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1.
Medicine (Baltimore) ; 99(27): e21102, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629743

RESUMO

RATIONALE: Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare disease without standard treatments. Tripterygium wilfordii hook f (TwHF) is a traditional Chinese herb with anti-inflammatory effect, and 1.0 mg/(kg·d) dose of Tripterygium glycosides has been reported to significantly improve the disease activity of a SAPHO patient in a case report. However, the optimal dose of TwHF is still unclear. Here, we report the first case of SAPHO patient who achieved rapid remission in clinical symptoms after receiving 1.5 mg/(kg·d) dose of Tripterygium glycosides treatment. PATIENT CONCERNS: A 67-year-old woman noted palmoplantar pustulosis and pain in the anterior chest wall and waist. Bone scintigraphy demonstrated the typical tracer accumulation feature and magnetic resonance images showed bone marrow edema in lumbosacral vertebra. DIAGNOSES: The diagnosis was made by dermatological and osteoarticular manifestations and classical signs in bone scintigraphy in accordance with the diagnostic criteria proposed in 2012. INTERVENTIONS: Tripterygium glycosides was given with a primary dose of 1.5 mg/(kg·d) for 1 month and then reduced at a rate of 10 mg every 2 weeks until 1.0 mg/(kg·d) for a long-term maintenance. OUTCOMES: Fast-induced remission on clinical manifestations was achieved and magnetic resonance imaging abnormality was improved significantly. Additionally, no apparent side effects were observed. LESSONS: 1.5 mg/(kg·d) dose of Tripterygium glycosides seems to have fast-induced remission than 1.0 mg/(kg·d) with reliable safety. Besides, Tripterygium glycosides may also have a pharmacological effect of inhibiting osteolysis and enhancing bone strength.


Assuntos
Síndrome de Hiperostose Adquirida/tratamento farmacológico , Osso e Ossos/patologia , Medicamentos de Ervas Chinesas/uso terapêutico , Glicosídeos/uso terapêutico , Síndrome de Hiperostose Adquirida/patologia , Idoso , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/efeitos dos fármacos , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Glicosídeos/administração & dosagem , Humanos , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Imagem por Ressonância Magnética/métodos , Osteólise/prevenção & controle , Psoríase/etiologia , Cintilografia/métodos , Indução de Remissão , Resultado do Tratamento , Tripterygium
2.
Rev Assoc Med Bras (1992) ; 66(3): 345-352, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520156

RESUMO

Cardiac amyloidosis is an infiltrative disease which requires a high degree of clinical suspicion for appropriate diagnosis. Early diagnosis and the definition of the type of amyloidosis play a key role in the early treatment and prognosis of this disease. In this context, the use of cardiac biomarkers such as troponins and NT-proBNT associated with analysis by multimodality imaging methods like echocardiographic techniques such as strain, nuclear medicine, and cardiovascular resonance imaging have an increasing role in patients with cardiac amyloidosis. This article details the role of non-invasive diagnostic methods in patients with cardiac amyloidosis.


Assuntos
Amiloidose/diagnóstico , Biomarcadores , Ecocardiografia , Humanos , Espectroscopia de Ressonância Magnética , Prognóstico , Cintilografia , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 99(19): e19989, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384452

RESUMO

This study aimed to establish an optimal protocol for Tc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) Tc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for Tc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.


Assuntos
Hiperparatireoidismo , Hiperplasia , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides , Cintilografia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tecnécio Tc 99m Sestamibi/farmacologia , Feminino , Humanos , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/etiologia , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Cintilografia/métodos , Cintilografia/normas , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Clin Nucl Med ; 45(7): 534-535, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32404711

RESUMO

As the World Health Organization declared COVID-19 as "global pandemic," it is important for everyone, including nuclear medicine personnel, to know how to stop transmission, contain, and prevent the spread of COVID-19. We reach out to our ACNM (American College of Nuclear Medicine) international members from Wuhan, China and Singapore, who have participated in dealing with COVID-19 for the last 2 months, to learn from their lessons and experiences, so to provide advice to all ACNM members for their clinical practice and management strategies in responding to COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Humanos , Medicina Nuclear , Pandemias , Cintilografia/métodos , Cintilografia/normas , Sociedades Médicas
5.
Hell J Nucl Med ; 23(1): 2-3, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32361714

