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   2013| May-August  | Volume 12 | Issue 2  
    Online since July 14, 2014

 
 
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CASE REPORTS
Bone Scanning in the Adductor Insertion Avulsion Syndrome
Madhuri Shimpi Mahajan
May-August 2013, 12(2):73-75
DOI:10.4103/1450-1147.136698  PMID:25126001
A thigh splint (adductor insertion avulsion syndrome) is a relatively uncommon diagnosis analogous to shin splints. This article reports a 19-year-old female patient NOT a regular athlete who presented with groin pain. Physical examination was non-specific; magnetic resonance imaging pelvis did not reveal any abnormality. Patient referred for whole body bone scan, especially to locate any abnormality in the spine. This study highlights the role of whole body bone scan in the evaluation of groin pain and importance of evaluation of whole lower extremity.
  2 1,676 171
ORIGINAL ARTICLES
Factors Predicting Treatment Failure in Patients Treated with Iodine-131 for Graves' disease
Kuruva Manohar, Bhagwant Rai Mittal, Amit Bhoil, Anish Bhattacharya, Pinaki Dutta, Anil Bhansali
May-August 2013, 12(2):57-60
DOI:10.4103/1450-1147.136693  PMID:25125996
Treatment of Graves' disease with iodine-131 ( 131 I) is well-known; however, all patients do not respond to a single dose of 131 I and may require higher and repeated doses. This study was carried out to identify the factors, which can predict treatment failure to a single dose of 131 I treatment in these patients. Data of 150 patients with Graves' disease treated with 259-370 MBq of 131 I followed-up for at least 1-year were retrospectively analyzed. Logistic regression analysis was used to predict factors which can predict treatment failure, such as age, sex, duration of disease, grade of goiter, duration of treatment with anti-thyroid drugs, mean dosage of anti-thyroid drugs used, 99m Tc-pertechnetate ( 99m TcO 4- ) uptake at 20 min, dose of 131 I administered, total triiodothyronine and thyroxine levels. Of the 150 patients, 25 patients required retreatment within 1 year of initial treatment with 131 I. Logistic regression analysis revealed that male sex and 99m TcO 4- uptake were associated with treatment failure. On receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) was significant for 99m TcO 4- uptake predicting treatment failure (AUC = 0.623; P = 0.039). Optimum cutoff for 99m TcO 4- uptake was 17.75 with a sensitivity of 68% and specificity of 66% to predict treatment failure. Patients with >17.75% 99m TcO 4- uptake had odds ratio of 3.14 (P = 0.014) for treatment failure and male patients had odds ratio of 1.783 for treatment failure. Our results suggest that male patients and patients with high pre-treatment 99m TcO 4- uptake are more likely to require repeated doses of 131 I to achieve complete remission.
  2 1,660 295
CASE REPORTS
False-positive 111 In-pentetreotide Uptake in Gastritis
Sharjeel Usmani, Alshaima Alshammari
May-August 2013, 12(2):76-78
DOI:10.4103/1450-1147.136699  PMID:25126002
111 In-pentetreotide [ 111 In-octreoscan] is the most widely used radiolabeled somatostatin analog for evaluating neuroendocrine tumor overexpression of somatostatin receptors. False-positives studies of somatostatin receptor scintigraphy have been reported and often the cause is unexplained but assumed to be due to high number of somatostatin receptors in other pathologies. Causes of false-positives include visualization of the gallbladder, nasal mucosa and pulmonary hilar areas in respiratory infections, thyroid abnormalities, accessory spleens, recent Cerebrovascular accidents (CVA's) and activity at the site of a recent surgical incision. In infection or inflammation the cause of false-positive uptake is probably the result of tracer binding by somatostatin receptors on the inflammatory leukocytes. In this case report, we report, a 44-year-old male patient with false-positive 111 In-pentetreotide uptake due to gastritis.
  1 1,490 181
F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Staging of Linitis Plastica Caused by Primary Gastric Adenocarcinoma
Santhosh Sampath, Chandrashekar Natarajan Balasubramanian Harisankar, Anish Bhattacharya, Rajesh Gupta, Bhagwant Rai Mittal
May-August 2013, 12(2):67-69
DOI:10.4103/1450-1147.136696  PMID:25125999
Diffuse infiltration by a primary or metastatic malignancy into the submucosa and muscularis of the stomach (linitis plastica [LP]) has been described in literature. The authors present a case of LP caused by primary adenocarcinoma of the stomach, showing diffuse Fluorine-18 fluorodeoxyglucose uptake in the thickened wall of the stomach.
  1 1,540 165
LETTER TO EDITOR
Routine Whole Volume Single Photon Emission Tomography Reconstruction in Comparison to Cine Raw Data in the Detection of Extracardiac Uptake
Viroj Wiwanitkit
May-August 2013, 12(2):79-79
DOI:10.4103/1450-1147.136700  PMID:25126003
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ORIGINAL ARTICLES
Empiric Therapy with Low-Dose I-131 in Differentiated Cancer Thyroid: What is the Magic Number?
