Tumor-Induced Parkinsonism Due to a Large Meningioma Diagnosed by 99m Tc-TRODAT-1 SPECT/CT.

ABSTRACT: A 67-year-old woman complained of rest and postural tremors in her left upper extremity, associated with bradykinesia and gait disorder since 2 years ago, with no significant response to antiparkinsonism drugs. Dopamine transporter SPECT/CT revealed a remarkable area of 99m Tc-TRODAT-1 uptake in a huge tumoral lesion in the right frontotemporal region, compressing and dislocating the right striatum with evidence of significant midline shift. The patient underwent surgical resection with a diagnosis of meningioma on preoperative MRI and postoperative histology report, experiencing a marked recovery in symptoms after 1 month.

Comparing the role of 99m Tc-HYNIC-PSMA-11 and 99m Tc-MDP scintigraphy for the initial staging of intermediate to high-risk prostate cancer.

BACKGROUND: Although bone scintigraphy and abdominopelvic computed tomography (CT)/MRI have been the mainstay of initial staging in the intermediate to high-risk prostate cancer (PC) patients, prostate-specific membrane antigen (PSMA) PET/CT imaging provides promising additional value in the initial N/M staging of these patients in recent years. 99m Tc-PSMA scan is a new alternative to PSMA PET tracers with little evidence regarding its diagnostic value in the initial staging of PC. METHODS: This prospective study included 40 patients with newly diagnosed PC with initial intermediate or high-risk features [prostate-specific antigen (PSA) > 10 ng/dl, Gleason score ≥7 or stage cT2b and more]. All patients underwent both 99m Tc-methylene diphosphonate (MDP) bone scan and 99m Tc-HYNIC-PSMA-11 scan with maximum interval of 2 weeks. Abdominopelvic CT and MRI were also performed in this timeframe. Then, the results of these methods were compared with the final diagnosis data. RESULTS: Among the 40 included patients, 28 patients had finally been diagnosed as localized PC and 12 patients showed lymph node or metastatic involvement. The sensitivity, specificity and accuracy of 99m Tc-HYNIC-PSMA-11 vs. 99m Tc-MDP were 83.3% vs. 50.0%, 100% vs. 82.1% and 95% vs. 72.5%, respectively. However, when combined with the results of abdominopelvic CT/MRI the sensitivity reached 100% for both and the specificity raised to 100% and 96.4% for 99m Tc-HYNIC-PSMA-11 and 99m Tc-MDP, respectively. CONCLUSION: 99m Tc-HYNIC-PSMA-11 performs well in the initial staging of intermediate to high-risk PC and especially in low source areas without PET/CT it can be used as the first-line method of metastatic evaluation instead of bone scintigraphy. However, the combination and correlation of cross-sectional imaging is essential to gain the optimal diagnostic value.

Incidental Detection of Papillary Thyroid Carcinoma in Tc-99 m PSMA Imaging in a Case with Negative FNA Result.

Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein and is expressed in multiple solid malignant neoplasms. We presented a case of a prostate cancer patient who went through Tc-99 m PSMA SPECT, and multifocal increased radiotracer uptake in the thyroid gland was demonstrated. Despite negative FNA results for malignancy, post-operative histopathologic examination illustrated papillary thyroid carcinoma.

Plasma leptin level is positively associated with blood pressure measures independent of gender and BMI.

Background: Since the introduction of leptin, many studies suggest an important role for this hormone in obesity-related hypertension. However, in non-obese patients, there are controversial results regarding the possible role of leptin in essential hypertension especially in both sexes and different groups of body mass index (BMI). We aimed to evaluate the association of leptin and hypertension in both female and male gender.Materials and Methods: This cross-sectional study was conducted, recruiting 80 essential hypertensive patients and 80 healthy normotensive volunteers using convenience sampling method. Subjects without history of diabetes mellitus, hyperlipidemia, smoking, thyroid disease and insulin or corticosteroid use were included in two groups of normotensive and hypertensive subjects who were matched for age, sex and BMI. Systolic and diastolic blood pressure (SBP and DBP), weight and height were measured for all subjects and a blood sample was obtained for measurement of leptin, fasting blood sugar and lipid profiles.Results: Leptin was significantly higher in hypertensive patients as compared to normotensive subjects in all study population and both male and female subgroups (p < 0.001). Statistically significant correlation was also found between leptin and both SBP and DBP in above-mentioned subgroups. In comparison of controlled and uncontrolled hypertensive patients, leptin was significantly higher in uncontrolled hypertensive patients (p < 0.001).Conclusion: Comparing two groups of hypertensive and normotensive subjects, leptin is found to be positively correlated with hypertension in both genders. Leptin level also tends to be higher in uncontrolled hypertensive patients which may indicate a possible role for leptin in mechanism of uncontrolled hypertension.

