Magnesium Picolinate Improves Bone Formation by Regulation of RANK/RANKL/OPG and BMP-2/Runx2 Signaling Pathways in High-Fat Fed Rats.

Magnesium (Mg) deficiency may affect bone metabolism by increasing osteoclasts, decreasing osteoblasts, promoting inflammation/oxidative stress, and result in subsequent bone loss. The objective of the present study was to identify the molecular mechanism underlying the bone protective effect of different forms of Mg (inorganic magnesium oxide (MgO) versus organic magnesium picolinate (MgPic) compound) in rats fed with a high-fat diet (HFD). Forty-two Wistar albino male rats were divided into six group (n = 7): (i) control, (ii) MgO, (iii) MgPic, (iv) HFD, (v) HFD + MgO, and (vi) HFD + MgPic. Bone mineral density (BMD) increased in the Mg supplemented groups, especially MgPic, as compared with the HFD group (p < 0.001). As compared with the HFD + MgO group, the HFD + MgPic group had higher bone P (p < 0.05) and Mg levels (p < 0.001). In addition, as compared to MgO, MgPic improved bone formation by increasing the levels of osteogenetic proteins (COL1A1 (p < 0.001), BMP2 (p < 0.001), Runx2 (p < 0.001), OPG (p < 0.05), and OCN (p < 0.001), IGF-1 (p < 0.001)), while prevented bone resorption by reducing the levels of RANK and RANKL (p < 0.001). In conclusion, the present data showed that the MgPic could increase osteogenic protein levels in bone more effectively than MgO, prevent bone loss, and contribute to bone formation in HFD rats.

Is it possible to achieve more accurate mediastinal nodal radiotherapy planning for NSCLC with PET/CT?

Objective: To assess whether more accurate mediastinal lymph nodes radiotherapy can be performed with fluorode oxyglu cosepositron emission tomogaphy/computed tomography. METHODS: The retrospective study was conducted at Inonu University Medical Faculty, Malatya, Turkey, and Afyon Kocatepe University Medical Faculty, Afyon, Turkey, and comprised record of patients histopathologically diagnosed with non-small cell lung carcinoma and who underwent fluorodeoxyglucose positron emission tomography / computed tomography between January 2013 and December 2016. Surgery and pathology reports of the patients were reviewed. Histopathologically proven malignant and benign lymph nodes were re-identified with fluorodeoxyglucose positron emission tomography / computed tomography imaging. Anatomical and metabolic parameters of lymph nodes were re-assessed by specialists and compared with histopathology reports. Maximum standardised uptake values were used to assess sensitivity, specificity, positive predictive value, and negative predictive values. SPSS 22 was used for data analysis. RESULTS: The study included 144 mediastinal lymph nodes related to 42 patients who had a mean age of 62.4±9.8 years (range: 41-79 years). In terms of subtypes of the primary squamous cell carcinoma was found in 24(57.2%) patients, adenocarcinoma in 12(27.5%), and other subtypes in 6(15.3%) patients. Of the 144 lymph nodes, 48(33.3%) were metastatic. Sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 64.3%, 56.9%, and 94.7%, respectively when maximum standardised uptake value >2.5 was used as the malignancy criterion. When lymph node maximum standardised uptake value / liver standardised uptake value-mean>1.69 was used as the criterion, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.83%, 91.67%, 85.2%, and 97.8%, respectively. When the same values with lymph node >8mm was used as the criterion, the four resultant values were 89.6%, 93.8%, 87.8%, and 94.7%, respectively. When lymph node was replaced with mean attenuation >35 as the criterion, the consequent values were 79.2%, 93.8%, 86.4%, and 90.0%, respectively. CONCLUSIONS: Lymph node maximum standardised uptake value / liver standardised uptake valuemean> 1.69 was associated with higher negative predictive value and more useful positive predictive value compared to maximum standardised uptake value >2.5. When this parameter was used along with short axis or mean attenuation value, there were no significant increase in positive predictive value, but there was a decrease in negative predictive value.

