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   Table of Contents - Current issue
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July-September 2019
Volume 18 | Issue 3
Page Nos. 227-344

Online since Friday, August 9, 2019

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REVIEW ARTICLE  

Investigating patients with normocalcemic hyperparathyroidism: When is a parathyroid scintigraphy indicated? Highly accessed article p. 227
Elias E Mazokopakis, Spyridon-Nikitas I Skarakis
DOI:10.4103/wjnm.WJNM_61_18  
In clinical practice, physicians often encounter patients with persistent elevated serum parathyroid hormone levels and normal serum calcium levels, a state known as normocalcemic hyperparathyroidism (NHPT). The investigation of NHPT cases can lead to unnecessary use of parathyroid scintigraphy (PS) and consequently unnecessary health-care costs. In this clinical review, the most common causes of NHPT and the possible indications for PS performance in such cases are mainly presented and discussed.
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ORIGINAL ARTICLES Top

Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography compared with diagnostic computed tomography in relapsed prostate cancer p. 232
Marcus Edward Asokendaran, Danielle P Meyrick, Laura A Skelly, Nat P Lenzo, Andrew Henderson
DOI:10.4103/wjnm.WJNM_59_18  
The aim of this study was to evaluate if prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has a higher detection rate compared to standard contrast CT imaging for patients with a rising prostate-specific antigen (PSA) following definitive treatment (i.e., curative radical prostatectomy, radiotherapy, and brachytherapy) for prostate cancer in a private hospital setting. A retrospective single-site clinical audit was conducted on 150 PSMA PET/CT scans done for patients with a rising PSA after definitive treatment for prostate cancer. All studies were performed using I and T Ga-68 PSMA produced on a Scintomics radiopharmaceutical unit (Munich). All scans were performed on a GE 710 PET/CT scanner. All studies were compared to standard CT and other imaging. Of the 150 patients who had a 68Gallium (Ga)-PSMA PET/CT for a rise in their PSA levels, 102/150 (68%) of patients had PSMA-avid scans compared to the conventional imaging group which had an overall detection rate of 42% (63/150). The rates of detection were 100%, 90%, 92%, 67%, and 25% at PSA levels of >10 μg/L, 5–10 μg/L, >1.5 μg/L, 0.5–1.5 μg/L, and <0.5 μg/L, respectively. PSMA PET/CT also solely picked up 39/102 (38%) of prostate cancer relapses compared to the conventional imaging group. In our study of 150 patients with biochemical recurrence of prostate cancer, 68Ga-PSMA PET/CT demonstrated a superior detection rate (P < 0.05) compared to conventional imaging, including patients with low PSA levels (<0.5 μg/L).
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Evaluation of left ventricular mechanical dyssynchrony with phase analysis in end-stage renal disease patients with normal gated SPECT-MPI p. 238
Dharmender Malik, Bhagwant Rai Mittal, Ashwani Sood, Ashish Sharma, Madan Parmar, Komalpreet Kaur, Ajay Bahl
DOI:10.4103/wjnm.WJNM_49_18  
Phase analysis using gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is a relatively new tool for the assessment of ventricular synchrony. Hypertension, diabetes, renal diseases, and dyslipidemia may affect the phase parameters though their impact is not well understood. The present study aimed to evaluate the incidence of the left ventricular mechanical dyssynchrony (LVMD) in end-stage renal disease (ESRD) patients with normal gated SPECT-MPI and QRS duration (<120 ms) on electrocardiogram. Data of 129 patients (86 males) referred for gated SPECT-MPI for their pretransplant evaluation with normal gated stress SPECT-MPI (SSS <3 and ejection fraction ≥50%) were included in the study analysis. Documented clinical history along with confounding factors such as hypertension, dyslipidemia, smoking, and alcoholism were evaluated. Left ventricle functional (end-diastolic, end-systolic, and LV myocardial volume) and phase parameters (phase standard deviation [PSD], phase bandwidth [PBW] and entropy) were calculated using the QPS-QGS program. LVMD was noted in 36 (28%) of ESRD patients with normal QRS duration and gated SPECT-MPI. The mean attenuated corrected LV myocardial volume, ejection fraction, mean PSD, and PBW values were 84.3 ± 38.1 ml, 65.3 ± 13.5%, 9.8° ± 3.9°, and 61.4° ± 24.7°, respectively. The LV myocardial volume shows statistically significant correlation with the phase parameters (r = 0.31–0.47; P < 0.001). LVMD is present in a significant number of ESRD patients, and its extent is more with increase in LV myocardial volume. It may have an additional role in risk-stratification for cardiovascular disease in ESRD patients.