RESUMO

The coronavirus COVID-19 pandemic is the defining global health crisis of our time. Health care systems globally are amid an unprecedented challenge. Since its emergence in December 2019 in Wuhan, China, the virus has spread to 185 countries worldwide, with more than 2.63 million cases confirmed and more than 183 thousand related deaths (as of 23/04/2020). According to current evidence, the novel coronavirus is transmitted from human-to-human mainly via respiratory droplets of different sizes, contact with bodily fluids, or from contaminated surfaces. In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures that generate aerosols are performed. The common clinical symptoms of the highly pathogenic and large-scale epidemic virus include fever, cough, fatigue, ageusia and anosmia and in some patients, gastrointestinal infection symptoms. The elderly and patients with comorbidities are susceptible to infection and prone to severe complications, which may be associated with acute respiratory distress syndrome (ARDS) and cytokines storm. Currently, there are few specific antiviral strategies, but several potent candidates of antivirals and repurposed drugs are under urgent investigation. Under these circumstances, it is critical for health care settings, including nuclear medicine departments to take infection control measures, to prevent a potential spread not just among patients but also to staff members as well as to reconsider the performance of randomized clinical trials. There have already been papers on the radiology preparedness that should be applied to radiology and nuclear medicine departments to support the care of patients with COVID-19 and maintain radiologic diagnostic and interventional support for the entirety of the hospital and healthcare system, particularly for emergencies, without jeopardizing an outbreak in the units. Since most nuclear medicine diagnostic and therapeutic interventions are non-urgent, the general guidance from the International Atomic Energy Agency (IAEA) for infection prevention and control is to postpone scheduled procedure after cautious risk assessment, with certain exceptions. Individualized approach of each case is a sine qua non of ensuring low transmission of COVID-19 as well as effective and safe management of patients admitted to nuclear medicine departments. Another major issue raised is the possible impact COVID-19 on the transport of medical radioisotopes. By the 1st of April 2020, the Euratom Supply Agency (ESA) co-chaired the European Observatory on Supply of Medical Radioisotope expressing their concerns related to the impact of COVID-19 on the supply chain and inconsequence on the availability of the most vital medical radioisotopes used in nuclear medicine. Due to the current lockdown situation, extended border controls, reductions and elimination of many commercial passenger flights, competition and cost of cargo and charter options, required appropriate additional support. The new era of nuclear medicine practice worldwide coincides with a new era for the Hellenic Society of Nuclear Medicine (HSNM) and the Hellenic Journal of Nuclear Medicine (HJNM). The founder and Editor in Chief for more than 28 consecutive years, Professor Emeritus Philip Grammaticos, resigned leaving behind a benchmark for the presidencies and editors to come. His commitment to the conservation of a high level of scientific excellence of the published papers is the legacy which we wish to maintain in the future publications. The interim Editor in Chief of the current issue, would like to express her gratitude to Professor Emeritus Philip Grammaticos for his contribution to the global scientific community as well as to the incoming Editor in Chief Konstantinos Anagnostopoulos, MD, PhD, FRCP, FESC for accepting this new role. We wholeheartedly welcome the new Editor in Chief and the new members of the Editorial Board, wishing them an active, attentive and successful mandate. Hellenic Journal of Nuclear Medicine will remain true to the set principles, values and past and prepared to cope with future challenges in the scientific and clinical setting.