Dynamic renal scintigraphic estimation of deceased donor kidneys in a rat model.

At present a large number of the renal transplantations are being performed from the deceased donors. The success of these transplantations depends on the viability of the deceased donor kidneys. The aim of this study was to investigate the reliability of scintigraphic estimation of function of deceased donor kidneys by comparing the histopathologic and scintigraphic findings. Ten rats were included in the study (2-3 months old, 250-300 g, all male). Control scintigraphy was performed to all the rats by injection of 37 MBq Tc-99m DTPA from the tail vein in a dynamic manner. Brain death of the rats was achieved by inflation of a Fogartys catheter in the cranial cavity. Immediately, after brain death confirmation, dynamic renal scintigraphy was performed with the same parameters of control scintigraphy. In the comparison of scintigraphies obtained in the before and just after brain death period, there was impairment of tubular functions, concentration and excretion functions in the postbrain death period. In the immediate postbrain death period, there was a significant elevation in the glomerular filtration rate and time to maximum concentration values. In the histopathological evaluation of the kidney samples in the postbrain death period, there were definitive findings of tubular impairment. Dynamic renal scintigraphy also demonstrated definite impairment of tubular system and tubular functions in the deceased donor kidneys. This could explain the reason of the increased frequency of acute tubular necrosis seen among deceased donor kidneys.

Insufficiency of bone scintigraphy in vertebral lesions of langerhans cell histiocytosis compared to f-18 fluorodeoxyglucose positron emission tomography/computed tomography and diagnostic computed tomography.

Langerhans cell histiocytosis (LCH) is a benign disorder related to the histiocytes which can infiltrate bone tissue. The most effective method for demonstrating severity of this disease is PET/CT and bone scintigraphy might show bone lesions. We present a seventeen year old male patient with disseminated LCH presented with exophtalmos and having multiple vertebral lesions which were identified by F-18 FDG PET/CT scan and diagnostic CT but not in the bone scintigraphy.

Classical vs. unit area method in the evaluation of differential renal function in unilateral hydronephrosis.

BACKGROUND: There are some problematic results in determination of differential renal function (DRF) by means of Tc-99m DMSA renal scintigraphy in hydronephrotic kidneys. In this study the classical method (CM) and unit area methods (UAM) in the estimation of DRF in unilateral hydronephrosis before and after intervention were compared. METHODS: Twenty patients (12 M, 8 F; mean: 42.6±18.5 years old) who were candidates for surgery or intervention because of unilateral hydronephrosis were the subjects of this study. All the patients were evaluated by Tc-99m DMSA scintigraphy before and 3-6 months after the intervention. In order to estimate DRF both CM and UAM (obtained by division of the counts including the kidney ROI to pixel of the same ROI) were performed. Bland-Altman analyses were performed in order to compare the DRF values obtained from both methods. RESULTS: The agreement between CM and UAM was poor in the preoperative estimation, however, the agreement was good after the operation or intervention. CONCLUSIONS: In this study it seems that DRF estimation with CM in unilateral hydronephrosis might be problematic in the determination of surgery thus UAM might be introduced as the method of choice in the determination of DRF in unilateral hyronephrosis.

Current surgical therapy for bronchiectasis: surgical results and predictive factors in 86 patients.

