99mTc-TRODAT-1 SPECT Imaging in Early and Late Onset Parkinson's Disease.

OBJECTIVES: 99mTc-TRODAT-1, which binds to the dopamine transporter, could be used to image the dopaminergic system in diagnosis of Parkinson's disease (PD). PD can be classified into two groups: late onset Parkinson's disease (LOPD) and early onset Parkinson's disease (EOPD). In this study we tried to determine the TRODAT SPECT findings in EOPD as compared to LOPD. METHODS: Fifteen patients were studied. The diagnosis of PD was defined by clinical criteria based on UK Parkinson's Disease Society Brain Bank criteria. Six patients whose age at onset of PD were younger than 50 were defined as patients with EOPD and 9 patients with older than 50 years were defined as patients with LOPD. All patients underwent 99mTc-TRODAT Brain SPECT. RESULTS: There was a significant decrease of striatal 99mTc-TRODAT-1 (TRODAT) binding in PD patients in both EOPD and LOPD. No significant difference was noticed between EOPD and LOPD in disease stage and symptoms. In visual analysis, 20 (66.67%) caudate nucleuses had decreased tracer uptake while all 30 (100%) putamens had decreased or absent tracer uptake. No significant difference between EOPD and LOPD was noticed in visual analysis. Striatum, Caudate and Putamen uptake ratio to background were calculated. No significant difference was noticed between EOPD and LOPD in these ratios. However there was significant difference in visual analysis (tracer uptake) as well as in uptake ratio between putamen and caudate nucleuses in both groups (P=0.001). On the other word, we found more diminished uptake in putamen as compared the caudate. Frequency and severity of putamen involvement were much more than caudate. CONCLUSION: 99mTc-TRODAT-1 SPECT imaging showed lower presynaptical dopami-nergical terminals density in both EOPD and LOPD. There was no difference between EOPD and LOPD in TRODAT uptake. Putamen showed more involvement and more diminished TRODAT uptake.

99mTc-Pertechnetate imaging for detection of ectopic gastric mucosa: a systematic review and meta-analysis of the pertinent literature..

BACKGROUND AND AIMS: 99mTc-pertechnetate scintigraphy has long been used for detection of ectopic gastric mucosa (EGM) in the medical practice and evaluation of children with lower gastrointestinal bleeding. In the current study, we reviewed the available medical literature in this regard. METHODS: Medline and SCOPUS were searched for relevant studies. Studies with sample size of at least 5 patients which provided enough numerical data to calculate the sensitivity and/or specificity of 99mTc-pertechnetate for detection of EGM were includ ed in the systematic review. RESULTS: Overall 40 studies were included in our systematic review. Overall diagnostic indices of the 99mTc-pertechnetate scintigraphy for EGM diagnosis were: sensitivity 92.1% [95% CI: 90.2-93.8], specificity 95.4% [943-963], positive likelihood ratio 16.5 [9.9-27.], negative likelihood ratio 0.15 [0.1-0.2], diagnostic odds ratio 120.7 [73-199]. The pooled sensitivity was higher for studies using H2 blockers as a premedication (92.4% vs. 86.4%), studies using delayed imaging (943% vs. 88.4%), children (92.3% vs. 81.8%), and patients with gastrointestinal bleeding (953% vs. 75.3%). CONCLUSIONS: 99mTc-pertechnetate imaging is a highly accurate diagnostic modality for detection of EGM. This imaging is more accurate in children and patients presenting with gastrointestinal bleeding. Premedication with H2 blockers and delayed imaging can increase the diagnostic accuracy and should be routinely included in the imaging protocol.

Comparison between 99mTc-sestamibi gated myocardial perfusion SPECT and echocardiography in assessment of left ventricular volumes and ejection fraction--effect of perfusion defect and small heart.