Assuntos
Infecções por Coronavirus , Saúde Global , Medicina Nuclear , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças , Humanos , Medicina Nuclear/tendências , Pandemias/prevenção & controle , Publicações Periódicas como Assunto , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Editoração/tendências , Cintilografia
8.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281763

RESUMO

In recent years imaging techniques that use radionuclides have become more and more clinically relevant as they can provide functional information for specific anatomical districts. This has also involved nephrology, where radionuclides are used to study patients with different degrees of renal function failure up to terminal uremia. Although chronic kidney disease, and dialysis in particular, may affect the distribution and the elimination of radiopharmaceuticals, to date there are no consistent data on the risks associated with their use in this clinical context. In addition to the lack of data on the safety of radio-exposure in dialysis patients, there is also a shortage of information concerning the risk for healthcare staff involved in conducting the dialysis sessions performed after a nuclear test. This study, performed on 29 uremic patients who underwent hemodialysis immediately after a scintigraphic examination, assessed the extent of radio-contamination of the staff and of hemodialysis devices such as monitor, kits and dialysate. The data collected has been used to quantify the radiological risk in dialysis after the exposure to the most common radionuclides.


Assuntos
Falência Renal Crônica/diagnóstico por imagem , Compostos Radiofarmacêuticos/metabolismo , Diálise Renal , Soluções para Diálise/química , Soluções para Diálise/metabolismo , Humanos , Falência Renal Crônica/metabolismo , Cintilografia/efeitos adversos , Cintilografia/métodos , Compostos Radiofarmacêuticos/efeitos adversos , Medição de Risco , Uremia/metabolismo
9.
Clin Oral Implants Res ; 31(7): 625-633, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32181919

RESUMO

OBJECTIVES: To compare the accuracy of an original and two newly designed CAD/CAM scan bodies used in digital impressions with one another as well as conventional implant impressions. MATERIAL AND METHODS: A reference model containing four implants was fabricated. Digital impressions were taken using an intraoral scanner with different scan bodies: original scan bodies for Group I (DO), CAD/CAM scan bodies without extensional structure for Group II (DC), and CAD/CAM scan bodies with extensional structure for Group III (DCE). For Group IV, conventional splinted open-tray impressions (CI) were taken. The reference model and conventional stone casts were digitalized with a laboratory reference scanner. The Standard Tessellation Language datasets were imported into an inspection software for trueness and precision assessment. Statistical analysis was performed with a Kruskal-Wallis test and Dunn-Bonferroni test. The level of significance was set at α = .05. RESULTS: The median of trueness was 35.85, 38.50, 28.45, and 25.55 µm for Group I, II, III, and IV, respectively. CI was more accurate than DO (p = .015) and DC (p = .002). The median of precision was 48.40, 48.90, 27.30, and 19.00 for Group I, II, III, and IV, respectively. CI was more accurate than DO (p < .001), DC (p < .001), and DCE (p = .007). DCE was more accurate than DC (p < .001) and DO (p < .001). CONCLUSIONS: The design of the extensional structure could significantly improve scanning accuracy. Conventional splinted open-tray impressions were more accurate than digital impressions for full-arch implant rehabilitation.


Assuntos
Implantes Dentários , Técnica de Moldagem Odontológica , Desenho Assistido por Computador , Materiais para Moldagem Odontológica , Modelos Dentários , Imageamento Tridimensional , Cintilografia
10.
Artigo em Japonês | MEDLINE | ID: mdl-32074528

RESUMO

Specific binding ratio (SBR) is mainly used as a quantitative index of dopamine transporter scintigraphy, although it was reported that standardized uptake value (SUV) is useful for clinical diagnosis in recent years. The aim of this study is to evaluate whether xSPECT is useful for SUV in dopamine transporter scintigraphy. xSPECT is a recently developed, high-resolution image reconstruction technique that transforms single photon emission computed tomography (SPECT) to a computed tomography (CT) coordinate system. Furthermore, low-penetration high-resolution (LPHR), which there has been no previous physical evaluation report was also evaluated. The radioactive concentration of the image with xSPECT is automatically calculated by the periodic sensitivity calibration and one volume sensitivity calibration. In the case of images with conventional reconstruction methods as filtered back projection (FBP) and ordered subset expectation maximization (OSEM), the calibration factor related to the photon count and radioactive concentration was calculated from measuring a cylinder phantom filled with Iodine-123. Radioactive concentrations of the SUV factor were measured by SPECT data acquisition with the striatal phantom in various conditions. Radioactive concentrations with conventional reconstruction methods had a lower value (for example, with FBP it was 7.53 kBq/ml, with OSEM it was 7.22 kBq/ml) compared to the actual measurement value, although that with xSPECT (12.45 kBq/ml) got close to the actual measurement value (14.68 kBq/ml). LPHR showed an approximation to low-energy high-resolution (LEHR) in terms of spatial resolution and scatter fraction estimated from energy windows. The quantitative accuracy of radioactive concentration was the highest under xSPECT.