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Initial experience of Ga-68 prostate-specific membrane antigen positron emission tomography/computed tomography imaging in evaluation of biochemical recurrence in prostate cancer patients p. 244
Aravintho Natarajan, Archi Agrawal, Vedang Murthy, Ganesh Bakshi, Amit Joshi, Nilendu Purandare, Sneha Shah, Ameya Puranik, Venkatesh Rangarajan
DOI:10.4103/wjnm.WJNM_47_18  
Gallium-68 labeled prostate-specific membrane antigen (Ga-68 PSMA) ligand (HBED-CC) is a novel tracer used for prostate cancer imaging. The aim of the study was to investigate the performance of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in patients with biochemical recurrence (BCR) after definitive treatment. Scans of 96 consecutive patients were analyzed. Sixty-two patients received external beam radiotherapy, 34 underwent radical prostatectomy (RP), and 20 patients were on androgen deprivation therapy. Patients with prostate-specific antigen (PSA) level ≥>0.2 ng/mL following RP and PSA rise by 2 ng/mL or more above the nadir PSA following RT (Phoenix criteria) was considered as BCR, respectively. All patients underwent contrast-enhanced PET/CT after injection of 67–111 MBq Ga-68 PSMA ligand. Detection rates were correlated with serum PSA level. Detection rate for nodal metastases was compared with CT. Results of the scan were validated by using either biopsy or follow-up imaging or clinical follow-up. Seventy-four (77%) patients showed abnormal finding in Ga-68 PSMA PET/CT. The median serum PSA level of the population was 5.5 ng/ml (range 0.2–123 ng/ml). The median PSA of the positive scans was higher than that of the negative scans (6 vs. 1.7 ng/ml) and was statistically significant (P = 0.001 by Mann–Whitney U-test). In post-RP group, the detection rates were 23%, 50%, and 82% for PSA <1, 1–2, and >2 ng/ml, respectively. For post-RT, the detection was 86%, 85%, and 95% for PSA 2–5, 5.1–10, and >10 ng/ml, respectively. PSMA PET/CT revealed nodal metastases in 52 (54%) patients while CT showed pathological nodes only in 27 (28%) patients. Overall PSMA PET/CT revealed more number of nodes than CT (111 vs. 48 nodal station). PSMA PET/CT showed relapse in prostate/prostatic bed in 26 (27%) patients, nodal metastases in 50 (52%), skeletal metastases in 20 (21%), and other sites in 4 (4%) patients. Ga-68 PSMA PET/CT has high detection rate for localizing the site of recurrence in patients with biochemical failure and is superior to CT scan in the detection of nodal disease.
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Quantitative comparison between single-photon emission computed tomography and positron emission tomography imaging of lung ventilation with 99mTc-technegas and 68Ga-gallgas in patients with chronic obstructive pulmonary disease: A pilot study p. 251
Enrique Gustavo Cuna, Juan Pablo Gambini, Liliana Servente, Eduardo Savio, Henry William Engler, Gabriel Adrián González, Omar Alonso
DOI:10.4103/wjnm.WJNM_45_18  
The aim of this study was quantitative comparison between 68Ga-Gallgas positron emission tomography (PET) and 99mTc-Technegas single photon emission computed tomography (SPECT) for lung ventilation function assessment in patients with moderate-to-severe obstructive pulmonary disease and to identify image-derived texture features correlating to the physiologic parameters. Five patients with moderate-to-severe chronic obstructive pulmonary disease with PET and SPECT lung ventilation scans were selected for this study. Threshold-based segmentations were used to compare ventilated regions between both imaging techniques. Histograms of both scans were compared to reveal main differences in distributions of radiotracers. Volumes of segmentation as well as 50 textural features measured in the pulmonary region were correlated to the forced expiratory volume in 1 s (FEV1) as the relevant physiological variable. A better peripheral distribution of the radiotracer was observed in PET scans for three out of five patients. A segmentation threshold of 27% and 31% for normalized scans, for PET and SPECT respectively, was found optimal for volume correlation with FEV1. A high correlation (Pearson correlation coefficient >0.9) was found between 16 texture features measured from SPECT and 7 features measured from PET and FEV1. Quantitative measurements revealed different tracer distribution in both techniques. These results suggest that tracer distribution patterns may depend on the cause of the pulmonary obstruction. We found several texture features measured from SPECT to correlate to FEV1.