BACKGROUND: This study retrospectively evaluated the surgical indications and outcomes of 86 patients with bronchiectasis. METHODS: Between 2000 and 2013, the clinical and surgical specifications as well as follow-up results of patients with bronchiectasis were reviewed. Cystic and cylindric morphologic features were determined by chest computed tomography and hemodynamics (perfused and nonperfused), by lung ventilation/perfusion scans. The main indication for surgical resection was localized areas of cystic, nonperfused bronchiectasis. RESULTS: Patients were a mean age of 37.8 ± 14.5 years. Symptom duration was 43.4 ± 36.9 months. Bronchiectasis was saccular in 66 patients (76.7%) and varicose in 20 (23.3%). Localized defects were limited in one region of the lung in 53 (61.6%), and 54 (62.8%) showed a mixed or an obstructive ventilatory pattern. Failure of medical therapy was the most common indication for pulmonary resection. The 86 patients underwent 98 operations. Ten underwent staged thoracotomies (contralateral lobectomy, 7; contralateral segmentectomy, 3). Complete resection of all bronchiectatic areas was done in 78 patients (90.7%). Complications developed in 14 patients (14.6%). The mortality rate was 1.1% (n = 1). After surgical treatment, 71 of 86 patients (82.5%) were free of symptoms (excellent), and the remaining 15 (17.5%) had a reduction in preoperative symptoms. The 53 patients with localized perfusion defects underwent complete resection and had symptom-free (excellent) postoperative results. Complete resection independently predicted symptom-free outcome (p < 0.05); a forced expiratory volume in 1 second of less than 60% of the predicted value, an incomplete resection, and a preoperative antibiotic therapy independently predicted postoperative complications (p < 0.05). CONCLUSIONS: Bronchiectasis can be improved with operation. In properly selected patients, pulmonary resection can be done with acceptable morbidity and mortality rates and can lead to lasting symptomatic improvements.

Brain death scintigraphy and pathology results in a rat model.

OBJECTIVES: Brain scintigraphy with Tc-99m-labeled diethylenetriaminopenta-acetic acid is a sensitive diagnostic method showing loss of cerebral blood flow that occurs after brain death. Cerebral blood flow can be quantitatively estimated by this method. The aim of this study was to compare histopathologic changes occurring with the decrease of cerebral blood flow (as shown by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy) after brain death in an experimental model. MATERIALS AND METHODS: The study included examination of cerebral blood flow by Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy in the 20 rats, 1 day before brain death, after producing brain death in 11 surviving rats. Tc-99m-labeled diethylenetriaminopenta-acetic acid brain scintigraphy was performed under intubation and monitored. The Mann-Whitney U test was performed to compare groups (scintigraphic quantification results before and after brain death). RESULTS: In the time activity curves generated from the analysis of the scintigraphies, decreases in counts in the brain death group were obtained in the arterial phase (P < .01). Decreases of the cerebral blood flow between the first and the sixth minutes were statistically significant (P < .05). Common principal histopathologic changes of the brain death (ie, autolysis and color loss in the nerve cells, diffuse edema, petechial hemorrhage in the brain tissues) were observed in all subjects. CONCLUSIONS: Quantitative findings of the brain scintigraphy by Tc-99m-labeled diethylenetriaminopenta-acetic acid was related with the histopathologic findings seen during the early brain death, with significant decreases of the cerebral blood flow. Quantification of Tc-99m-labeled diethylenetriaminopenta-acetic acid brain death scintigraphy as an easier and less-expensive scintigraphic method of cerebral blood flow might indicate a definite diagnosis of brain death and thus, potential donors can be determined earlier, leaving to increased transplant rates.

Abdominal lymph node metastasis in patients with non-small-cell lung cancer as shown by PET/CT.

PURPOSE: The aim of this study is to investigate the frequency and the spread of abdominal lymph node metastasis in patients with non-small-cell lung cancer (NSCLC) by (18)F-FDG PET/CT. PATIENTS AND METHODS: Retrospective evaluation of the (18)F-FDG PET/CT examinations of 1191 patients diagnosed with NSCLC was performed. The metastatic abdominal lymph nodes of the patients were classified as inside the routine imaging field (covering the field of chest CT including adrenal glands) and outside the field. RESULTS: Seventy-four patients (6 F, 68 M; mean: 61 ± 11 years old) among 1191 patients (6%) were identified to have abdominal lymph node metastases. These abdominal lymph node metastasis changed management in 10 out of 74 patients (14%), and there were lymph node metastases outside the routine conventional imaging field in 43 (58%) patients. CONCLUSION: (18)F-FDG PET/CT provided identification of the distant metastatic lymph nodes out of conventional imaging field in more than half of NSCLC patients with abdominal metastasis which changed patient management in 14% of the patients due to abdominal lymph node metastasis outside the routine imaging field. This study shows the necessity of imaging NSCLC patients with an imaging protocol with larger imaging field like PET/CT.

