A Different Scintigraphic Perspective on the Systolic Function of the Left Ventricle-1.

Objectives: The aim of this study was to analyze the systolic part of the left ventricular (LV) volume curve obtained by gated myocardial perfusion imaging with the formula used in exponential decay and to investigate the clinical value of the results. Methods: One hundred fifty eight patients were retrospectively enrolled in the study. The study group was divided into three groups as normal, ischemia, and infarct. The systolic portion of the LV volume curve was also analyzed using the exponential decay formula. The scintigraphic parameter obtained using this formula is called the ejection constant (Ec). Results: The Ec results were 1.8±0.8, 2.7±0.9, 3.5±1 in infarct, ischemia, and normal groups, respectively, and the difference in Ec results between the groups was statistically significant (p≤0.001). Conclusion: It appears that Ec may play a clinical role as a scintigraphic parameter in the evaluation of systolic functions of the left ventricle.

Correlation of Morphological and Functional Cardiac Images: Fusion of Myocardial Perfusion SPECT and CT Angiography.

Objectives: The current study evaluates the value of cardiac hybrid imaging (CHI), performed by the fusion of functional and anatomic cardiac images, in the detection of hemodynamically significant coronary stenosis in cases with multiple coronary stenosis. Methods: A total of 36 patients (10 female, 26 male) in whom ischemia or infarction was detected on gated myocardial perfusion single photon emission computed tomography (gMPS) and multiple coronary stenosis were concomitantly detected on coronary computed tomography angiography (CCTA) and undergone invasive coronary angiography (ICA) was included in this study. Statistical analyses were performed using SPSS 22 Windows software. McNemar test was applied to show concordance between coronary CT angiography, ICA and CHI in the detection of anatomically or hemodynamically significant stenosis in three major coronary arteries. Comparison results of coronary arteries responsible for perfusion defects on CHI and gMPS are presented as percentages (%). Results: There was total accordance between coronary arteries leading to perfusion defects detected by gMPS and CHI in 50% of patients. It was observed a partial accordance in 36.1% of the patients. Additionally, it was also detected perfusion defects originated from side branches in 25% of the patients. Between results of CCTA and ICA, no statistically significant difference was noted in the detection of anatomically significant stenoses in the left main coronary artery, left anterior descending artery (LAD), left circumflex artery (LCx) and right coronary artery (RCA) (p=1.000, 0.070, 0.549, and 1.000, respectively). In addition, no statistically significant difference was found in the detection of anatomically and hemodynamically significant stenoses in LAD, LCx and RCA by CCTA and CHI (p=0.344, 0.629, and 0.219, respectively). No statistically significant difference was observed in the detection of anatomically and hemodynamically significant stenoses in LAD, LCx and RCA by ICA and CHI (p=0.804, 1.000, and 0.344, respectively). Conclusion: It is possible to detect hemodynamically significant coronary stenosis directly by CHI modality in patients with multiple coronary stenosis, wide perfusion defects.

Prognostic risk factors for rare oncocytic variantin 101 cases of papillary thyroid carcinoma.

OBJECTIVE: Oncocytic variant (OV) is an unusual subtype of papillary thyroid cancer whose histopathologic diagnostic criteria, clinicopathologic features and biological behavior are different and have not been comprehensively studied, characterized in literature. Previous studies present conflicting results upon its prognosis. We investigated demographic and clinicopathologic risk factors affecting its prognosis while presenting our clinical experience. SUBJECTS AND METHODS: This is a retrospective cohort study reviewing 101 patients of OV from an archive of 4500 well-differentiated thyroid cancer patients treated with iodine-131 (131I) between 1991 and 2017. Predefined parameters of age, gender, tumor size (TS), total 131I dose, time to recurrent disease, overall survival, extrathyroidal extension, multifocality, vascular invasion, accompanying other variants, capsular status of thyroid gland, initial cervical lymph node (LN) metastases, preablation stimulated thyroglobulin level, background thyroiditis and stage were evaluated by statistical comparison between metastatic and nonmetastatic groups. RESULTS: Seventeen cases (17%) developed metastases/recurrence, 70% of the recurrences occured before 24 months. Four patients (4%) died during the follow-up. Metastatic sites were usually cervical LN, local recurrence in thyroid bed and lungs. Multivariate analysis revealed stage (IV) and TS were the main parameters impacting recurrence/metastases. In the follow-up, isolated cervical LN metastases were found in 41% of metastatic cases, while 12% had sole recurrence in thyroid bed. Eighty eight percent of the metastatic disease included locoregional (cervical) and/or remote LN. The recurrences were associated with initial thyroid masses greater than 3.5cm in diameter. CONCLUSION: We found that the prognosis of OV is not poor in our series. Stage (IV) and tumor size are the main risk factors in metastatic development.