Assuntos
Proteínas da Membrana Plasmática de Transporte de Dopamina , Processamento de Imagem Assistida por Computador , Cintilografia , Tomografia Computadorizada de Emissão de Fóton Único , Humanos , Imagens de Fantasmas , Tomografia Computadorizada por Raios X
11.
Urologe A ; 59(3): 261-265, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32030434

RESUMO

A primary, congenital megaureter means a dilatation of the ureter with a ureteric diameter ≥7 mm due to a structural or functional obstruction of the ureterovesical junction and represents the second most likely cause of neonatal hydronephrosis. Conservative management is the primary treatment option for many patients due to a high spontaneous remission rate of up to 85%. Concerning diagnostic management, meticulous and repeat postnatal evaluation by ultrasound is mandatory to identify patients who are at risk of renal deterioration. Routine voiding cystourethrography or contrast-enhanced voiding urosonography is currently recommended for all patients to detect vesicoureterorenal reflux and other concomitant pathologies. The relevance of the additional information provided by this examination must be critically questioned considering the lack of clinical consequences. Moreover, the question arises as to whether these examinations should be prolonged until clinical symptoms occur. Nevertheless, a subvesical obstruction should still be ruled out for male patients with a bilateral megaureter. The same critical discussion is necessary for the routine use of diuretic renography in patients with primary megaureter. In principal, this examination is used to determine the global as well as the split renal function and in addition is considered to offer an evaluation of the extent of obstruction. Similarly, the question arises of whether this examination should be mandatory for every child with a primary megaureter or whether the decision should be based on the extent of the upper urinary tract dilatation. The trend of diagnostic management should go towards individualized and risk-adapted diagnostic measures.


Assuntos
Hidronefrose/diagnóstico por imagem , Ureter/anormalidades , Doenças Ureterais/diagnóstico por imagem , Obstrução Ureteral/congênito , Criança , Humanos , Hidronefrose/terapia , Masculino , Cintilografia , Ultrassonografia Pré-Natal , Ureter/diagnóstico por imagem , Doenças Ureterais/terapia , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/terapia , Micção , Urografia/métodos
12.
Can Assoc Radiol J ; 71(2): 174-185, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063004

RESUMO

Spontaneous intracranial hypotension (SIH) is a significant cause of chronic, postural headaches. Spontaneous intracranial hypotension is generally believed to be associated with cerebrospinal fluid (CSF) leaks, and these leaks can be posttraumatic, iatrogenic, or idiopathic in origin. An integral part of the management of patients with this condition consists of localizing and stopping the leaks. Radiologists play a central role in the workup of this condition detecting leaks using computed tomography, magnetic resonance imaging, or nuclear imaging. In this article, we briefly review SIH and the various imaging modalities, which can be used to identify and localize a spontaneous CSF leak.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Cefaleia/diagnóstico por imagem , Hipotensão Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Mielografia/métodos , Tomografia Computadorizada por Raios X , Vazamento de Líquido Cefalorraquidiano/complicações , Cefaleia/etiologia , Humanos , Hipotensão Intracraniana/etiologia , Pressão Intracraniana , Imagem por Ressonância Magnética/métodos , Cintilografia/métodos , Tomografia Computadorizada por Raios X/métodos
13.
Can Assoc Radiol J ; 71(2): 149-153, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063019

RESUMO

Meckel diverticulum is the most common and well-known congenital anomaly of the digestive system. Although most cases are asymptomatic, Meckel diverticulum can have a variety of complications, including gastrointestinal bleeding as a result of peptic ulceration, diverticulitis, and small bowel obstruction. Although the radiologic findings of these complications have been reported, they are difficult to diagnose preoperatively because Meckel diverticulum is a small entity. Computed tomography and scintigraphy play an important role in the diagnosis of Meckel diverticulum and its complications. It is important to be familiar with the radiologic features of acute abdomen due to complications of Meckel diverticulum to be able to manage the condition appropriately.