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Efficacy and safety of 177Lutetium-prostate-specific membrane antigen therapy in metastatic castration-resistant prostate cancer patients: First experience in West Asia – A prospective study p. 258
Ramin Akbarian Aghdam, Mahasti Amoui, Mohammadali Ghodsirad, Sepide Khoshbakht, Bahram Mofid, Fateme Kaghazchi, Mehrdad Tavakoli, Elahe Pirayesh, Hojjat Ahmadzadehfar
DOI:10.4103/wjnm.WJNM_66_18  
Prostate-specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on the surface of prostate cancer (PC) cells, making it an excellent radiotracer for both therapeutic and diagnostic purposes. In this prospective study, we investigated the efficacy and toxicity of 177Lutetium (Lu)-PSMA in metastatic castration-resistant PC (mCRPC) patients for the establishment and approval of this therapy in Iran. Fourteen mCRPC patients (mean age 70.57 ± 7.3 years) were treated with a single dose of 177Lu-PSMA. Complete blood count, liver function tests (aspartate aminotransferase and alanine aminotransferase), alkaline phosphatase levels, renal function tests (urea and creatinine), and prostate-specific antigen (PSA) levels were obtained for the patients at baseline and every 2 weeks. A majority of the patients (11 patients, 64.2%) experienced a decline in their PSA levels; in 5 (45.4%) of these patients, the PSA levels declined > 50%.The severity of pain decreased in 8 (57.1%) patients, and performance status was improved in 5 (45.4%) patients. The treatment was well tolerated, and no severe hematological or nonhematological side effects were observed. Our findings show that 177Lu-PSMA had a high efficacy and a low toxicity in an Iranian population and is a promising treatment option for PC patients.
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Utility of FET-PET in detecting high-grade gliomas presenting with equivocal MR imaging features p. 266
Ameya D Puranik, Mathew Boon, Nilendu Purandare, Venkatesh Rangarajan, Tejpal Gupta, Aliasgar Moiyadi, Prakash Shetty, Epari Sridhar, Archi Agrawal, Indraja Dev, Sneha Shah
DOI:10.4103/wjnm.WJNM_89_18  
High-grade gliomas, metastases, and primary central nervous system lymphoma (PCNSL) are common high-grade brain lesions, which may have overlapping features on magnetic resonance (MR) imaging. Our objective was to assess the utility of 18-fluoride-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) in reliably differentiating between these lesions, by studying their metabolic characteristics. Patients with high-grade brain lesions suspicious for glioma, with overlapping features for metastases and PCNSL were referred for FET-PET by Neuroradiologists from Multidisciplinary Neuro-Oncology Joint Clinic. Tumor-to-contralateral white mater ratio (T/Wm) at 5 and 20 min was derived and compared to histopathology. Receiver operating characteristic curve analysis was used to find the optimal T/Wm cutoff to differentiate between the tumor types. T/Wm was higher for glial tumors compared to nonglial tumors (metastases, PCNSL, tuberculoma, and anaplastic meningioma). A cutoff of 1.9 was derived to reliably diagnose a tumor of glial origin with a sensitivity and specificity of 93.8% and 91%, respectively. FET-PET can be used to diagnose glial tumors presenting as high-grade brain lesions when MR findings show overlapping features for other common high-grade lesions.