BACKGROUND: Agreement between gated myocardial perfusion SPECT (GSPECT) and echocardiography (ECHO) in the calculation of left ventricular end-diastolic volume (EDV), end-systolic volume (ESV) and LVEF was assessed. Effect of perfusion defect and small hearts on this agreement was obtained. Because ECHO is a routine and widely used noninvasive modality for this purpose, we chose this technique for comparison with GSPECT. MATERIAL AND METHODS: In a prospective study, 50 consecutive patients (age = 59.7 ± 10.64 years) underwent rest Tc99m-sestamibi GSPECT and 2-D ECHO. The LVEF, EDV and ESV were calculated using QGS (Quantitative Gated SPECT) software. RESULTS: Fourteen (28%) patients had perfusion defect in rest phase tomograms, while 36 (72%) had no perfusion defect. There was a significant correlation between two modalities in calculation of EDV, ESV and LVEF (all: p < 0.001, Pearson's correlation coefficients: r = 0.764, 0.831 and 0.813, respectively). A good correlation was noticed even in small hearts or in patients with or without previous myocardial infarction. There was a significant difference between GSPECT and ECHO in patients with no perfusion defect as well as in patients with small heart (ESV < 25 ml). On the other hand, no remarkable difference was noticed between two techniques in the presence of perfusion defect or in patients with ESV ≥ 25 ml. CONCLUSION: There was a good agreement between EDV, ESV and LVEF derived from GSPECT and ECHO. There was a significant difference between two modalities in small hearts and in patients without perfusion defect, although in larger ventricles or in the presence of myocardial infarction no remarkable difference between two modalities was noticed.

Diagnostic performance of fluorine 18 fluorodeoxyglucose positron emission tomography imaging for detection of primary lesion and staging of endometrial cancer patients: systematic review and meta-analysis of the literature.

OBJECTIVES: Fluorine 18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) imaging has been used for staging of endometrial cancer. In the current study, we systematically searched the available literature on the accuracy of (18)F-FDG PET imaging for staging of endometrial cancer. METHODS: PubMed, SCOPUS, ISI Web of Knowledge, Science Direct, and Springer were searched using "endometr* AND PET" as the search terms. All studies evaluating the accuracy of (18)F-FDG PET in the staging of endometrial carcinoma were included. Statistical pooling of diagnostic accuracy indices was done using random-effects model. Cochrane Q test and I(2) index were used for heterogeneity evaluation. RESULTS: Sixteen studies (807 patients in total) were included in the meta-analysis. Sensitivity and specificity for detection of the primary lesions were 81.8% (77.9%-85.3%) and 89.8% (79.2%-96.2%); for lymph node staging were 72.3% (63.8%-79.8%) and 92.9% (90.6%-94.8%); and for distant metastasis detection were 95.7% (85.5%-99.5%) and 95.4% (92.7%-97.3%). CONCLUSIONS: Because of low sensitivity, diagnostic utility of (18)F-FDG PET imaging is limited in primary tumor detection and lymph node staging of endometrial cancer patients. However, high specificities ensure high positive predictive values in these 2 indications. Diagnostic performance of (18)F-FDG PET imaging is much better in detection of distant metastases. Larger studies with better design are needed to draw any more definite conclusion.

Pattern and distribution of bone metastases in common malignant tumors.

BACKGROUND: Bone scan is a sensitive but not specific method for evaluation of bone metastases. However, the clinical data and the pattern of bone scan findings help the physician to narrow the diagnostic differentials. We tried to investigate the distribution of bone metastases in common cancers using bone scintigraphy. MATERIAL AND METHODS: 160 consecutive patients with malignancy (prostate cancer: 32, breast cancer: 107, lung cancer:8, and gastrointestinal cancers: 13) underwent bone scan. RESULTS: From the 160 patients, 58 patients (36.3%) had abnormal bone scans attributable to metastatic tumor. Bone metastases were found in 32.7%, 40.6%, 38.5% and 62.5% of patients with breast, prostate, GI and lung cancers, respectively (P = 0.35). The most frequently involved area was the spine, followed by ribs and pelvic bones. Spine was the most frequent site of bone metastases in breast and GI cancers. Except for the spine, common locations of bone metastases from breast cancer were ribs and sternum. In prostate cancer, the most frequent site were spine and pelvis, with similar incidences. In lung cancer, ribs followed by spine were most frequent sites of bone metastases. 97 (60.6%) of the cancer patients studied had symptoms of bone pain. The highest incidence was associated with metastatic lesions in bone scan (P = 0.004). Significant correlation between location of bone pain and evidence of bone metastasis in the same region was noticed in the pelvis (P =0.001), skull (P = 0.04), sternum (P = 0.01), spine (P = 0.003) and femur (P < 0.001). CONCLUSIONS: Our results indicate that the spine and pelvis in prostate carcinoma and the spine, ribs and sternum in breast carcinoma as well as ribs and spine in lung cancer are most frequently invaded. Bone pain in the skull, sternum, lumbar vertebrae, pelvis and proximal portion of femurs are more important to keep in mind for metastatic bone involvement.

Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in patients with Merkel cell carcinoma: a systematic review and meta-analysis.

BACKGROUND: Some studies reported the usefulness of fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/computed tomography (CT) in patients with Merkel cell carcinoma (MCC). OBJECTIVE: The aim of this study was to systematically review and meta-analyze published data about the diagnostic performance of 18F-FDG PET and PET/CT in patients with MCC. METHODS: A comprehensive literature search of studies published through June 2013 regarding 18F-FDG PET and PET/CT in patients with MCC was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR−) and diagnostic odds ratio (DOR) of 18F-FDG PET or PET/CT in patients with MCC on a per examination-based analysis were calculated. The area under the summary receiver operating characteristic (ROC) curve was calculated to measure the accuracy of 18F-FDG PET or PET/CT in these patients. RESULTS: Ten studies comprising 329 patients (549 scans) with MCC were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of six selected studies (including 92 patients with MCC) provided the following results on a per examination-based analysis: sensitivity was 90 % (95 % CI 80­96), specificity 98 % (95 % CI 90­100), LR+ 12 (95 % CI 4.3­33.0), LR− 0.15 (95 % CI 0.08­0.28), and DOR 86.8 (95 % CI 23­327). The area under the summary ROC curve was 0.96. No significant statistical heterogeneity between the studies was found. CONCLUSIONS: In patients with MCC, 18F-FDG PET or PET/CT demonstrated high sensitivity and specificity, being accurate methods in this setting. Nevertheless, the literature focusing on the use of PET and PET/CT in MCC still remains limited. Prospective studies are needed to substantiate the high diagnostic accuracy of these methods in MCC.

Accuracy of hepatobiliary scintigraphy for differentiation of neonatal hepatitis from biliary atresia: systematic review and meta-analysis of the literature.

Hepatobiliary scintigraphy is an important diagnostic modality for work-up of neonatal cholestasis. Therefore, our objective was to evaluate the literature regarding the accuracy of hepatobiliary scintigraphy in differentiating biliary atresia from non-biliary atresia causes of cholestasis (collectively called neonatal hepatitis). Our search included Medline, SCOPUS and Google Scholar. Only studies using Tc-99 m-labeled immunodiacetic acid (IDA) derivatives were included. Overall, 81 studies were included in the meta-analysis. Pooled sensitivity and specificity were 98.7% (range 98.1-99.2%) and 70.4% (range 68.5-72.2%), respectively. Factors that increased specificity included the use of radiotracers with high hepatic extraction, administration of hepatic-inducing drugs (such as phenobarbital), use of a calculated dose/kg and administration of a booster dose in cases of non-excretion of the tracer in the bowel. SPECT imaging and duodenal fluid sampling also had high specificity; however, they need further validation because of the low number of studies. Semiquantitative imaging methods do not seem to have any incremental value. We conclude that hepatobiliary scintigraphy using IDA derivatives can be very useful for diagnostic work-up of neonatal cholestasis. To improve the specificity, several measures can be followed regarding type and dose of the radiotracer and imaging protocols. Non-imaging methods seem to be promising and warrant further validation.

Spontaneous perforation of common bile duct in a pediatric patient: application of hepatobiliary scintigraphy.

We report a case of spontaneous biliary perforation in a 21-month old female pediatric patient with the presenting symptoms of abdominal distension, jaundice, and umbilical hernia. Hepatobiliary scintigraphy showed tracer accumulation in the peritoneal cavity. Preliminary diagnosis of spontaneous biliary perforation was confirmed during surgery. After surgical repair of the biliary leakage, the patient recovered fully. This case shows the importance of hepatobiliary scintigraphy in patients suspicious for this condition.