The role of positron emission tomography/CT in hypoxic ischaemic encephalopathy in children.

The role of positron emission tomography/CT (PET/CT) in diagnosis and follow-up of newborns with hypoxic ischaemic encephalopathy has been documented before; however, this is the first presentation of elder children with both diagnostic and follow-up PET/CT results as far as we know.

The role of the three phase bone scintigraphy in the management of the patients with costochondral pain.

AIM: The bone scintigraphy is indicated in patients with costochondral pain in order to identify the organic etiology. We aimed to investigate the local and projecting pain, or incidental findings in the three phase bone scintigraphy of the patients referred for costochondral pain. METHODS: We included 50 patients (36F, 24M; mean: 41±18 years-old) referred to our department for three phase bone scintigraphy for costochondral pain between January 2009-July 2012. RESULTS: Among the 50 patients 22 had normal scintigraphy. An increased activity accumulation in the sternoclavicular joint was observed in 12 patients (right in 4, left in 4 and bilateral in 4) only in late phase and in 9 patients (right in 2, left in 1 and bilateral in 6) with increased vascularity. Among projecting pain causes, activity was present on sternum in 4 patients, on humerus in 2 patients and on the first costae in 2 patients. For the characterization of inflammatory pathology, the three phase bone scintigraphy showed sensitivity, specificity, accuracy, positive and negative predictive values of 43%, 94%, 78%, 77% and 78% respectively. CONCLUSION: Bone scintigraphy is an effective diagnostic method for the identification of local or projecting pain, and additionally unexpected incidental pathologies ssociated with costochondral pain. However regarding the characterization of inflammatory process false negatives should be considered. CONFLICT OF INTEREST: None declared.

Twenty four hour imaging delay improves viability detection by Tl-201 myocardial perfusion scintigraphy.

OBJECTIVE: Since twenty-four-hour imaging by Tl-201 myocardial perfusion scintigraphy has been introduced as an effective additional procedure, the aim of this study was to compare this method's result with only rest redistribution procedure in the diagnosis of myocardial viability. METHODS: Thirty patients (Seven female, 23 male; mean: 59.8 ± 10.7, 55.8-63.8 years old) with diagnosis of coronary artery disease were involved in this study. All patients had anamnesis of previous myocardial infarction and/or total occlusion of any main artery in the coronary angiography. Myocardial perfusion scintigraphy with Tl-201 with rest four hour (early) redistribution and 24 hour delayed redistribution protocol were performed to all of the patients. The images were evaluated according to 17 segment basis by an experienced nuclear medicine physician and improvement of a segment by visual interpretation was considered as viable myocardial tissue. RESULTS: Viability was found at 52 segments in the early redistribution images and additional 18 segments in the 24 hour delayed redistribution images on segment basis in the evaluation of 510 segments of 30 patients. On per patient basis, among the 26 patients who had viable tissue, 14 (54%) had additional improvement in 24 hour delayed images. Three (12%) patients had viable tissue in only 24 hour delayed images. CONCLUSION: Delayed imaging in Tl-201 MPS is a necessary application for the evaluation of viable tissue according to considerable number of patients with additional improvement in 24 hour images in our study, which is restricted to the patients with myocardial infarct.

Bone marrow uptake in parathyroid scintigraphy is a consequence of extremely high parathyroid hormone levels.