The effect of chewing-gum on dose rate of salivary gland in differentiated thyroid carcinoma patients treated with radioiodine.

BACKGROUND: Although, different methods have been suggested on reducing salivary gland radiation after radioiodine administration, an effective preventive or therapeutic measure is still debated. To the best of our knowledge this is the second study that aimed to evaluate the effect of chewing-gum as a sialagogue on the radioiodine content of salivary gland, and radioiodine-induced symptoms of salivary gland dysfunction. METHODS: Twenty-two patients who were referred to radioiodine therapy were randomized into chewing-gum (group A) and control (group B) groups. Anterior and posterior planar images including both head and neck were obtained 2, 6, 12, 24 and 48 hours after the administration of radioiodine in all patients and round regions of interest (ROI) were drawn for both left and right parotid glands with a rectangular ROI in the region of cerebrum as the background. All patients were followed once, 6 months after radioiodine administration via a phone call for subjective evaluation of symptoms related to salivary gland damage. RESULTS: There was no significant difference between the two groups regarding the mean age, gender and initial iodine activity. The geometric mean of background-corrected count per administrated dose and acquisition time was calculated for bilateral parotid glands. This normalized parotid count showed a significant reduction in net parotid count in both groups during the first 48 hours after the radioiodine administration. However, no significant difference was found between the groups according to the amount and pattern of dose reduction in this time period. CONCLUSIONS: This study revealed that chewing-gum had no significant effect on the radioiodine content of parotid glands during the first 48 hours after radioiodine administration. Also, no significant difference was found in the incidence of relevant symptoms after 6 months comparing both groups.

Comparison of Quantitative Perfusion and Function Parameters of Gated-SPECT Myocardial Perfusion Imaging in Patients With Concordant and Discordant Left Bundle-Branch Block.

BACKGROUND: Patients with left bundle-branch block (LBBB) can be classified to discordant LBBB (dLBBB) and concordant LBBB (cLBBB) according to T-wave orientation in lateral leads. This classification indicates different functional left ventricular (LV) parameters with worse prognosis in dLBBB patients. However, there are no data regarding the impact of this classification on perfusion status of the left ventricle. The aim of this study is to evaluate and compare the SPECT myocardial perfusion imaging (MPI) findings of LV perfusion and function between dLBBB and cLBBB patients. METHODS: All patients who were referred for SPECT MPI during an 11 months' period were evaluated. Patients with evidence of LBBB on standard baseline 12-lead ECG were included, and their demographic, medical history, and imaging data were recorded. Quantitative perfusion and function parameters of LV included summed stress score, summed rest score, summed difference score, total perfusion deficit (TPD) at both phases with delta TPD, ejection fraction, end-diastolic volume, end-systolic volume, summed motion score, summed thickening score, phase SD, and phase histogram bandwidth. All baseline ECGs were further assessed by a cardiologist to categorize patients as the cLBBB or dLBBB group according to concordance of the T wave with QRS complex in lateral leads. RESULTS: Finally, 97 patients with 46 cLBBB and 51 dLBBB cases were included. Baseline characteristics and cardiovascular risk factors including diabetes mellitus, hypertension, hyperlipidemia, history of coronary artery disease (CAD), family history of CAD, and smoking were not significantly different between the 2 groups. However, summed stress score (12.2 vs 6.7), summed difference score (4.0 vs 2.6), stress TPD (11.0 vs 6.4), and delta TPD (4.8 vs 3.9) were significantly higher in dLBBB patients. In addition, functional parameters were also significantly worse in dLBBB patients with lower ejection fraction and higher end-diastolic volume, end-systolic volume, summed motion score, and summed thickening score in these patients. Mean phase SD and phase histogram bandwidth were also significantly higher in dLBBB patients. CONCLUSIONS: This study revealed that LBBB patients with discordant T wave in lateral leads have significantly higher ischemic scores and worse functional parameters with more dyssynchrony in gated SPECT MPI.

Role of Hepatobiliary Scintigraphy in the Diagnosis of Gallbladder Agenesis; A Case Report and Brief Review of Literature.

Gallbladder agenesis (GA) is a rare congenital anomaly. Only 50% of the cases with GA are symptomatic, presenting mostly in the 4th or 5th decade of life. The clinical presentation of GA and imaging findings are non-specific and often misinterpreted as other diseases such as ectopic gall bladder. This can lead to unnecessary surgery when the final diagnosis is usually made. Although GA can cause an identical pattern to acute cholecystitis in hepatobiliary scintigraphy, in certain clinical settings, scintigraphy can be helpful as a confirmatory study, especially to rule out the possibility of ectopic gall bladder. In our case, the combination of imaging findings including ultrasonography, computed tomography, and hepatobiliary scintigraphy led to accurate diagnosis avoiding further surgeries.