Accuracy of 18F-FDG PET/CT for diagnosing inguinal lymph node involvement in penile squamous cell carcinoma: systematic review and meta-analysis of the literature.

PURPOSE: Metastatic involvement of the inguinal lymph nodes is associated with decreased survival and is a strong prognostic factor in penile squamous cell carcinoma. The aim of the current systematic review was to evaluate the accuracy of (18)F-FDG PET/CT for inguinal lymph node staging in penile squamous cell carcinoma and possible influential factors. MATERIALS AND METHODS: Medline, SCOPUS, Springer, Science Direct, and Google Scholar were searched using the key words "(penile or penis) and PET," with no date or language limitation. The meeting abstracts were not excluded either. Statistical pooling was performed using the random-effects model. RESULTS: Seven studies were included in the meta-analysis. One article had 2 different subgroups of patients, and each subgroup was considered as a separate study. Pooled sensitivity and specificity were 80.9% (95% confidence interval [CI]: 69.5%-89.4%) and 92.4% (95% CI: 86.8%-96.2%), respectively. Pooled sensitivity was 96.4% (95% CI: 81.7%-99.9%) for cN+ and 56.5% (95% CI: 34.5%-76.8%) for cN0 patients. CONCLUSIONS: (18)F-FDG PET/CT imaging has relatively low sensitivity (especially in cN0 patients) for detection of inguinal lymph node involvement in penile cancer patients, which does not justify its routine use. However, patients with clinically palpable lymph nodes may benefit from (18)F-FDG PET/CT because the sensitivity in this subgroup of patients is high.

Accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma: systematic review and meta-analysis of the literature.

PURPOSE: Sentinel lymph node biopsy is emerging as a promising method for inguinal lymph node staging of penile squamous cell carcinoma. In the current systematic review we evaluated the accuracy of sentinel lymph node biopsy for inguinal lymph node staging of penile squamous cell carcinoma and studied possible influential factors. MATERIALS AND METHODS: MEDLINE®, Scopus®, ISI®, Ovid SP®, Springer, ScienceDirect® and Google™ Scholar were searched by the key words "(penile OR penis) AND sentinel". No date or language limitation was imposed on the search and meeting abstracts were not excluded from analysis. A random effects model was used for statistical pooling. RESULTS: A total of 17 studies suitable for meta-analysis were detected. Three articles had 2 different subgroups of patients and each subgroup was considered as a separate study. Overall 18 studies (including the subgroups) were used for detection rate meta-analysis and 19 for sensitivity meta-analysis. The pooled detection rate was 88.3% (95% CI 81.9-92.6). Pooled detection rate of 90.1% (95% CI 83.6-94.1) was calculated for the studies using blue dye and radiotracer. The pooled sensitivity was 88% (95% CI 83-92). The highest pooled sensitivity (92% [95% CI 86-96]) was in the studies using radiotracer and blue dye, and recruiting only cN0 cases. CONCLUSIONS: Sentinel lymph node mapping in penile squamous cell carcinoma is a method with a high detection rate and sensitivity. Using radiotracer and blue dye for sentinel lymph node mapping and including only cN0 disease ensures the highest detection rate and sensitivity.

The efficacy of Tc-99m sestamibi for sentinel node mapping in breast carcinomas: comparison with Tc-99m antimony sulphide colloid.

BACKGROUND: To study the value of periareolar intra-dermal injection of Tc-99m sestamibi (MIBI) for sentinel node mapping in breast carcinoma. MATERIAL AND METHODS: Fifty patients with early-stage breast cancer were included in our study. 17.5 MBq Tc-99m-MIBI was injected intradermally to 25 patients and the remainders were injected with the same dose of Tc-99m-antimony sulphide colloid. Anterior and lateral static images were taken at 2 minutes. If sentinel lymph node was not detected, delayed imaging by up to 180 minutes was carried out. The patients were operated on 2-4 hours post-injection. Sentinel lymph node biopsy was performed by the aid of gamma probe and blue dye during surgery. RESULTS: In the Tc-99m-MIBI group, 23 patients had lymph nodes on scintigraphy images, and sentinel nodes were detected during surgery in all 23 patients. In the Tc-99m-antimony sulphide colloid group, 24 patients had lymph nodes on scintigraphy images, and sentinel nodes were identified during surgery in 24 patients. CONCLUSIONS: We concluded that 99mTc-MIBI is a suitable radiopharmaceutical for sentinel node detection.

