False Positive in [ 99m Tc]Tc-DPD Scintigraphy for Cardiac Amyloidosis Due to Intravenous Iron Administration.

ABSTRACT: [ 99m Tc]Tc-DPD (3,3-diphosphono-1,2-propanodicarboxylic acid) scintigraphy is an essential tool for diagnosing transthyretin amyloid cardiac amyloidosis. An 86-year-old woman suffering from heart failure with preserved ejection fraction underwent [ 99m Tc]Tc-DPD scintigraphy and a SPECT/CT for suspected transthyretin amyloid cardiac amyloidosis. The scan showed intracardiac and liver uptake. As the patient had taken intravenous iron on the morning of the scan, we decided to repeat the scan, but this time, it showed no uptake in the heart or the liver. Accordingly, we concluded the first result was a false positive due to drug interaction.

An Interuniversity Competition for Medical Students to Learn Radiology in the Second Life Metaverse.

PURPOSE: The aim of this study was to evaluate an interuniversity competition online to learn radiology held in a 3-D virtual world, the Second Life metaverse, by analyzing the results of the game and students' perceptions. METHODS: Medical students voluntarily participated in teams of four, for 6 weeks, successively covering radiologic anatomy and radiologic semiology of the chest, abdomen, and musculoskeletal. Each week, participants had 4.5 days to study self-learning presentations and 2.5 days to complete an individual multiple-choice test and a team task, the results of which determined the game's ranking. Participants were asked to complete a cognitive-load test, a perception questionnaire, and a postexposure knowledge test. RESULTS: The competition was repeated for 2 years (editions), in 2020 and 2021. Seventy-five of 102 teams (73.5%) registered completed the game; 76% of them included third-year students. The average percentage of correct answers in the individual tests and team tasks was 74.2 ± 15.1 and 71.6 ± 14.7 respectively, without significant differences between both competitions. In general, the experience was valued positively (scores >8 on a 10-point scale). A lower perception score was found in 2021 among students from universities other than the organizing university, showing a positive correlation with the in-game score. CONCLUSIONS: An interuniversity competition in the Second Life metaverse for undergraduate learning radiology is feasible and reproducible. Participating medical students considered it interesting and useful and also identified this activity during the 2 years of the coronavirus disease 2019 pandemic as a playful learning and social interaction experience.

Training Scientific Communication Skills on Medical Imaging within the Virtual World Second Life: Perception of Biomedical Engineering Students.

Second Life is a multi-user virtual world platform which enables online learning through immersive activities. This study evaluates the perception of third-year biomedical engineering students about learning activities complementary to a biomedical imaging course carried out within Second Life and focused on training in the public presentation of scientific content to their peers. Between 2015 and 2017, students gave oral presentations on medical imaging topics selected from the proposals of their classmates. Participants were invited to complete an evaluation questionnaire. In the three years of the study, 133 students enrolled in the course (48, 46, and 39 consecutively), and 97 of them delivered the questionnaire (48%, 83%, and 92%, consecutively). Attendance at the sessions ranged between 88% and 44%. The students positively value the experiences, especially the teacher, the educational content, and the virtual island environment, with mean scores greater than or equal to 8.4, 7.7, and 7.7, respectively, on a 1-10-point scale. Overall, they valued Second Life as an attractive and suitable environment for their training in science communication skills, in which they gain self-confidence and are less afraid of speaking in public. Second Life enables students to present scientific content effectively to their peers, receiving hands-on training in the tasks of collecting, organizing, and presenting data, with the benefits of remote access, collaborative work, and social interaction.

Diagnostic relevance of 2-[18 F]-FDG PET/CT in patients recently diagnosed with monoclonal gammopathy of undetermined significance.

2-[18 F]-FDG PET/CT is a useful diagnostic technique to assess bone and soft tissue disease in multiple myeloma (MM) but is not recommended by the International Myeloma Working Group for the evaluation of monoclonal gammopathy of undetermined significance (MGUS). The objective of this study was to evaluate the role of 2-[18 F]-FDG PET/CT in the management of these patients. An observational retrospective study was conducted on 338 patients with MGUS who underwent 2-[18 F]-FDG PET/CT. The mean age was 70.80 ± 11.84 years, and 69.2% of patients had cardiovascular risk factors. Patients were classified according to their progression risk (Mayo Clinic). The mean post-diagnosis follow-up was 8.35 ± 14.46 months. Pathological findings were recorded in 49 patients: 30 with myeloma bone lesions (15 in the initial study and 15 in follow-up) and 19 with other neoplastic (n = 13) or pathologically significant findings (n = 6). Body mass index, monoclonal component rate (MCR) > 1 g/dL and ≥1 risk factors for MM were significant in univariate logistic regression analyses. The MCR emerged as the main predictor of a positive 2-[18 F]-FDG PET/CT in adjusted multivariate regression analysis, with an area under the receiver operating characteristic curve of 0.785 and cutoff for optimal sensitivity/specificity of 1.0 ng/mL (71.4% sensitivity, 71.2% specificity). 2-[18 F]-FDG PET/CT results correctly classify patients with MGUS and could improve the detection of bone lesions over existing techniques, with the additional possibility of detecting neoplastic processes. The best parameter to predict a positive 2-[18 F]-FDG PET/CT was the MCR.

