Pleuropericardial Cyst Mimicking a Metastasis of Differentiated Thyroid Carcinoma on Whole-Body Iodine-131 Scan: a Case Report.

Post-therapeutic whole-body scan (WBS) with I-131 has been widely used for the follow-up of patients with well-differentiated thyroid cancer (DTC). Although the sensitivity of WBS with I-131 in detection of functioning thyroid tissues is high, its specificity is low. So, a further evaluation is required in cases of unexpected findings. The purpose of the study was to demonstrate that awareness of the potential pitfalls of WBS in DTC, knowledge of physiology and characteristics of radioiodine uptake, and correlation with other imaging modalities are needed to avoid incorrect management of patients with DTC. This is a case report of a 49-year-old woman with an unexpected area of increased I-131 uptake in the posterior lower chest, which was finally diagnosed as a pleuropericardial cyst. Due to the false-positive uptake of I-131 in the chest, an accurate interpretation of the scintigraphic findings should be made.

Hybrid cardiac imaging: insights in the dilemma of the appropriate clinical management of patients with suspected coronary artery disease.

AIM: To evaluate the potential of SPECT myocardial perfusion imaging (MPI)-computed tomography coronary angiography (CTCA) hybrid fusion imaging to improve the diagnostic performance of cardiac SPECT/MPI and CTCA alone in order to act as more accurate gate keeper to further investigation invasive or not. METHODS AND RESULTS: Twenty-five patients were subjected to SPECT/MPI and CTCA within a period of 1 month without any medical treatment modification. A fusion software package was used for cardiac SPECT-CTCA image fusion. Semiquantitative analysis was performed for cardiac SPECT, CTCA and SPECT/MPI-CTCA fusion images. Patients were classified in 2 groups according to the clinical decision for further investigation (group A), or not (group B). Statistically significant differences were observed when SPECT/MPI-CTCA fusion images were used instead of cardiac SPECT alone (p<0.05). No statistically significant differences were observed comparing CTCA alone to SPECT/MPI-CTCA fusion images (p=0.25). A mid-term follow-up (mean 3.58 ± 0.24 years) showed that all patients classified in group A based on the interpretation of SPECT MPI-CTCA fused images underwent conventional coronary angiography with further necessity for PTCA or CABG whereas absence of major or minor cardiac events was revealed for all patients of group B. CONCLUSION: In patients suspected for coronary artery disease, cardiac SPECT/MPI-CTCA fusion imaging was found to considerably alter the clinical decision for referral to further investigation derived from SPECT/MPI.

Sustained improvement of vascular endothelial function during anti-TNFalpha treatment in rheumatoid arthritis patients.

OBJECTIVES: Vascular endothelial function and common carotid artery intima-medial thickness (CCA-IMT) are well-established surrogate markers for early atherosclerotic disease, which accounts for 30-40% of excess mortality in rheumatoid arthritis (RA) patients. Our aim was to investigate whether long-term treatment with anti-tumour necrosis factor (TNF)alpha agents can modulate endothelial function and CCA-IMT. METHODS: Twelve patients with RA (mean age 54.8+/-15 years) on anti-TNFalpha treatment (seven adalimumab, five infliximab) due to uncontrolled disease activity, with mean Disease Activity Score (DAS28) 5.7 (range 4.6-6.9) despite disease-modifying anti-rheumatic drugs (DMARDs), were studied prospectively. Patients were assessed at baseline and after 3 and 18 months for endothelial-dependent vasodilatation, assessed by flow-mediated vasodilatation (FMD), endothelial-independent vasodilatation and CCA-IMT. RA disease activity and response to therapy were assessed by the DAS28 index. RESULTS: After 18 months of treatment, 67% of the patients were responders according to European League Against Rheumatism (EULAR) response criteria. Anti-TNFalpha treatment improved FMD (from 7+/-4.3% to 11.1+/-3.8%, p = 0.026) whereas CCA-IMT did not change significantly [from 0.67 (0.4-1) to 0.68 (0.39-1.2) mm; mean change 0.01 (-0.06 to 0.08) mm]. Endothelial-independent vasodilatation remained stable (20.4+/-7.3% to 22.9+/-6.5%, p = 0.4). CONCLUSIONS: In this small cohort of patients with RA and no clinically overt cardiovascular disease (CVD), after 18 months of treatment with anti-TNFalpha agents, endothelial function improved significantly while CCA-IMT remained stable. Longitudinal studies using more patients are needed to determine the clinical significance of these findings in relation to the risk of atherosclerosis.