Giant Abdominal Aortic Aneurysm in Bone Scan

Abdominal aortic aneurysm (AAA) may be incidentally detected in three-phased bone scintigraphy. AAA should be diagnosed prior to the development of symptoms to perform elective repair surgery. We present a rare case who presented with back pain and underwent a 3-phase bone scan with Tc-99m methylene diphosphonate, which revealed a giant AAA on blood-flow and blood-pool phases in addition to bone metastases. F-18-fluorodeoxyglucose positron emission tomography/computed tomography (CT) identified hypermetabolic liver, lung, and bone lesions, and CT component of the study confirmed the diagnosis of AAA with a maximum diameter of 92 mm. The initial two phases of a 3-phase bone scintigraphy are decisive to identify vascular pathologies that may be life-threatening, if left untreated.

Earlier Phases of Bone Scintigraphy Can Better Delineate the Extent of Soft Tissue Involvement of Bone Metastasis.

Three-phase bone scintigraphy is sometimes of great value in the detection of uncharacteristic metastases and assists the management of patients in terms of primary focus detection. While evaluating the skeletal system with whole-body bone scintigraphy, other system pathologies may also be detected incidentally. In this case, we present the extraordinary findings on the 3-phase MDP bone scintigraphy and F-FDG PET/CT imaging of the complicated bone metastases in a patient with thyroid carcinoma.

Sphenoid Bone Fibrous Dysplasia Detected Incidentally on Bone Scintigraphy by the Contribution of SPECT/CT Hybrid Imaging.

Fibrous dysplasia (FD) is a benign fibroosseous bone disorder. It has poliostotic and monostotic patterns. Monostotic FD is frequently asymptomatic and is usually discovered incidentally by radiologic imaging performed for other reasons. Bone scintigraphy is valuable for identifying disease extent. Craniofacial FD (CFD) is a form of the disease where lesions are limited to contiguous bones of the craniofacial skeleton. We presented a case with monostotic CFD who was detected incidentally on bone scintigraphy single-photon emission computed tomography/computerized tomography while being investigated for inflammatory arthropaties.

Risk factors and stratification for recurrence of patients with differentiated thyroid cancer, elevated thyroglobulin and negative I-131 whole-body scan, by restaging 18F-FDG PET/CT.

OBJECTIVE: In nearly 20%-30% of patients with differentiated thyroid carcinoma (DTC) relapse and 7% of them die during the next 10 years after initial diagnosis. In 10%-30% of patients with DTC after ablation therapy during the follow-up show a negative iodine-131 (131I) whole-body screening test (131I WBS) and increased serum thyroglobulin (Tg) level. Loss of ability of DTC metastatic lesions to trap 131I is associated with pure survival and often aggressive disease. Several studies have shown that in DTC cases non trapping 131I, fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) can detect recurrence or metastases with high sensitivity (80%-90%). The purpose of this study was to investigate the clinicopathologic features and other related risk factors of patients with DTC having elevated Tg levels and negative 131I WBS in which recurrence was detected by 18F-FDG PET/CT. We tried to study and stratify patients in this grey zone who could benefit from 18F-FDG PET/CT for the detection of metastases/recurrence according to predefined risk factors not investigated by other researchers. SUBJECTS AND METHODS: We studied retrospectively 165 DTC patients with elevated Tg levels and a negative 131I WBS during their follow-up between 2004-2015. Metastases/recurrence was found in 49% of the patients on restaging with 18F-FDG PET/CT and were compared with nonmetastatic group according to predefined risk factors. These factors were also evaluated in true positive and false negative cases. RESULTS: The sensitivity and specificity of 18F-FDG PET/CT for detecting recurrent/metastatic disease were 90% and 98.5%, respectively. No apparent predefined risk factor impacting a false negative 18F-FDG PET/CT was found. Findings in follicular carcinoma, Hürtle cell carcinoma and papillary carcinoma were not different from positive PET findings. The variants of papillary carcinoma also had no statistically difference with regard to 18F-FDG results. CONCLUSION: The most important factors affecting a true positive 18F-FDG PET/CT study were: ETE, high total 131I dose and the SUVmax values over 4.5.

Multimodality imaging in an adult patient with scimitar syndrome.

