The bone scintigraphy in the diagnosis and management in children with febrile osteoarticular pain.

BACKGROUND: Bone and joint infections are common diseases in pediatrics. They still are a public health problem in Tunisia. The diagnosis is based on clinical, biological, radiological and skeletal scintigraphy arguments. The purpose of this study is to determine the contribution of triple phase bone scan in the exploration of musculoskeletal pain febrile child. METHODS: This was a descriptive and retrospective study. It was conducted over a period of 5 years. It has interested all children explored in nuclear medicine department with suspected acute osteomyelitis (OMA) , osteoarthritis (OA) or septic arthritis (SA) referred from Orthopaedic Infantile service. All these patients had, alongside the conventional radiologic exams, a triple phase bone scan HMDP-Tc99m. RESULTS: We collected 62 patients. Among the selected diagnoses, there were: 22 OMA, 4 OA, 4 SA. The mean age of the patients was 5.58 years with a male predominance. The main reason for consultation was pain. Fever was ≥ 38° C in 80 % of cases. The preferential localization was the lower limb (93.5 %). The quantitative and qualitative bone scan abnormalities objectified led to a correct diagnosis of: 18 OMA, 3 OA and 2 SA with a respectively estimated sensitivity and specificity of 76.6% and 90.6% in the all population. CONCLUSIONS: Bone scan demonstrates early abnormalities allowing osteoaricular infection diagnosis. It highlights the infection site, and draws a map of the lesions. Currently, imaging modalities differ in their availability, their cost, their input and diagnostic accuracy but they are complementary.

Hemorrhagic Meckel's diverticulum. Interest of the digestive pertechnetate scintigraphy.

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Clinical symptoms can result in pain, bleeding and perforation caused by peptic ulceration. Among all imaging modalities, Tc-99m pertechnetate scintigraphy is the most sensitive method for Meckel's diverticulum diagnosis, but only mentioned in a few publications. We report the case of a young child with rectal bleeding related hemorrhagic Meckel's diverticulum. Endoscopy and ultrasound were normal. The diagnosis was done by scintigraphy with technetium revealing an accumulation of radiotracer by mucous cells in ectopic gastric mucosa, which allows a detection of Meckel's diverticulum. Our case illustrates the importance of this exam to the diagnosis of gastrointestinal bleeding with normal endoscopy.

Hemorrhagic Meckel's diverticulum. Interest of the digestive pertechnetate scintigraphy.

Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract. Clinical symptoms can result in pain, bleeding and perforation caused by peptic ulceration. Among all imaging modalities, Tc-99m pertechnetate scintigraphy is the most sensitive method for Meckel's diverticulum diagnosis, but only mentioned in a few publications. We report the case of a young child with rectal bleeding related hemorrhagic Meckel's diverticulum. Endoscopy and ultrasound were normal. The diagnosis was done by scintigraphy with technetium revealing an accumulation of radiotracer by mucous cells in ectopic gastric mucosa, which allows a detection of Meckel's diverticulum. Our case illustrates the importance of this exam to the diagnosis of gastrointestinal bleeding with normal endoscopy.

Advances in the management of differentiated thyroid cancer with follicular cell strain.

The management of nodules and thyroid cancer is evolving. The aim is to individualize the treatment, decreasing aggression in the forms low risk and instead seeking new therapeutic options in advanced disease. This update shows the main recent advances in this field.

[The value of multimodal imaging by single photon emission computed tomography associated to X ray computed tomography (SPECT-CT) in the management of differentiated thyroid carcinoma: about 156 cases]. / Place de l'imagerie multimodale par tomoscintigraphie couplée au scanner dans la prise en charge des cancers différenciés de la thyroïde: étude sur 156 cas.

BACKGROUND: Single photon emission computed tomography combined with a low dose computed tomography (SPECT-CT), is a hybrid imaging integrating functional and anatomical data. The purpose of our study was to evaluate the contribution of the SPECTCT over traditional planar imaging of patients with differentiated thyroid carcinoma (DTC). METHODS: Post therapy 131IWhole body scan followed by SPECTCT of the neck and thorax, were performed in 156 patients with DTC. RESULTS: Among these 156 patients followed for a predominantly papillary, the use of fusion imaging SPECT-CT compared to conventional planar imaging allowed us to correct our therapeutic approach in 26.9 % (42/156 patients), according to the protocols of therapeutic management of our institute. CONCLUSION: SPECT-CT is a multimodal imaging providing better identification and more accurate anatomic localization of the foci of radioiodine uptake with impact on therapeutic management.

Primary iliac bone lymphoma with multiple bone involvement evaluated by 18 fluorodeoxyglucose positron emission tomography: A case report.