Pilocarpine effect on dose rate of salivary gland in differentiated thyroid carcinoma patients treated with radioiodine.

OBJECTIVE: Although different methods have been suggested on reducing salivary gland radiation after radioiodine administration, an effective preventive or therapeutic measure is still up for debate. The aim of this study was to evaluate the effect of pilocarpine, as a sialagogue drug on the radioiodine content of the salivary gland, and radioiodine-induced symptoms of salivary gland dysfunction. PATIENTS AND METHODS: Patients who were referred for radioiodine therapy were randomized into pilocarpine and placebo groups. The patients as well as the nurse who administered the tablets, and the specialist who analyzed the images, were all unaware of the patients' group. Anterior and posterior planar images including that of both the head and neck were obtained 2, 6, 12, 24, and 48 h after the administration of radioiodine in all patients, and round regions of interest were drawn for both left and right parotid glands, with a rectangular region of interest in the region of the cerebrum as background. All patients were interrogated once, 6 months after radioiodine administration, by a phone call for subjective evaluation of symptoms related to salivary gland damage. RESULTS: There was no significant difference between the two groups with regard to the mean age, sex, and initial iodine activity. The geometric mean of background-corrected count per administered dose and acquisition time was calculated for the bilateral parotid glands. This normalized parotid count showed a significant reduction in net parotid count in both groups during the first 48 h after radioiodine administration. However, no significant difference was found between the groups according to the amount and pattern of dose reduction in this time period. CONCLUSION: This study revealed that pilocarpine had no significant effect on the radioiodine content of parotid glands during the first 48 h after radioiodine administration. No significant difference was found in the incidence of symptoms between the two groups treated with placebo and pilocarpine.

Impact of the Amount of Liquid Intake on the Dose Rate of Patients Treated with Radioiodine.

PURPOSE: Despite therapeutic effects of radioiodine in patients with differentiated thyroid cancer, there are some disadvantages due to harmful radiation to other tissues. According to the current guidelines, patients are recommended to drink lots of water and frequent voiding to reduce the amount of 131I in the body. This study was designed to assess the impact of the amount of liquid intake on reduction of the measured dose rate of radioiodine-treated patients. MATERIALS AND METHODS: A total of 42 patients with differentiated thyroid cancer without metastasis who had undergone total thyroidectomy and had been treated with radioiodine were selected. The patients were divided into two groups according to the amount of their fluid intake which was measured during the first 48 h after 131I administration. In all patients, the dose rate was measured immediately and 48 h after iodine administration. RESULTS: Each group included 21 patients. Dose rate ratio (the ratio of the second dose rate to the first dose rate) and dose rate difference ratio (the ratio of the difference between the two measured dose rates to the first dose rate) were calculated for each patient. Despite the significant difference in the amount of the liquid drunk, no statistically significant difference was seen between the different groups in parameters of dose-rate ratio and dose-rate difference ratio. CONCLUSION: Higher fluid intake (>60 ml/h in our study) alone would not effectively reduce the patient's radiation dose rate at least not more than a well-hydrated state. It seems that other interfering factors in the thyroidectomized patients may also have some impacts on this physiologic process.

Importance of Heparin Provocation and SPECT/CT in Detecting Obscure Gastrointestinal Bleeding on 99mTc-RBC Scintigraphy: A Case Report.

We presented a pediatric case with a history of intermittent melena for 3 years because of angiodyplasia of small intestine. The results of frequent upper gastrointestinal endoscopies and colonoscopies as well as both Tc-red blood cell (RBC) and Meckel's scintigraphies for several times were negative in detection of bleeding site. However, Tc-RBC scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT) after heparin augmentation detected a site of bleeding in the distal ileum which later was confirmed during surgery with final diagnosis of angiodysplasia.It could be stated that heparin provocation of bleeding before Tc-RBC scintigraphy accompanied by fused SPECT/CT images should be kept in mind for management of intestinal bleeding especially in difficult cases.

Multiple Myeloma and Abdominal Aortic Aneurysm on Myocardial Perfusion Raw Images.

Reviewing cine display of planar projections just after data acquisition of myocardial perfusion imaging is helpful not only for checking quality of the study but also for better interpretation of incidental findings by acquiring more helpful images. We present a patient with significant skeletal Tc-MIBI uptake accompanied by a large photopenic area in abdominal cavity in myocardial perfusion imaging raw images that were further confirmed as multiple myeloma and thrombotic abdominal aortic aneurysm, respectively.

Solitary metastasis of gastric cancer to fibula: a case report.

Gastric cancer is one of the most common and most fatal neoplasms in human. Its skeletal metastasis is less frequent, particularly when solitary. The objective of this article is to represent a case of solitary fibular metastasis from this cancer not reported before based on Medline search.