The Effect of an Asymmetric Energy Window on Bone Scintigraphy Image Quality.

Bone scintigraphy is one of the most common nuclear medicine tests. Previous work investigated the effectiveness of an asymmetric window (ASW) for planar bone scintigraphy using simulation and phantom data. Phantom studies concluded that the ASW improved both the resolution and the contrast-to-noise ratio when imaging objects with high scatter. The aim of this study was to confirm this improvement increased image quality in patients. This study also investigated whether the differences between a symmetric window (SW) and an ASW depended on body mass index. Methods: Fifty-eight patients had 2 scans: a standard scan using an SW of 140 keV ± 10% and a scan using an ASW of 140 keV + 10% and - 7.5%. Three readers independently compared the 2 image sets and scored them using a 5-score scale (ranging from 1 = ASW better [clinically important] to 5 = SW better [clinically important]). Scores from all radiologists were pooled and analyzed statistically. A P value of less than 0.05 was considered statistically significant. Results: In 93 cases (53%), the readers scored the ASW images better than the SW images. In 5 cases (3%), the ASW images were preferred, with the difference considered clinically important; there were no cases in which the SW was similarly preferred. For the sign test, we determined whether the total of 93 scores of 1 or 2 (ASW preferred) was significantly different from the 15 scores of 4 or 5 (SW preferred). The P value was less than 0.00001, demonstrating that the difference was significant. Conclusion: In patients undergoing bone scintigraphy, ASW provided an improvement in image quality that in some cases was judged clinically important.

Value of a Lower-Limb Immobilization Device for Optimization of SPECT/CT Image Fusion.

UNLABELLED: The foot and the ankle are small structures commonly affected by disorders, and their complex anatomy represents a significant diagnostic challenge. By providing information on anatomic and bone structure that cannot be obtained from functional imaging, SPECT/CT image fusion can be particularly useful in increasing diagnostic certainty about bone pathology. However, because of the lengthy duration of a SPECT acquisition, a patient's involuntary movements may lead to misalignment between SPECT and CT images. Patient motion can be reduced using a dedicated patient support. We designed an ankle- and foot-immobilizing device and measured its efficacy at improving image fusion. METHODS: We enrolled 20 patients who underwent SPECT/CT of the ankle and foot with and without a foot support. The misalignment between SPECT and CT images was computed by manually measuring 14 fiducial markers chosen among anatomic landmarks also visible on bone scintigraphy. ANOVA was performed for statistical analysis. RESULTS: The absolute average difference without and with support was 5.1 ± 5.2 mm (mean ± SD) and 3.1 ± 2.7 mm, respectively, which is significant (P < 0.001). CONCLUSION: The introduction of the foot support significantly decreased misalignment between SPECT and CT images, which may have a positive clinical influence in the precise localization of foot and ankle pathology.

[Complications on two cases of peritoneal dialysis (authors transl)]. / Dos casos de complicaciones de la diálisis peritoneal en niños.

Two newborns with abdominal perforation during peritoneal dialysis are presented. The first probably before dialysis and the second iatrogenic. Both needed surgical intervention. Incidence in children in comparation with adults is discussed. Severe clinic complications of both patients that needed complete parenteral nutrition, mechanic ventilation and treatment of Candida sepsis are comented. Both survived without sequels in spite of severe complications.

[Renal venous thrombosis in infants of diabetic mothers (author's transl)]. / Trombósis venosa renal en hijos de madre diabética.

Six cases of renal venous thrombosis in infants of diabetic mothers, out of a series of 61 infants under two months old affected of R.V.T. (9.8%), are reported. The clinical, metabolic and histopathological features of these cases are discussed, as well as the different etiological theories that exist in the literature. An etiopathogenic hypothesis that maintains a similarity with the theory that explains the origin of R.V.T. in classical cases, is suggested. Prophilactic attitudes in order to prevent R.V.T. by a control of diabetes in the pregnant and close control of the newborn in the 10 first days of life, are pointed out.

[Renal venous thrombosis treatment in the newborn (author's transl)]. / Tratamiento de la trombosis venosa renal del recién nacido.

Based on the experience of 61 cases, the recommended treatment for R.V.T. in newborns and infants is described. A historical review of its management is made. Therapeutic evolution and exposition of conservative therapy, founded on the following points: Close control of the hydrosaline disorder, early peritoneal dialysis and heparinization is given. Eventually thrombectomy can be advisable when the thrombous invades the inferior vena cava. A decreasing incidence of R.V.T., after a good prophilaxis and an evident improvement of the survival of children with R.V.T. is confirmed.