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Clinical significance of thyroid incidentalomas detected on fluorodeoxyglucose positron emission tomography scan (PETomas): An Indian experience p. 273
AVS Anil Kumar, Gaurav Datta, Harkirat Singh, Partha Brata Mukherjee, Shashindran Vangal
DOI:10.4103/wjnm.WJNM_46_18  
Thyroid incidentalomas (TIs) are being frequently detected on positron emission tomography (PET) scan. The risk of malignancy in these focal hot spots is substantially high as compared to incidentalomas detected on ultrasonography (USG)/magnetic resonance imaging/computed tomography (CT). Majority of the studies on the prevalence of TIs in PET and the risk of malignancy in them are retrospective and have had varied results. Very few prospective studies are available and very few Indian studies have been done on the subject. Hence, this study was undertaken to evaluate the clinical significance of TIs detected on fluorodeoxyglucose (FDG)-PET scan. The study included all patients undergoing FDG-PET scan for nonthyroid illness from October 2015 to October 2016. Twenty-three consecutive patients detected to have focal TI (FTI) were prospectively evaluated with detailed history and clinical examination, serum thyroid-stimulating hormone, total T4 and total T3 levels, USG neck, fine-needle aspiration cytology (FNAC), and surgery when indicated. The prevalence of FTI was 2.26%. Out of the 23 FTI cases, 19 patients agreed to undergo further evaluation and malignancy was detected in 5 patients (all papillary carcinomas) making a risk of malignancy of 26.3%. There was no significant correlation between CT attenuation characteristics and size of benign and malignant PETomas or between the maximum standardized uptake value (SUVmax) of benign and malignant PETomas. Hence, the risk of malignancy in thyroid PETomas is substantially high and warrants USG-guided FNAC and further work-up. Their SUVmaxvalues, size, and CT attenuation characteristics do not contribute in differentiating benign from malignant lesions.
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The effect of retinoic acid in the ability of cold solid thyroid nodule to take up radioactive iodine: A preliminary study p. 283
Andreas Lim, Hendra Budiawan, Budi Darmawan, Basuki Hidayat, Hadyana Sukandar, Achmad Hussein Sundawa Kartamihardja
DOI:10.4103/wjnm.WJNM_48_18  
One of the treatment options for benign thyroid nodules is radioactive iodine (RAI). However, this treatment is more effective for hot/warm solid thyroid nodules. Cold thyroid solid nodules are characterized by the lack of iodine uptake compared to normal thyroid tissue. Oral retinoic acid (RA) is a synthetic derivative of Vitamin A. The effect of RA on the uptake of RAI is still controversial. The aim of this study was to evaluate the effect of RA in the ability of a cold solid thyroid nodule to take up RAI. Individuals with a cold solid thyroid nodule based on ultrasonography and thyroid scintigraphy were included. Participants with liver dysfunction, smokers, and pregnant patients were excluded from the study. Each participant underwent thyroid uptake scintigraphy twice (pre- and post-RA consumption) using 35–37 MBq NaI-131. Participants consumed RA at a dose of 1 mg/kg body weight (BW) followed with 1.5 mg/kg BW. This study was approved by Dr. Hasan Sadikin General Hospital Ethic Committee. A total of 12 cold thyroid solid nodules were evaluated. The mean percentage of the nodule uptake value pre- and post-intervention was 1.11% and 0.62%, respectively (P = 0.004), while normal thyroid tissue uptake values pre- and post-intervention were 27.57% and 13.40%, respectively (P = 0.002). The percentage alteration of nodules and normal thyroid tissue uptake value were 42.4% and 51.5% lower, respectively (P = 0.354). This study showed that RA reduces the ability of cold solid thyroid nodule, as well as normal thyroid tissue, to take up RAI.
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Statistical analysis of the occupational radiation doses in three different positron emission tomography–computed tomography centers in Egypt p. 287
Ibrahim Elsayed Saad Ahmed, Abdulrahman M.M Zamzam, Hossam Mahmoud Yassin
DOI:10.4103/wjnm.WJNM_42_18  
In the present study, we investigated the radiation doses received by the positron emission tomography (PET)/computed tomography (CT) staff in three different diagnostic centers in Egypt. The whole-body effective dose measured by thermoluminescent dosimeters (TLDs) for staff working in PET and the effective dose per study received by physicist, technician, and nurse were measured by an electronic pocket dosimeter (EPD) during a period of 6 months. Statistical analysis was held between the measurements of the TLDs as well as for the EPD for the three studied PET-CT centers. After combining TLD and EPD prospective annual scores for the three studied categories in the three centers, the one-way ANOVA test results have shown that there were statistically significant differences between group means with respect to their TLD mean score (P = 0.041). The mean nurse group TLD score, across the three centers, appeared to be the lowest scoring 3.83 (standard deviation [SD] 0.012) compared to the physicist and technician who measured 4.62 (SD 0.231) and 6.92 (SD 0.018), respectively. Scheffe's test for complex comparisons revealed a significant difference between nurse group and technologist group (P = 0.001). Regarding the annual combined EPD scores, the post hoc test, namely Scheffe's test for complex comparisons, revealed a significant difference between nurse group and technologist group (P = 0.001). This was measured after the one-way ANOVA test results have shown that there were statistically significant differences between annual group EPD means (P = 0.032). Finally, there was no recorded significance for the studied categories across the three centers between their annual TLD and EPD dose scores (P = 0.072). Technicians group received the highest mean effective whole-body doses when compared with the International Commission on Radiological Protection dose limit, each individual worker can work with many more 18F-fluorodeoxyglucose (FDG) PET/CT studies for a (period time) without exceeding the occupational dose limits if the average received effective dose continues with the same rate. The study also confirmed that low levels of radiation dose are received by medical personnel involved in 18F-FDG PET/CT procedures in those centers due to implementing radiation protection measures and procedures.