The "Scimitar syndrome" is a rare congenital anomaly characterized by combination of partial or complete pulmonary venous return from the right lung to the inferior vena cava either above or below the diaphragm together with hypoplasia of the right lung and sometimes systemic arterial supply to the right lung. In this case, multimodality imaging findings such as the vein draining into the inferior vena cava, the presence of hypertrophied and dilated right ventricle, the absence of other cardiac abnormalities, displacement of the heart without malrotation and the mediastinum to the right, normal bronchial and vascular continuity in the whole lung, absence of pulmonary sequestration and systemic collaterals, normal perfusion and systolic functions of the left ventricle were reported.

Clinical impact of (18)F-FDG PET/CT on initial staging and therapy planning for breast cancer.

The purpose of this study was to determine the clinical significance of (18)F-FDG PET/CT on initial staging and therapy planning in patients with invasive breast cancer. One hundred and forty-one consecutive, biopsy proven preoperative and 195 postoperative high-risk breast cancer patients who were referred for PET/CT for initial staging were included in this retrospective study. The clinical stage had been determined by conventional imaging modalities prior to the PET/CT scan. Of the 141 examined preoperative patients, 19 had clinical stage I (T1N0), 51 had stage IIA (12 T2N0 and 39 T1N1), 49 had stage IIB (2 T3N0 and 47 T2N1), 12 had stage IIIA (11 T3N1, 1 T2N2), 2 had stage IIIB (2 T4N1) and 8 had stage IV. PET/CT modified the staging for 26% of stage I patients, 29% of stage IIA patients, 46% of stage IIB patients, 58% of stage IIIA patients and 100% of stage IIIB patients. PET/CT scans detected extra-axillary regional lymph nodes in 14 (9.9%) patients and distant metastasis in 41 (29%) patients. PET/CT scans detected multifocal lesions in 30 (21%) patients, multicentric lesions in 21 (14%) patients and malign foci in the contralateral breast (bilateral breast cancer) confirmed by biopsy in 5 (3.5%) patients. Of the examined 195 postoperative patients PET/CT detected axillary lymph nodes in 22 (11%) patients, extra-axillary regional lymph nodes in 21 (10%) patients and distant metastasis in 24 (12%) patients. PET/CT findings altered plans for radiotherapy in 22 (11%) patients and chemotherapy was adapted to the meta-static diseases in 24 (12%) patients. PET/CT was revealed to be superior to conventional imaging modalities for the detection of extra-axillary regional metastatic lymph nodes and distant metastases. These features make PET/CT an essential imaging modality for the primary staging of invasive breast cancer, particularly in patients with clinical stages II and III.

Osteopenia in children with cerebral palsy can be treated with oral alendronate.

PURPOSE: Cerebral palsy is one of the most common reasons of osteopenia in childhood. Patients have a significantly decreased bone mineral density, and painful fractures with minor traumas are common. Biphosphonates in the treatment of childhood osteoporosis are increasingly being used. This study aimed to evaluate the efficacy of oral alendronate treatment in children with cerebral palsy. METHODS: Twenty-six children (16 boys and 10 girls) aged 3 to 17 years who had quadriplegic cerebral palsy and osteopenia were included in the study. The patients received alendronate (1 mg/kg/week), calcium (600 mg/day), and vitamin D(3) (400 U/day) over a year. A complete blood count, kidney and liver functional tests, plasma calcium, phosphate and alkaline phosphatase levels, and lumbar vertebral bone mineral density were measured before and after treatment. RESULTS: Compared with pretreatment values, bone mineral density, serum calcium, and phosphate levels of the patients statistically increased and alkaline phosphatase levels decreased after treatment. No patient needed to interrupt treatment because of side effects. CONCLUSIONS: Oral alendronate at a dose of 1 mg/kg/week for the treatment of osteopenia in children with cerebral palsy was found to be safe and effective.

Decreased Tc-99m sestamibi uptake in a sternal brown tumor indicating response to anti metabolic therapy for secondary hyperparathyroidism.

Brown tumors are rare but serious complications of renal osteodystrophy, and can be treated by parathyroidectomy or by pharmacological treatment of hyperparathyroidism. In addition to parathyroid lesions such as adenoma, hyperplasia, and carcinoma, brown tumors have been detected effectively by using dual phase Tc-99m sestamibi and Tl-201 chloride. We describe an unusual case of brown tumor at the manibrium sterni which shows marked increased Tc-99m sestamibi uptake on the initial scan, with decreasing tracer activity on follow-up scan indicating a response to antimetabolic therapy.