[18F]FDG PET/CT in Short-Term Complications of COVID-19: Metabolic Markers of Persistent Inflammation and Impaired Respiratory Function.

SARS-CoV-2 virus infects organs other than the lung, such as mediastinal lymph nodes, spleen, and liver, but, to date, metabolic imaging studies obtained in short-term follow-ups of patients hospitalized with severe COVID-19 infection are rare. Our objective was to evaluate the usefulness of [18F]FDG-PET/CT in the short-term follow-up of patients admitted for COVID-19 pneumonia and to explore the association of the findings with clinical prognostic markers. The prospective study included 20 patients with COVID-19 pneumonia (November 2020-March 2021). Clinical and laboratory test findings were gathered at admission, 48-72 h post-admission, and 2-3 months post-discharge, when [18F]FDG-PET/CT and respiratory function tests were performed. Lung volumes, spirometry, lung diffusion capacity for carbon monoxide (DLCO), and respiratory muscle strength were measured. Volumetric [18F]FDG-PET/CT results were correlated with laboratory and respiratory parameters. Eleven [18F]FDG-PET/CT (55%) were positive, with hypermetabolic mediastinal lymphadenopathy in 90.9%. Mediastinal lesion's SUVpeak was correlated with white cells' count. Eleven (55%) patients had impaired respiratory function, including reduced DLCO (35%). SUVpeak was correlated with %predicted-DLCO. TLG was negatively correlated with %predicted-DLCO and TLC. In the short-term follow-up of patients hospitalized for COVID-19 pneumonia, [18F]FDG-PET/CT findings revealed significant detectable inflammation in lungs and mediastinal lymph nodes that correlated with pulmonary function impairment in more than half of the patients.

Dual-Phase 18F-Florbetaben PET/CT: Unsuspected Thalamic Infarction Mimicking Alzheimer Disease.

ABSTRACT: Dual-phase amyloid PET is considered a useful protocol to study patients with cognitive impairment. Early-phase 18F-florbetaben PET/CT has been proposed as a surrogate of 18F-FDG PET/CT providing information related to regional brain perfusion. We report the case of a 61-year-old woman referred to the cognitive impairment unit for study, preliminary diagnosed as probable Alzheimer disease. The dual-phase 18F-florbetaben PET/CT was shown as the main finding, no uptake in the left anterior thalamus. Memory and language symptoms have been described as primary clinical features of anterior thalamic infarctions that could be confused with the main manifestations of Alzheimer disease.

Impact of compulsory participation of medical students in a multiuser online game to learn radiological anatomy and radiological signs within the virtual world Second Life.

Competitive game-based learning within Second Life enables effective teaching of basic radiological anatomy and radiological signs to medical students, with good acceptance and results when students participate voluntarily, but unknown in a compulsory context. The objectives of this study were to reproduce a competitive online game based on self-guided presentations and multiple-choice tests in a mandatory format, to evaluate its development and student perceptions compared to a voluntary edition in 2015 (N = 90). In 2016 and 2017, respectively, 191 and 182 third-year medical students participated in the game as a mandatory course activity. The mean (±SD) score of the game was 74.7% (±19.5%) in 2015, 71.2% (±21.5%) in 2016, and 67.5% (±21.5%) in 2017 (P < 0.01). Participants valued positively the organization and educational contents but found the virtual world less attractive and the game less interesting than in the voluntary edition. The experience globally was rated with 8.2 (±1.5), 7.8 (±1.5), and 7.1 (±1.7) mean points (±SD) in a ten-point scale, in the 2015, 2016, and 2017 editions, respectively (P < 0.05). Competitive learning games within virtual worlds like Second Life have great learning potential in radiology, but the mean score in the game decreased, acceptance of virtual world technology was lower, and opinion about the game was worse with a compulsory participation, and even worse when dropouts were not allowed. Under the conditions in which this study was conducted, learning games in three-dimensional virtual environments should be voluntary to maintain adequate motivation and engagement of medical students.

A team-based competition for undergraduate medical students to learn radiology within the virtual world Second Life.