OBJECTIVE: We retrospectively evaluated patients with end-stage renal disease (ESRD) who were referred to our department for parathyroid scintigraphy. The aim of this study was to investigate the causes of bone marrow uptake observed on parathyroid scintigraphy. METHODS: We included 18 ESRD patients (10 F, 8 M; mean, 52 ± 13 years old; range, 45-59) in the study. The disease duration of the patients was mean 7.7 ± 4.7 years. The patients' mean plasma calcium and parathormone (PTH) levels were 9.7 ± 1.4 mg/dL and 1,553.3 ± 691.7 pg/mL, respectively. Dual-phase technetium-99m 2-methoxyisobutyl-isonitrile (Tc-99m MIBI) parathyroid imaging and, if necessary, additional Tc-99m pertechnetate scintigraphy were performed. Quantification of the planar early phase parathyroid images was performed for various regions (sternum, humerus, ribs) with the same size rectangular region of interest (ROI, 176 × 176 pixels). Average counts were compared with paired samples Student's t tests, and P<.05 was considered statistically significant. RESULTS: Tc-99m MIBI parathyroid imaging revealed parathyroid hyperplasia, adenoma, and ectopic adenoma in 7, 3, and 2 patients, respectively. The other 7 patients had normal scintigraphy results with regard to parathyroid pathologies. Bone marrow uptake in the sternum, ribs, and humerus was observed in 6 patients. The difference between the average quantitative value obtained from the ROIs drawn on the sternum and humerus was also statistically significant compared to patients without bone marrow uptake (P<.05). All 6 patients' exhibited extremely high PTH levels (>2,000 pg/mL; mean, 2,413.7 ± 150 pg/mL) compared to the other 12 patients (mean, 1,342.8 ± 249 pg/mL). CONCLUSION: Our results show that bone marrow uptake on parathyroid scintigraphy is a consequence of extremely high PTH levels in ESRD patients; no further analysis is required.

Gall bladder visualization in lymphoscintigraphy.

BACKGROUND: The aim of this study was to evaluate gall bladder visualization in lymphoscintigraphy of extremities. METHODS AND RESULTS: Thirteen patients who had prediagnoses of lymphedema and were referred for lower extremity lymphoscintigraphy to our department were retrospectively evaluated. Lower extremity lymphoscintigraphy with Tc-99m sulfur colloid was performed on the patients, and planar images of the lower extremity and abdominal region were taken in early phase and late phase (at the 24th hour) routinely. Lymphoscintigraphy results of eight patients were normal regarding lymphatic flow or lymph nodes; however, additional pathologic tracer accumulations in gall bladder were observed, which disappeared at 24th hour images in three patients. Five patients had various pathologies regarding lymph flow or lymph nodes. However, there were no patients with gall bladder activity except those three patients who had casual anamnesis of fasting prior to the exam. CONCLUSION: The fasting state of the patients might be the cause of gall bladder visualization during the lymphoscintigraphy of the extremities with sulfur colloid.

A novel false-positive cause in testis scintigraphy in the diagnosis of testis torsion.

Testis scintigraphy is the most reliable modality in the diagnosis of testis torsion since it directly reflects the vascularity of the testis. The 'rim sign' is considered as the pathognomonic sign of the missed torsion. However, there are some possible false-positive cases. In this case report, we would like to present an unexpected false-positive cause of the 'rim sign' in testis scintigraphy in an 18-year-old male patient.

Isolated left pulmonary artery agenesis: a case report.

UNLABELLED: Unilateral pulmonary artery agenesis without any cardiovascular malformation is a rare anomaly. We present the imaging findings of a patient who was diagnosed as isolated left pulmonary artery agenesis. A 27-year-old female patient was admitted to our hospital due to dyspnea during exercise for five years. Chest X-ray revealed minimally small left pulmonary hilum and left lung. She was admitted to our clinic with the suspicion of pulmonary artery pathology. Absent perfusion of the left lung with normal ventilation was visualized on scintigraphy. MDCT angiography of pulmonary arteries showed absent left main pulmonary artery with systemic collaterals around left hemithorax. Pulmonary artery agenesis can be asymptomatic and isolated until adulthood. Both scintigraphy and CT angiography images of pulmonary artery agenesis of a patient are rare in the literature. Pulmonary ventilation-perfusion scintigraphy can be used not only for pulmonary embolism but also pathologies involving pulmonary artery and its branches. CONFLICT OF INTEREST: None declared.