Assuntos
Abdome Agudo/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Divertículo Ileal/diagnóstico por imagem , Abdome Agudo/etiologia , Diverticulite/diagnóstico por imagem , Diverticulite/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Obstrução Intestinal/etiologia , Divertículo Ileal/complicações , Cintilografia , Tomografia Computadorizada por Raios X
15.
BMC Oral Health ; 20(1): 10, 2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914986

RESUMO

BACKGROUND: The concentration and persisting time of antimicrobial agents in the periodontal pockets are important factors for their antimicrobial efficacy. Increased clearance time in the periodontal pocket is a significant criterion for the selection of intrapocket irrigants. The aim of this study was to estimate the clearance time of a cationic agent from the periodontal pocket. METHODS: Thallium-201(Tl-201) was chosen as a tracer to simulate the clearance of cationic substance because of its electrical activity. Twenty patients with periodontitis and probing depths 6 to 9 mm were included in this study. In each patient, 3 Mega Becquerel (MBq) of Tl-201 were inserted into the periodontal pocket. Dynamic imaging was performed and clearance of radioactivity was measured. RESULTS: Clearance of radioactivity was 67.1 ± 16.9, 83.1 ± 13.9, 90.4 ± 10.4, 93.39 ± 8.0% at 30, 60, 90 and 120 min, respectively. Half-life of wash-out was determined as 20.3 ± 10.2 min. CONCLUSION: The results of this study demonstrate that the half-life of the cationic solution applied subgingivally was approximately 20 min and labelling of oral irrigants with radiotracers may be used to determine their clearance in further research.


Assuntos
Bolsa Periodontal/diagnóstico por imagem , Bolsa Periodontal/metabolismo , Periodontite/tratamento farmacológico , Radioisótopos de Tálio , Irrigação Terapêutica , Meia-Vida , Humanos , Taxa de Depuração Metabólica , Periodontite/microbiologia , Cintilografia , Fatores de Tempo
16.
Medicine (Baltimore) ; 99(4): e18905, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977903

RESUMO

Although pathological confirmation is the gold standard for diagnosis of amyloidosis, there is a need for a relevant imaging modality to identify involved organs and evaluate disease extent. Thus, we prospectively investigated imaging findings of Tc-DPD scintigraphy in AL and ATTR amyloidosis.A total of 21 subjects with pathologically confirmed AL or ATTR amyloidosis were included. Pretreatment whole body Tc-DPD planar scanning and regional SPECT/CT were performed in all subjects. For allegedly involved organs, Tc-DPD uptake was visually and semi-quantitatively evaluated on a 4-point scale (grade 0: no uptake, 1: uptake less than spine, 2: uptake similar to spine, and 3: uptake greater than spine).There were 29 organs involved in AL and 12 in ATTR. Significant Tc-DPD uptake was found in 24 organs (sensitivity = 82.8%) in AL and 9 organs (sensitivity = 75.0%) in ATTR. Additional SPECT/CT was helpful to ensure abnormal DPD uptake in the involved organs, which was uncertain by attenuation in planar imaging. Degree of Tc-DPD uptake was significantly higher in ATTR compared with AL amyloidosis (P = .017). Diffuse soft tissue uptake with photon defects in the liver area was found only in ATTR amyloidosis.This study showed that Tc-DPD scintigraphy might have capacity to differentiate between AL and ATTR subtypes with good sensitivity in various organs involving primary systemic AL and ATTR amyloidosis. Additional SPECT/CT significantly improved the diagnostic efficacy of Tc-DPD scintigraphy.