INTRODUCTION: Involvement of bone by lymphoma usually occurs in the setting of widespread systemic disease. The primary bone lymphoma (PBL) is a rare entity, accounting for 3 to 7% of primary malignant bone tumors and less than 2% of all lymphomas. The Multifocal forms are even rarer and can be confused with bone metastases. The diagnosis is guided by the clinic and radiology, but only the histology confirms accurate diagnosis. OBSERVATION: We report a rare case of primitive iliac lymphoma in a 58-year-old man. The pathological study was in favor of a diffuse large B-cell lymphoma. An 18 fluorodesoxyglucose (FDG) positron emission tomography computed tomography (PET/CT) performed as part of the staging assessment revealed multifocal bone involvement. CONCLUSION: This case highlights the importance to evoke the diagnosis of primary bone lymphoma, even if it presents in an unusual site, as well as the value of metabolic imaging in assessing the extent of the disease.

[Metaiodobenzylguanidine scintigraphy in the diagnosis and followup of neuroblastoma. Apropos of 16 cases]. / La scintigraphie à la méta-iodo-benzyl-guanidine dans le diagnostic et le suivi des neuroblastomes. A propos de 16 cas.

AIMS: The aim of this study is to evaluate meta-iodo-benzyl-guanidine scintigraphy in the diagnosis and the management of neuroblastoma. PATIENTS AND METHODS: betwen september 1999 and jun 2004, 16 children aging from 4 months to 6 years, with neuroblastoma, underwent mIBG scintigraphy in military hospital nuclear medicine department. RESULTS: 23 mIBG scans were done. The exam was indicated for the initial staging in 7 cases, to evaluate chemotherapy or surgery in 12 cases and to seek for reccurences in 3 cases. The sensitivity of mIBG was 57% in the detection of the primary tumor, 100% for liver metastases and 67% for medullar involvement. CONCLUSION: mIBG scintigraphy should be a standard in the initial staging of neuroblastoma and in evaluating therapy response.

[Treatment of painful bony metastases with Samarium 153-EDTMP in prostate carcinoma]. / Traitement des metastases osseuses douloureuses par le Samarium 153-EDTMP dans le cancer de la prostate.

UNLABELLED: THE OBJECTIVE of this work is to evaluate a new therapy, the metabolic radiotherapy to the 153Samarium-EDTMP, of recent introduction in Tunisia, in the painful bony metastasis treatment observed at the patients affected of cancer of the prostate. METHODS: It is about a retrospective survey with a receding of 40 months, achieved through 45 files of patients having benefited all of this new treatment for painful bony metastases in relation with a prostatic adenocarcinoma and collected by three centers of Nuclear Medicine of the capital: the institute Salah Azaiez (state-controlled), the Center CERU (deprives) and the Military hospital (HMPIT). RESULTS: We tried to appreciate essentially four parameters: the therapeutic efficiency, the factors influencing the answer in the treatment, the toxicity of the treatment and the sources of failure. We observed a positive answer in 92,1% of the cases, this answer was complete in 36,5% of the cases. The results gotten after multiple administrations show that the cures could be repeated with results comparable to those of the first cure. The therapeutic efficiency is at least equivalent to those of the other therapeutic means, with nearly non-existent secondary effects. The only toxicity is of hematological order; it is the most often moderate and reversible with a complete recuperation at the end of 8 weeks. Besides, the effect on the pain came with an improvement of the quality of life of the patients treaties. CONCLUSION: Its precocious introduction in the taken in charge of the metastatic patients, would allow them to benefit better from its efficiency, simplicity and weak toxicity and therefore to enjoy a better quality of life.

[Myocardial perfusion scintigraphy]. / La scintigraphie myocardique de perfusion.

The aim of this review was to recall the relevance of the myocardial perfusion scintigraphy procedure in the diagnosis of coronary artery disease. Myocardial perfusion scintigraphy is undergone after treadmill exercise or pharmacological stress by infusion of Dipyridamole. Thallium-201, sestamibi-Tc99m and tetrofosmine-Tc99m are the most frequently used tracers. Gated single photon emission computed tomography provides a combined evaluation of both myocardial perfusion and function. Myocardial perfusion imaging is an accurate tool for the diagnosis of coronary artery disease with a high sensitivity 93% and good specificity 80%. Its prognostic value is now well established among patients with known coronary artery disease. In particular for risk stratification and patient management decisions. Thallium-201 SPECT is clinically accurate in assessing myocardial viability. As it is for assessment after myocardial revascularisation. Thus myocardial perfusion scintigraphy is a reliable and a cost-effective investigation for coronary artery disease.

Malar bone metastasis revealing a papillary thyroid carcinoma.

Papillary thyroid carcinoma is the most common form of differentiated thyroid carcinoma. It is generally confined to the neck with or without spread to regional lymph nodes. Metastatic thyroid carcinomas are uncommon and mainly include lung and bone. Metastases involving oral and maxillofacial region are extremely rare. We described a case of malar metastasis revealing a follicular variant of papillary thyroid carcinoma, presenting with pain and swelling of the left cheek in a 67-years-old female patient with an unspecified histological left lobo-isthmectomy medical history. To our knowledge, this is the first recorded instance of a malar metastasis from a follicular variant of papillary thyroid carcinoma.