The effect of excisional biopsy on the accuracy of sentinel lymph node mapping in early stage breast cancer: comparison with core needle biopsy.

Despite the successful application of sentinel node mapping in breast cancer patients, its use in patients with a history of previous excisional biopsy of the breast tumors is a matter of controversy. In the present study we evaluated the accuracy of sentinel node biopsy in this group of patients and compared the results with those in whom the diagnosis of breast cancer was established by core needle biopsy. Eighty patients with early stage breast carcinoma were included into our study. Forty patients had a history of previous excisional biopsy and the remainder 40 had undergone core needle biopsy. Intradermal injections of 99mTc-antimony sulfide colloid as well as patent blue were both used for sentinel node mapping. Sentinel nodes were harvested during surgery with the aid of surgical gamma probe. All patients underwent standard axillary lymph node dissection subsequently. Detection rate was 97.5 per cent for both groups of the study. Number of detected sentinel node during surgery was not significantly different between groups. False negative rate was 0 per cent for both groups of the study. In conclusion sentinel node biopsy is reliable in patients with previous history of excisional biopsy of the breast tumors and has a low false negative rate.

Comparison of early and delayed lymphoscintigraphy images of early breast cancer patients undergoing sentinel node mapping.

OBJECTIVE: We compared early and delayed lymphoscintigraphy images using intradermal injection of (99m)Tc-antimony sulfide colloid, which has small particles. METHODS: Eighty patients with early-stage breast cancer were included into the study. Intradermal injection of (99m)Tc-antimony sulfide colloid was used for sentinel node mapping. After radiotracer injection, 30 min and 20 h later, lymphoscitigraphy images were obtained in lateral and anterior views. After the completion of each image sets, the location of the visible nodes in the axilla was marked on the skin. Two nuclear medicine specialists reviewed the images independently and the number and location of detected nodes were recorded. RESULTS: At least one hotspot was detected in the axillary region in 78 (97.5%) and 79 (98.75%) patients on the early and delayed images, respectively. No extra-axillary drainage was noted in the patients. The number and location of detected hot spots were the same in 77 patients on both image sets. In one patient the early image did not show any axillary hot spot despite its visualization on the delayed image set and in one patient no hot spot was noted on either images. In one patient an additional axillary hot spot was noted on the delayed image, which was not apparent on the early image. CONCLUSION: Our study showed that a delay of up to 20 h in sentinel lymph node biopsy using intradermal injection of (99m)Tc-antimony sulfide colloid does not result in washout of the tracer from the true sentinel node or migration of the radiotracer into second-echelon nodes.

Electrocardiographic changes after dipyridamole infusion in patients undergoing myocardial perfusion imaging.

OBJECTIVES: Although the diagnostic and prognostic importance of perfusion defects has been clearly established, the meaning of the development and characteristics of electrocardiographic (ECG) changes during dipyridamole infusion is less well defined. This study tries to evaluate the prevalence and significance of ECG changes after dipyridamole infusion and their relation to ischemia in myocardial perfusion single-photon emission computed tomography (SPECT). METHODS: Two hundred patients underwent 2-day dipyridamole stress/rest Tc-99m-sestamibi myocardial perfusion SPECT. Basal and post dipyridamole ECGs were analyzed. Myocardial perfusion images were interpreted visually and semiquantitatively. RESULTS: New ECG changes were noted in 20.2% of cases and consisted of 1.1% T-wave flattening, 1.1% T-wave inversion and 14.8% ST depression and 4.2% psuedonormalization. Abnormal ECG changes were noted after dipyridamole infusion in approximately 27.7% of patients with and 14.3% of patients without reversible defect in myocardial perfusion SPECT. A new ST depression was noted in lateral leads in 72.2% of new ST changes. The mean post-dipyridamole heart rate increment in patients with reversible or partially reversible defects was significantly lesser than in patients with normal myocardial perfusion SPECT. In addition, the corrected QT interval (QTc) increment in patients with reversible defects was significantly more than in patients with fixed defects; however, there was no difference when compared with patients with no defects. Using linear regression model, the severity of ST depression and QTc increment were significant predictors of summed difference score. Sensitivity, specificity, and negative and positive predictive values of ST-segment depression for the diagnosis of ischemia were 20.2, 89.5, 60.7, and 58.4%, respectively. CONCLUSION: The most common ECG change seen after dipyridamole infusion is ST-segment depression. The new ST-segment depression after dipyridamole infusion is highly specific for ischemia. Reversible defects are associated with a lesser increment in heart rate, whereas QTc increment and severity of ST segment depression were significant predictors of summed difference score.