Assuntos
Neuropatias Amiloides Familiares/diagnóstico por imagem , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Cintilografia/métodos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos de Organotecnécio/administração & dosagem , Imagem Corporal Total
17.
Ann R Coll Surg Engl ; 102(4): 294-299, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31918555

RESUMO

INTRODUCTION: Accurate localisation of the abnormal hyperfunctioning gland with preoperative imaging has a critical role in parathyroid surgery to obtain a successful outcome. This study aimed to evaluate the diagnostic performance of second-line imaging and their contribution to the treatment success in primary hyperparathyroidism when the first-line methods were negative or discordant. METHODS: Among the patients who underwent parathyroidectomy due to primary hyperparathyroidism, 33 who underwent four-dimensional computed tomography and/or four-dimensional magnetic resonance imaging because of negative or discordant first-line imaging results were included. Persistent and recurrent cases were excluded. RESULTS: The majority of the patients were female (84.8%) and the mean age was 59.2 years. Seventeen patients had four-dimensional computed tomography and 25 had four-dimensional magnetic resonance imaging, respectively. Four-dimensional computed tomography and four-dimensional magnetic resonance imaging localised the culprit gland successfully in 52.9% and 84%, respectively. Twenty-five patients in whom single adenoma was detected underwent focused parathyroidectomy. The culprit gland was solitary in 32 cases and one patient had double adenoma. Normocalcaemia was achieved in all cases. Among the 29 patients who completed their postoperative sixth month success rate was 100%. CONCLUSION: Four-dimensional magnetic resonance imaging had high accuracy with fast dynamic imaging in detecting parathyroid adenomas. When the first-line imaging methods were negative or inconclusive, four-dimensional magnetic resonance imaging should be considered primarily since it is cost effective in Turkey and emits no radiation.


Assuntos
Tomografia Computadorizada Quadridimensional , Hiperparatireoidismo Primário/cirurgia , Imagem por Ressonância Magnética/métodos , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Imagem por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico , Valor Preditivo dos Testes , Cintilografia/economia , Sensibilidade e Especificidade , Turquia , Ultrassonografia/economia
18.
Medicine (Baltimore) ; 99(2): e18681, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914064

RESUMO

Hyperparathyroidism is a common endocrine disorder. The precise localization of causal parathyroid gland is crucial to guide surgical treatment. Several studies report the added value of 18F-fluorocholine (FCH) positron emission tomography-computed tomography (PET/CT) as second line imaging but rely on suboptimal first-line imaging using 99mTc-sestaMIBI dual phase scintigraphy. The aim of this study is to evaluate the percentage of successful parathyroid localization with FCH PET/CT after failure of a more sensitive first-line detection protocol associating neck ultrasonography and 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy.We included retrospectively 47 patients who underwent a FCH PET/CT as second line imaging for biologically proven primary hyperparathyroidism from November 2016 to October 2018 in Godinot Institute (Reims, France). 99mTc-Pertechnetate/99mTc-sestaMIBI dual tracer subtraction scintigraphy and neck ultrasonography were used as first-line imaging and failed to localize the causal parathyroid lesion in all cases.FCH PET/CT demonstrated at least 1 parathyroid target lesion in 29 patients (62%). 21/29 patients underwent surgery. Target lesions corresponded histologically to hyperfunctioning parathyroid glands for all 21 patients and surgery was followed by hyperparathyroidism biological resolution. Calcium serum levels were associated to FCH PET/CT positivity (P = .002) and a trend toward significance was seen for Parathyroid hormone (PTH) levels (P = .09).FCH PET/CT is a promising tool in second-line parathyroid imaging. Large prospective studies and cost-effectiveness analyses are needed to precise its role.