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CASE REPORTS Top

Radioiodine (131I) therapy in a child with autism spectrum disorder: A complex and demanding task p. 293
Giovanni Bibbo, Ian Kirkwood, Victoria Sigalas, Tracy Benger
DOI:10.4103/wjnm.WJNM_40_18  
In January 2017, an 11.5-year-old male child with autism was referred for radioiodine (RAI) therapy post total thyroidectomy for papillary thyroid carcinoma. The treatment required swallowing a RAI capsule and remaining isolated (48–72 h). Initially, obstacles to a successful treatment seemed insurmountable as he had complex needs and behavioral issues due to his autism, mild intellectual disability, and family environment. His mother was adamant that he would not be able to swallow the capsule and comply with the required isolation period. A multidisciplinary team was formed to explore options for successful treatment. Each option considered had its own risks and challenges. Behavioral therapy was considered to be the only possible option. It was pursued with regular, frequent contact between the child, his parents, and members of the team for counseling and behavioral modification, familiarization of the child with the staff, procedures, trial visits, and admission. The patient was successfully treated in October 2017.
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Malignant peripheral nerve sheath tumor of thigh with sphenoid and brain metastases: Extremely rare occurrence with dismal prognosis despite significant response to palliative chemoradiotherapy p. 296
Abhishek Purkayastha, Sankalp Singh, Amul Kapoor, Jasvinder Kaur Bhatia, Niharika Bisht, Azhar Husain
DOI:10.4103/wjnm.WJNM_54_18  
Malignant peripheral nerve sheath tumor (MPNST) is a neurogenic tumor arising from peripheral nerves or nerve sheaths. MPNSTs are highly aggressive sarcomas mainly associated with neurofibromatosis type-1 (NF-1) with high rates of local recurrence and distant metastasis carrying a dismal prognosis. Lung is the most common metastatic site. Bone metastasis although documented in the literature is still very rare, while dissemination to brain without the involvement of lungs and that too in a non-NF-1 case is extremely unusual. A 48-year-old female was diagnosed with a case of non-NF-1 MPNST left thigh with bone metastases including sphenoid. Despite showing complete resolution of skeletal and primary lesions postpalliative chemoradiotherapy, she developed brain metastases and succumbed to her disease. This case is discussed to highlight an unusual scenario we encountered, the clinical course of the disease with its management, and overall poor prognosis. To the best of our knowledge, this may be the earliest case of MPNST with sphenoid metastases detected by 18-fluorodeoxyglucose positron-emission computed tomography scan and a sporadic case of brain metastases reported in the world literature.
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A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases p. 301
Alex Cheen Hoe Khoo, Soo Ling Chen
DOI:10.4103/wjnm.WJNM_43_18  
Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (131I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.