The additive value of transient left ventricular dilation using two-day dipyridamole 99mTc-MIBI SPET for screening coronary artery disease in patients with otherwise normal myocardial perfusion: a comparison between diabetic and non-diabetic cases.

The prognostic value of transient ischemic dilation (TID) has been previously confirmed; however, its clinical significance for screening coronary artery disease (CAD) with balanced ischemia, as a cause of false negative myocardial perfusion imaging (MPI), is unclear. The goal of this study was to determine the additive diagnostic value of TID ratio for screening CAD in separate subgroups of diabetic and non-diabetics with normal perfusion. Eighty six patients with intermediate probability of CAD who had TID more than one in the presence of otherwise normal MPI using two-day technetium-99m methoxy isobutyl isonitrile ((99m)Tc-MIBI) single photon emission tomography (SPET) and dipyridamole stress (summed stress score<3 and left ventricular cavity<90 mL) were included in a prospective cohort study comprising two subgroups of diabetic and non- diabetic patients. An inclusive work-up with multiple noninvasive tests was performed for all patients from whom 38 cases subsequently underwent coronary angiography and 48 cases were categorized in the group with a very low likelihood (<5%) of CAD on the basis of clinical and paraclinical data over a minimum of 18 months follow up. The TID ratio was calculated using automated software. Gensini score (GS) as an indicator of severity/extent of stenosis and coronary artery index (CAI) as the number of arteries with more than 50% narrowing were calculated based on angiographic findings. Our results showed that only in diabetic patients with three-vessel disease, TID ratio (1.47 ± 0.23) differs significantly from the other groups of CAD. In diabetic patients subgroup, TID ratio correlated strongly with GS (r=0.957, P<0.0001) and CAI (r=0.659, P=0.001), while such correlations were not seen in the non-diabetic patients. On the basis of receiver operating characteristic curve analysis for screening CAD in diabetic patients with normal myocardial perfusion, 100% sensitivity and 77.8% normalcy rate were achieved when TID more than 1.16 was regarded as abnormal. No distinct cut-off value for abnormal TID was obtained in the non-diabetic patients. In conclusion, TID in diabetic patients without regional myocardial perfusion abnormality is an important sign of CAD especially when TID ratio exceeds 1.16. The higher TID ratio in these cases may predict increasing possibility of severe and extensive CAD. The value of TID in non-diabetic patients with otherwise normal MPI is not clearly determined.

Significance of abnormal myocardial perfusion scintigraphy in young adult patients with SLE.