Assuntos
Colina/análogos & derivados , Radioisótopos de Flúor/administração & dosagem , Hiperparatireoidismo/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Idoso de 80 Anos ou mais , Colina/administração & dosagem , Feminino , Humanos , Hiperparatireoidismo/patologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/patologia , Cintilografia/métodos , Estudos Retrospectivos , Tecnécio Tc 99m Sestamibi/administração & dosagem
19.
Am J Physiol Gastrointest Liver Physiol ; 318(1): G203-G209, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31682161

RESUMO

Our aim was to investigate the feasibility of measuring antral contractions and duodenal bolus propagation (DBP) during dynamic antral contraction scintigraphy (DACS) as an assessment of antro-pyloro-duodenal coordination (APDC). Gastric emptying scintigraphy (GES) with DACS was performed with Tc-99m sulfur colloid (SC) using increasing doses of 74 MBq (2 mCi) for 10 subjects, 185 MBq (5 mCi) for 11, and 370 MBq (10 mCi) for 11. DACS was performed for 10 min after static images at 0, 30, 60, 120, 180, and 240 min in anterior and right anterior oblique (RAO) projections. Best projection and lowest dose of Tc-99m SC were assessed visually. DBP were quantified utilizing duodenal activity peaks from a region of interest in the first portion of the duodenum. DBP was better visualized in the RAO projection than anterior projection and using 185 MBq (5 mCi) and 370 MBq (10 mCi) compared with 74 MBq (2 mCi). DBP showed infrequent and irregular bolus transfers from the antrum to the duodenum. Antral activity peaks at 60 min averaged 2.91 ± 0.66 per minute and duodenum bolus peaks 0.36 ± 0.18 per minute (ratio 0.36/2.91 = 0.12). DBP activity peaks can be measured during GES with DACS but requires a 185-MBq (5 mCi) dose of Tc-99m SC radiolabeled test meal for adequate DBP signal detection and is better imaged in RAO than anterior projection. DBPs over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess APDC.NEW & NOTEWORTHY This study shows that duodenal bolus propagations after meal ingestion can be measured during gastric emptying scintigraphy using dynamic scintigraphy. Duodenal bolus propagation over the first 60 min postmeal ingestion are infrequent with only 12% of the antral contractions propagating into the duodenum. This methodology appears promising to assess antropyloroduodenal coordination in patients with unexplained symptoms of upper gastrointestinal dysmotility.


Assuntos
Duodeno/diagnóstico por imagem , Duodeno/fisiologia , Esvaziamento Gástrico , Trânsito Gastrointestinal , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/fisiologia , Cintilografia , Compostos Radiofarmacêuticos/administração & dosagem , Coloide de Enxofre Marcado com Tecnécio Tc 99m/administração & dosagem , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Tempo , Adulto Jovem
20.
AJR Am J Roentgenol ; 214(1): 185-193, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31593516

RESUMO

OBJECTIVE. The purpose of this study was to determine whether application of a proprietary image-processing algorithm would allow a reduction in the necessary administered activity for molecular breast imaging (MBI) examinations. MATERIALS AND METHODS. Images from standard-dose MBI examinations (300 MBq 99mTc-sestamibi) of 50 subjects were analyzed. The images were acquired in dynamic mode and showed at least one breast lesion. Half-dose MBI examinations were simulated by summing one-half of the dynamic frames and were processed with the algorithm under study in both a default and a preferred filter mode. Two breast radiologists independently completed a set of two-alternative forced-choice tasks to compare lesion conspicuity on standard-dose images, half-dose images, and the algorithm-processed half-dose images in both modes. RESULTS. Relative to the standard-dose images, the half-dose images were preferred in 4, the default-filtered half-dose images in 50, and preferred-filtered half-dose images in 76 of 100 readings. Compared with standard-dose images, in terms of lesion conspicuity, the half-dose images were rated better in 2, equivalent in 6, and poorer in 92 of 100 readings. The default-filtered half-dose images were rated better, equivalent, or poorer in 13, 73, and 14 of 100 readings. The preferred-filtered half-dose images were rated as better, equivalent, or poorer in 55, 34, and 11 of 100 readings. CONCLUSION. Compared with that on standard-dose images, lesion conspicuity on images obtained with the algorithm and acquired at one-half the standard dose was equivalent or better without compromise of image quality. The algorithm can also be used to decrease imaging time with a resulting increase in patient comfort and throughput.


Assuntos
Algoritmos , Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imagem Molecular/métodos , Doses de Radiação , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Cintilografia
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