BACKGROUND: A multi-user competitive game within the virtual world Second Life for undergraduate radiology learning was adapted for team participation. This study aimed to assess student perception, impact on learning, and eventual correlation of game results with post-exposure tests and course grades. METHODS: The game consisted of six weekly stages, dedicated to thoracic, abdominal, and musculoskeletal radiological anatomy and semiology. Participants had several days a week to review self-guided radiology educational content and then complete individual multiple-choice tests and solve team tasks to progress through the game's ranking. Additionally, they completed a cognitive load test, a questionnaire about the experience and a post-exposure knowledge test. RESULTS: Fifty-two students organised into 13 teams participated in the game and assessed different aspects of the experience with a mean score ≥ 7.8 on a 10-point scale, highlighting the participation of the teacher (9.3 ± 1.1), the educational contents (8.8 ± 1.4) and the usefulness for their education (8.7 ± 1.4). Participants obtained better post-exposure test results (p < 0.007) and better course grades (p < 0.021) than non-participants did. CONCLUSION: A multi-user game adapted to team competition to learn radiology in Second Life was very positively perceived by third-year medical students, who highly valued its content, organisation, and usefulness for their training. Most of the participants agreed that they had collaborated as a team and that playing in competitive environments helps them learn better. The best post-exposure and academic results compared to non-participating students indicate the potential impact of the game on learning.

Differential Diagnosis of Hepatic Mass with Central Scar: Focal Nodular Hyperplasia Mimicking Fibrolamellar Hepatocellular Carcinoma.

Fibrolamellar hepatocellular carcinoma is a primary hepatic tumor that usually appears in young adults. Radical surgery is considered curative for this kind of tumor, so early diagnosis becomes essential for the prognosis of the patients. The main characteristic of this entity is the central scar, which is the center of differential diagnosis. We report the case of a 30-year-old man who was diagnosed with fibrolamellar hepatocellular carcinoma by ultrasonography. Contrast-enhanced CT confirmed this diagnosis, and the patient underwent a [18F] fluorocholine PET/CT. Hypermetabolism and the morphology in the nuclear medicine exploration suggest neoplastic nature of the lesion. Radical surgery was performed, and histopathologic analysis was performed, which resulted in focal nodular hyperplasia. Hepatic masses with central scar could have a difficult differential diagnosis, and focal nodular hyperplasia could mimic fibrolamellar hepatocellular carcinoma imaging patterns. These morphofunctional characteristics have not been described in [18F] Fluorocholine PET/CT, so there is a need to find out the potential role PET/CT in the differential diagnosis of hepatic mass with central scar.

Game-Based Learning in Virtual Worlds: A Multiuser Online Game for Medical Undergraduate Radiology Education within Second Life.

Game-based learning can have a positive impact on medical education, and virtual worlds have great potential for supporting immersive online games. It is necessary to reinforce current medical students' knowledge about radiological anatomy and radiological signs. To meet this need, the objectives of this study were: to design a competition-based game in the virtual world, Second Life and to analyze the students' perceptions of Second Life and the game, as well as to analyze the medium-term retention of knowledge and the potential impact on the final grades. Ninety out of 197 (45.6%) third-year medical students voluntarily participated in an online game based on self-guided presentations and multiple-choice tests over six 6-day stages. Participants and non-participants were invited to perform an evaluation questionnaire about the experience and a post-exposure knowledge test. Participants rated the experience with mean scores equal to or higher than 8.1 on a 10-point scale, highlighting the professor (9.5 ± 1.1; mean ± SD) and the virtual environment (8.9 ± 1.1). Participants had better results in the post-exposure test than non-participants (59.0 ± 13.5 versus 45.3 ± 11.5; P < 0.001) and a lower percentage of answers left blank (6.7 ± 8.4 versus 13.1 ± 12.9; P = 0.014). Competitive game-based learning within Second Life is an effective and well-accepted means of teaching core radiological anatomy and radiological signs content to medical students. The higher medium-term outcomes obtained by participants may indicate effective learning with the game. Additionally, valuable positive perceptions about the game, the educational contents, and the potential benefit for their education were discovered among non-participants.

Medical Student Education for Abdominal Radiographs in a 3D Virtual Classroom Versus Traditional Classroom: A Randomized Controlled Trial.

OBJECTIVE. The purpose of this article is to compare the effectiveness of practical radiology learning by medical students in a 3D virtual world versus the real world. SUBJECTS AND METHODS. Two hundred fifteen 3rd-year medical students were randomized into two groups to attend the same workshop on abdominal radiography interpretation in a virtual world classroom (VW group) and in real life (RL group). Pre- and post-training knowledge tests consisting of 12 multiple choice questions were performed at the beginning of the workshop and 2 months later. RESULTS. Fifty-four of 107 and five of 108 students refused to attend their respective group, resulting in the participation of 53 students (VW group) and 103 students (RL group) in this study. No significant differences were found between groups in the tests taken before (VW group, mean [± SD], 4.5 ± 1.8 points; RL group, 4.0 ± 1.3 points) and after (VW group, 6.2 ± 1.2; RL group, 6.0 ± 1.7 points) training. CONCLUSION. Radiology education in a 3D virtual classroom fosters participatory learning and results in similar acquisition of interpretive skills as a traditional face-to-face classroom. Virtual worlds allow the performance of online activities to learn interpretive skills with guaranteed success in learning similar to that of conventional activities. Additionally, the relative lack of identity in the virtual workshops makes students less afraid to speak and more participatory.