OBJECTIVES: Detection of subclinical coronary artery disease (CAD) is a potential challenge in patients with systemic lupus erythematosus (SLE) and it is suggested that myocardial perfusion single photon emission computerized tomography (SPECT) is more sensitive than exercise test in this setting. However, the significance of perfusion abnormalities in SLE patients is not well known. In this study, we evaluated the prognostic significance of myocardial perfusion defects in patients with SLE. METHODS: Patients with proven diagnosis of SLE admitted to the hospital due to noncardiac problems with no history of CAD were studied. All patients underwent (99m)Tc-MIBI myocardial perfusion scan using dipyridamole as pharmacological stress. All patients were followed up by reviewing patients file in lupus clinic and any minor or major cardiac events were recorded. RESULTS: Eighteen female and two male patients with mean age of 28.2 +/- 12.05 years were included. Six patients had mild reversible perfusion defects with mean summed difference score of 2.5 +/- 1.0. Pattern of reverse redistribution (reverse fill-in) was noted in three patients. Eleven patients had normal myocardial perfusion. Hypokinesia was noted in three patients on gated images. One patient with abnormal perfusion died 21 days after imaging due to non-cardiac cause. Nineteen patients were followed for a mean time of 39.2 +/- 16.0 months. No major or minor cardiac events were noted during follow-up. Three patients (one with abnormal perfusion) had at least one readmission during follow-up period. CONCLUSION: Our study showed that myocardial perfusion abnormalities are fairly frequent in SLE patients but the defects are generally mild and do not advocate an adverse prognosis.

Review of the linogram and sinogram: an easy way to detect off-peak artifacts in myocardial perfusion SPECT.

The correct energy window setting and a stable photopeak position are crucial for good data acquisition. We report a patient whose myocardial perfusion SPECT images showed mildly irregular radiotracer uptake when the patient was prone but not when the patient was supine. Review of the sinogram showed clear interruptions in the sinusoidal shape of the raw data when the patient was prone. Detailed technical evaluation revealed that the artifact was caused by an unstable photopeak position due to malfunction of a power supply board of the gamma-camera. This case emphasizes the importance of reviewing the sinogram display and raw data to assess the integrity of data acquisition and to reveal any potential technical problems such as a spontaneous shift of the photopeak.

Comparison of pre-operative lymphoscintigraphy with inter-operative gamma probe and dye technique regarding the number of detected sentinel lymph nodes.

Sentinel lymph node (SLN) identification by lymphoscintigraphy (LS) and biopsy are the standard method for axillary lymph node staging in low stage breast cancer patients. Many previous studies did not compare the number of SLN on LS with SLN detected during surgery. We aimed to study the accuracy of pre-operative LS for the prediction of the number of SLN detected by surgical gamma probe and the dye technique during surgery. Sixty patients were included in our study. SLN biopsy was performed using the combined radioactive and blue dye methods. Patients without previous excisional biopsy of the tumor (45 patients) received periareolar intra-dermal injections of 17.5MBq/0.2mL technetium-99m-antimony sulfide colloid ((99m)Tc ASC). The remainder of the patients, with the history of excisional biopsy of the tumor (15 patients); received two intra-dermal injections of 17.5MBq/0.2mL (99m)Tc-ASC in both ends of the surgical incision. All injections were done 2-4 h before surgery and gentle massage was applied to the injection site. Results showed that the number of SLN was correctly detected by LS in 58 patients. Eighty SLN were totally detected during surgery. All these SLN were radioactive and could be identified by surgical gamma probe. No SLN was detected only by the blue dye. Of the 80 detected SLN, 60 (75%) were both radioactive and colored. Pre-operative LS correctly predicted the number of harvested SLN during surgery in 77.5% of the patients. Only 78.7% (63/80) of the total harvested SLN were detected by pre-operative LS. We conclude that pre- operative LS identifies 78.7% and the blue dye technique can identify 75% of the SLN found by the gamma probe during surgery. The pre-operative LS technique can correctly identify the number of SLN in 77.5% of the patients.

How to apply the evidence-based medicine concept to nuclear medicine diagnostic studies -- a review.

Evidence-based medicine (EBM) is defined as using the best available evidence for managing patients in daily healthcare practice. Although this approach has been applied successfully in many medical fields, it has not been addressed fully in the radiological discipline in general and nuclear medicine in particular. In this review, the concept of EBM has been introduced briefly and four steps of EBM practice have been explained. Asking answerable questions and finding the best evidence that constitutes the first two parts of EBM practice are explained in brief. The next two steps (appraising the available evidence and applying the best evidence) are explained in more detail. Since the bulk of nuclear medicine studies are of a diagnostic nature and most of the daily practice of a nuclear medicine specialist is involved in diagnosis, we have focused on the diagnosis studies. Systematic reviews are also explained to some extent. Appraisals of other kinds of study, such as interventional or prognosis studies, are not included in this review.