely due to stress related not only to aging and hospitalization but also to PHPT, resolved only four months after parathyroid surgery. Conclusion: Chronic hyperparathyroidism has been linked with increased all-cause mortality. A functional chronic hypercortisolism could be established, enhancing PHPT related disorders. Only parathyroid surgery has been demonstrated to cure PHPT and complications related, showing similar outcome between older and younger patients. However, the management of post-operative period should be more careful in fragile patients. In particular, the early diagnosis and treatment of a transient post-operative thyrotoxicosis could improve recovery. Due to the increase in prevalence and the evidence of many related complications even in asymptomatic PHPT, expert opinion-based guidelines for surgical treatment of PHPT should be developed especially for elderly patients

    The expanding role of nuclear medicine in therapeutic strategies

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    The concept of carrying a cytotoxic radionuclide directly to cancerous cells is an attractive alternative to conventional forms of radiation treatment. The very close contact between the radionuclide and the cell to be destroyed enables the absorbed radiation to be concentrated at the site of abnormality with the minimal injury to healthy tissue.1 The concept is not new. After a stalemate period in which radiometabolic treatment seemed to be unfashionable, not only has the already-existing radionuclide therapy returned to be appreciated and widely applied, but novel radionuclide therapies have also come about in recent years. In fact, the European Association of Nuclear Medicine (EANM) has published guidelines for the planning and actuating of most of these therapies. Prospects are excellent and they will revolutionise treatment of some common diseases as their use has been proven in studies and an increasing number centres are applying these treatments all over Europe, even as first-line. This article is a representative overview regarding the current common radionuclide therapy applications and the new radionuclide treatments available.peer-reviewe

    Progressive evolution of thyroid adenoma to thyroid carcinoma

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    Nodules (adenomas), enlarged thyroid (goiter) and inflammation of the thyroid (thyroiditis) are the most important risk factors for thyroid cancer. Adenomas have the largest increase in risk. Objectives: to discuss two cases of adenomas goiter that became aggressive during follow-ups. Cases: Two patients, with an average age of 64 years, referred to Nuclear Medicine dr. M. Djamil Hospital in Padang for bone scintigraphy examination. Both patients had thyroid surgery and histopathology results were adenomas. However, after the removal surgery, the patients did not have proper follow-ups. Both patients developed pelvic pain. Bone scintigraphy showed an increase of radiopharmaceutical uptake at pelvic bones and computerized tomography (CT Scan) result showed destruction at the pelvic bone areas. Conclusions: These cases highlight the necessity for adenoma thyroid patients with a risk factor for thyroid cancer to have a complete follow-up program and sufficient length period

    A rare case of solitary toxic nodule in a 3yr old female child – a case report

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    A three year old hyperactive female child presented with a midline neck swelling of one year duration. Clinical examination revealed a nodule in the isthmus of thyroid.Her Thyroid Stimulating Hormone (TSH) was suppressed and Free T3 and Free T4 levels were elevated. Radionuclide scintigraphy showed a hyperfunctioning nodule in the isthmus of thyroid. Patient was administered antithyroid medication and brought toeuthyroid state. Isthmectomy was done. Post-operative period was uneventful. Patient was discharged on third post-operative day and is on regular follow up.

    Automatic segmentation of whole-body bone scintigrams as a preprocessing step for computer assisted diagnostics

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    Bone scintigraphy or whole-body bone scan is one of the most common diagnostic procedures in nuclear medicine used in the last 25 years. Pathological conditions, technically poor quality images and artifacts necessitate that algorithms use su±cient background knowledge of anatomy and spatial relations of bones in order to work satisfactorily. We present a robust knowledge based methodology for detecting reference points of the main skeletal regions that simultaneously processes anterior and posterior whole-body bone scintigrams. Expert knowledge is represented as a set of parameterized rules which are used to support standard image processing algorithms. Our study includes 467 consecutive, non-selected scintigrams, which is to our knowledge the largest number of images ever used in such studies. Automatic analysis of whole-body bone scans using our knowledge based segmentation algorithm gives more accurate and reliable results than previous studies. Obtained reference points are used for automatic segmentation of the skeleton, which is used for automatic (machine learning) or manual (expert physicians) diagnostics. Preliminary experiments show that an expert system based on machine learning closely mimics the results of expert physicians
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