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Neuroendocrine prostate cancer or prostatitis? An unusual false positive on gallium-68 DOTA-Tyr3-octreotate positron emission tomography/computed tomography in a patient with known metastatic neuroendocrine tumor p. 304
Matthew Q Schmidt, Zachary Trenbeath, Bennett B Chin
DOI:10.4103/wjnm.WJNM_11_19  
The importance of gallium-68 DOTA-Tyr3-octreotate (68Ga DOTATATE) positron emission tomography/computed tomography (PET/CT) in the imaging of neuroendocrine tumors (NETs) has grown substantially over the past decade and is becoming markedly more common. We present the case of a male with known metastatic NET who underwent 68Ga DOTATATE PET/CT for restaging, incidentally revealing intense uptake of the prostate with a maximum standard uptake value of 17.4. Due to the patient's medical history, this finding was concerning for neuroendocrine prostate cancer. However, core biopsies of the prostate were negative for malignancy and positive for chronic inflammation. Chronic prostatitis is a very common condition in adult males and is often asymptomatic. Inflammatory conditions, including prostatitis, are important causes of false-positive findings on 68Ga DOTATATE PET/CT and should be considered as part of the differential diagnosis, even in an asymptomatic patient.
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Can radium 223 be a conservative non-surgical management of medication-related osteonecrosis of the jaw? p. 307
Renato Patrizio Costa, Vincenzo Tripoli, Alessandro Princiotta, Alessandra Murabito, Maria Licari, Rodolfo Mauceri, Giuseppina Campisi, Antonio Pinto
DOI:10.4103/wjnm.WJNM_7_19  
Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Radium 223 dichloride (Ra223) is the only targeted alpha therapy able to extend survival in patients with bone metastases from prostate cancer. Mechanism of action and data currently available focused mainly on osteoblastic metastases from prostate cancer. In 2018, a Caucasian 54-year-old woman presented to our institution for a breast cancer with bone metastases. Since the patient refused any treatment and taking into account the bone disease, our multidisciplinary team evaluated a supplementary strategy with radium 223. A total of six treatments were planned with a dose of 50 KBq/kg every 4 weeks according to Phase 2 data. Four days after the second cycle administration, the patient presented for examination with a self-extracted necrotic bone fragment. Oroantral communication remained in the absence of algic symptomatology or suppuration. The multidisciplinary approach between oncologists, nuclear physicians, and dental health teams is crucial throughout the treatment process to avoid unnecessary suffering in patients at risk. More prospective studies are needed; however, considering the limitation of the present case, radio 223 may play an adjuvant role in the medical treatment of cancer patients with active ONJ.
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Unusual presentation of jejunal hemangioma on Tc-99m pertechnetate scan with single-photon emission computerized tomography-computed tomography p. 310
Karan Peepre, Nitinkumar Borkar, Sunil N Jondhale, Mudalsha Ravina, Amal Moideen, Vipin Yadav, Sushmita Dey
DOI:10.4103/wjnm.WJNM_13_19  
Small bowel hemangioma is a rare benign tumor in the pediatric population. The usual presentation of these tumors is melena, anemia, or hematochezia. Our case demonstrates the usefulness of Meckel's/Tc-99m pertechnetate scan with single-photon emission computerized tomography/computerized tomography in diagnosing a vascular lesion in the small bowel in a child presenting with melena, unresponsive to medical management. We present a case of incidentally detected jejunal hemangioma during Tc-99m pertechnetate scintigraphy which would help the nuclear medicine physician and surgeon, to be cognizant of this atypical presentation in their clinical practice.
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Bone scintigraphy imaging of cardiac amyloidosis p. 314
Issa Menge Kuria, Samuel Nguku Gitau, Khalid Bashir Makhdomi
DOI:10.4103/wjnm.WJNM_9_19  
Transthyretin-related cardiac amyloidosis (ATTR) amyloidosis is an aggressive, rapidly progressive, and fatal disease, for which several promising therapies are in development. This condition is frequently underdiagnosed because of the limited specificity of echocardiography and the traditional requirement for histological diagnosis. It is well known that 99mtechnetium-labeled bone scan radiotracers can localize in the myocardial amyloid deposits, but the use of this imaging modality to differentiate between the two subtypes has only lately been revisited. We report a case of a 76-year-old man with a clinical diagnosis of amyloidosis who underwent a bone scan that had features of ATTR amyloidosis. To the best of our knowledge, this is the first case report in Sub-Saharan Africa.
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ABSTRACTS OF THE 14TH INTERNATIONAL CONFERENCE ON RADIOPHARMACEUTICAL THERAPY (ICRT 2019) & WORLD ASSOCIATION OF RADIOPHARMACEUTICAL AND MOLECULAR THERAPY (WARMTH), 22-25 AUGUST 2019, NANJING Top

Oral Presentations p. 317
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Poster Presentations p. 324
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