Detection of previous brain infarct on PET/CT study of a Hodgkin lymphoma patient.

Positron emission tomography/CT examination was performed to 62-year-old male patient with diagnosis of Hodgkin lymphoma for treatment response which revealed complete response. During re-evaluation process of this patient in our department, asymmetrical brain metabolism defect of right thalamus and hipometabolism of right parietal lobe was observed. This finding was confirmed with additional CT imaging as a subacute infarct tissue.

Unexpected Tc-99m labelled erythrocyte scintigraphy finding of a patient with suspicion of active bleeding into renal haematoma.

A 36-year-old male patient with suspicion of active bleeding into renal haematoma loge was sent to our clinic for Tc-99m labelled erythrocyte scintigraphy. Scintigraphy showed no active bleeding to renal haematoma but coexisting active haemorrhage of stomach which was confirmed as erosive bulbitis with further endoscopy.

Hepatobiliary scintigraphy findings of a patient with polianomaly presenting with icterus.

17-days-old baby girl with continuous crying and persistent icterus attended to our hospital. Hepatobiliary scintigraphy was performed in order to diagnose aetiology of icterus and polianomaly of patient was incidentally found with scintigraphic imaging.

A case of intraorbital hemangioma diagnosed with tc 99m labeled erythrocyte scintigraphy and magnetic resonance imaging.

UNLABELLED: We present a 20 year-old male patient who had prominent positional proptosis of the right eye and admitted to the hospital for tonsillectomy operation. After conventional ophthalmological examination, magnetic resonance imaging (MRI) and Tc 99m labeled erythrocyte scintigraphy were performed to confirm the diagnosis. Although it is rare to perform scintigraphy for this pathology, the visualization of intraorbital hemangioma was very obvious and we would like to present the visualization of the intraorbital hemangioma both with scintigraphy and MRI. CONFLICT OF INTEREST: None declared.

Bone mineral densitometry findings of children with newly diagnosed celiac disease.

OBJECTIVE: The effect of Celiac Disease (CD) on children's bone is the decrease in bone mineral density (BMD). Osteoporosis is a consequence of this decrease and usually manifests in adult ages. Studies in CD patients generally show that bone density of these patients can be different at the same ages for the same duration of disease. The aim of this study is to investigate the relationship between age and bone mineral density of CD patients at first diagnosis. MATERIAL AND METHODS: Ninety one patients (M/F: 36/55; age range: 3-16; mean age: 9.6±3.5) with diagnosis of CD were included in the study. BMD survey from L1-L4 lumbar spine and total hip of the patients was evaluated at presentation. We evaluated the patients in 3 groups according to their ages: Group 1: pre-school (3-7 years old), Group 2: elementary school (8-11 years old) and Group 3: adolescent (12-16 years old). RESULTS were compared using Student's t test and correlation analysis. RESULTS: The mean disease duration of the patients was 16.4±16.3 months. Mean height and weight of the patients were 124.8±17.9 cm and 27±9.3 kg, respectively and height and weight of 37 patients were in ≤ 3. percentile according to age. The BMD values of both lumbar spine and total hip and Z-scores of lumbar region were in mild correlation with age (r>0.5). There was significant difference between mean ages of patients with low bone mass for chronological age and normal bone densitometry values (p<0.05). There were 27, 36 and 28 patients in Group 1, Group 2 and Group 3, respectively. The difference between mean BMD values of these groups were statistically significant (p<0.05). The mean values of lumbar Z- scores of patients were -1.08±1.27, -1.42±1, -1.86±1.14, respectively for these three groups. CONCLUSION: Bone mineral densities of CD patients in childhood were lower in elder children at the time of diagnosis. This confirms the opinion that the diagnosis at earlier age results better treatment chance before bone mineral loss appears in CD patients. CONFLICT OF INTEREST: None declared.