Pathological Variables and Laboratory Values in Infants with Neonatal Cholestasis Showing Nonexcretion on Tc-99m Mebrofenin Hepatobiliary Scans: A Descriptive Study.

Introduction: Cholescintigraphy using Tc-99m Mebrofenin is routinely performed as an initial diagnostic test in infants with neonatal cholestasis suspected of having biliary atresia. Demonstration of drainage of bile into the small intestine indicates patency of the biliary tract and thus rules out biliary atresia. Non-excretion of tracer into the small intestine, however, can be caused by obstructive as well as non-obstructive conditions, and it is known that false-positive findings are found with the use of Tc-99m Mebrofenin scintigraphy. Aim: In the present study, we retrospectively calculated the proportion of infants eventually diagnosed to have biliary atresia that were initially ruled to have a non-excreting cholescintigraphy pattern in our institution. We have also attempted a systematic description of the cardinal histological characteristics, haematological and hepatic biochemical variables in infants with non-excreting patterns. Materials and Methods: This retrospective, descriptive study was conducted in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. We reviewed data from infants who underwent cholescintigraphy with Tc-99m Mebrofenin between January 2016 through June 2022. We included infants in whom the scan was ruled "non-excreting" i.e. those infants in whom biliary atresia could not be ruled out based on the results of the scan. The difference in mean for haematological parameters and ALP were compared between the two groups i.e., biliary atresia versus other than biliary atresia by using Independent student's t-test; the remaining liver biochemical parameters were compared by using Mann-Whitney U Test and a p value < 0.05 was considered to be statistically significant. Results: A non-excretory pattern on cholescintigraphy was found to be due to biliary atresia in 49% of cases (as confirmed by exploratory surgery) and an additional 19.6 % of cases by trucut biopsy (total 68.6%). The difference in the mean serum GGT levels was found to be statistically significant (<0.001). Conclusion: A non-draining pattern on cholescintigraphy is caused by biliary atresia in the greater percentage of cases presenting with cholestasis. The difference in mean GGT levels was found to be statistically significant between biliary atresia and other causes of non-draining patterns on cholescintigraphy.

Skull Base Metastasis and Krukenberg Tumor in a Pregnant Woman: An Unusual Presentation of Metastatic Gastric Cancer.

Gastric cancer is an infrequent cause of vomiting during pregnancy. It is often diagnosed at an advanced stage due to late presentation by patients, mistaking it for gestational symptoms. We report a 24-year-old pregnant woman with gastric cancer with skull base metastasis and Krukenberg tumor on initial diagnosis. She underwent medical termination of pregnancy and best supportive care before dying of her illness.

Adverse Allergic Reaction to Intrathecally Administered Technetium-99m Diethylenetriamine Pentaacetate: A Case Report.

Intrathecal administration of radiopharmaceuticals is an infrequently performed procedure in most nuclear medicine facilities. It is possible that adverse allergic reactions following the intrathecal administration of radiopharmaceuticals often go unreported. Here we present a case of spontaneous cerebrospinal fluid rhinorrhea with recurrent bacterial meningitis, who underwent radionuclide cisternography for localization of the site of leak and developed an adverse allergic reaction following the intrathecal administration of technetium-99m diethylenetriamine pentaacetate that resolved with appropriate treatment. Imaging, however, could be carried out to our satisfaction and the allergic reaction did not interfere with, or result in discontinuation of the scan procedure.

Role of [68Ga]-pentixafor positron emission tomography/computed tomography imaging in assessing disease activity in patients with lupus nephritis: A pilot study.

OBJECTIVE: The primary objective of our study was to evaluate renal uptake of 68Ga-pentixafor in patients with lupus nephritis. Eighteen patients who satisfied the inclusion criteria were included in our study. METHODS: The study participants were patients with histopathologically confirmed lupus nephritis who were referred to our department for 68Ga-pentixafor PET/CT scan. We studied the renal images in these patients for uptake patterns based on purely visual as well as semi-quantitative parameters. The visual parameters included uptake relative to the spleen and liver. Semi-quantitative analysis involved the uptake as given by SUVmax. These parameters were correlated with the patients' biochemical as well as histological parameters. Kendall's tau-b test was used to look for an association between renal uptake by visual assessment and histopathological findings. Mean SUVmax values were compared by using the Mann-Whitney U test and a p value < .05 was considered to be statistically significant. RESULTS: No significant association between the mean renal SUVmax of the bilateral kidneys in pentixafor PET and histopathological class was observed. We did not observe any heterogeneity in uptake patterns that could be attributed to the disease process in our patients. CONCLUSION: 68Ga-pentixafor PET is not a suitable imaging modality for assessment of disease activity in lupus nephritis patients. There is a void in non-invasive testing for patients with this chronic and often disabling condition which calls for further research in this area.