Ajit S Shinto, KK Kamaleshwaran, Deepu K Shibu, K Vyshak, Joppy Antony
May-August 2013, 12(2):61-64
DOI:10.4103/1450-1147.136694  PMID:25125997
Low dose radioactive iodine-131 (RAI) has been widely reported in the treatment of patients with differentiated thyroid cancer (DTC) since 1970's. However, the clinical outcomes, dosage of I-131 and criteria for successful ablation are different in various studies. The aim of this study was to assess clinical outcome 18-month after RAI therapy in selected DTC patients and identify factors associated with a good response. In this experimental study, among patients with DTC referred to the Nuclear Medicine Department and had an indication for RAI therapy in the period between December 2008 and January 2011, 108 subjects were selected randomly. The patients were randomly divided into three groups and empiric low dose therapy with 30, 50 or 75 mCi of I-131 was administered. Patients were monitored closely clinically and with serum thyroglobulin assays and I-131 whole-body scans at 6 monthly intervals for 18-month after treatment. Among 105 patients who completed follow-up, 86% were successfully ablated with a single low dose of I-131. There was no statistically significant difference in ablation rates in the subgroups receiving 30.50 or 75 mCi of I-131. Cumulative ablation rate was 99% in patients after the second dose of low dose therapy. If appropriate selection criteria are used in DTC, successful remnant ablation can be achieved with low doses of I-131 in the range of 30-75 mCi. No significant differences were found in results achieved with 30.50 or 75 mCi of I-131. As the majority of the DTC patients fall within the inclusion criteria of this study, they can be treated on an ambulatory basis with associated low cost, convenience, and low whole-body radiation-absorbed dose to the patients.
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CASE REPORTS
Autonomous Functioning Thyroid Nodule in a 4-year-old Male Child Treated with Radioiodine (I-131)
Abhishek Khare, Puneet Bhutani, Suneel Chauhan
May-August 2013, 12(2):65-66
DOI:10.4103/1450-1147.136695  PMID:25125998
Autonomous functioning thyroid nodules that cause toxic manifestations (toxic adenomas) are benign monoclonal tumors characterized by their capacity to grow and produce thyroxine (T4) and triiodothyronine (T3) autonomously, i.e. in the absence of thyrotropin thyroid stimulating hormone. Toxic adenomas are a rare presentation of hyperthyroidism in the pediatric population. Radioiodine (I-131) has been widely used for therapy of patients with toxic adenomas and is now accepted as a safe and effective treatment even in the pediatric age group. The authors here present a case of a 4-year-old boy with a solitary hyperfunctioning thyroid nodule, who was successfully treated with radioiodine (I-131) and is presently on follow-up.
  - 1,630 208
Vesicoureteral Reflux Detected on Post-void Image of 99m Tc MAG3 Renal Scintigraphy
Naureen Nizar, Akhtar Ahmed
May-August 2013, 12(2):70-72
DOI:10.4103/1450-1147.136697  PMID:25126000
99m Tc MAG3 scintigraphic scan is sensitive at depicting focal parenchymal abnormalities and can be used for the measurement of overall renal function. We experienced a 5-year-old boy presenting with bilateral flank fain, intermittent urinary stream and dysuria. On the post-void delayed image of 99m Tc MAG3 scintigraphic scan vesicoureteral reflux was detected in left non-functioning kidney, which was missed on voiding cystourethrography.
  - 2,091 222
EDITORIAL
"When Was the Last Tiame You Do Something for the First Time" Part 2
John Richard Buscombe
May-August 2013, 12(2):51-51
DOI:10.4103/1450-1147.136690  PMID:25125993
  - 923 125
ORIGINAL ARTICLES
Tc-99m Mebrofenin Hepatobiliary Scan in Obstructive Hepatobiliary Disease: Determining Causes with Early and Late Delayed Imaging
Robert Matthews, Mera Goodman, Pryanka Relan, Elham Safaie, Dinko Franceschi
May-August 2013, 12(2):54-56
DOI:10.4103/1450-1147.136692  PMID:25125995
Hepatobiliary radionuclide imaging is typically performed to detect cholecystitis. Infrequently, imaging reveals an obstructive pattern. Although delayed hepatobiliary imaging is commonly used to differentiate between intrahepatic (IH) and extrahepatic (EH) obstruction in the newborn; there is room to clarify the use of delayed imaging in the adult population. A retrospective review was performed of adult patients demonstrating a complete obstructive pattern on initial Tc-99m mebrofenin hepatobiliary imaging. Delayed imaging was divided into early delayed (ED) (<10 h) and late delayed (LD) (≥10 h) imaging. Two physicians qualified the presence of intestinal radiotracer (negative, low to high) on delayed images. Determination of EH or IH pathology was obtained from chart review. A total of 24 patients demonstrated an obstructive pattern using delayed Tc-99m mebrofenin hepatobiliary imaging, with delayed imaging ranging from 4 to 30 h. EH pathologies (choledocholithiasis, stricture, other) represented 63% of cases (n = 15), IH pathologies (cirrhosis, hepatitis, other) represented 33% cases (n = 8) and 1 case was indeterminate. 67% of EH cases showed intestinal activity on delayed imaging (67% on ED and 67% on LD imaging), whereas 63% of IH cases showed intestinal activity on delayed imaging (67% on ED imaging and 60% on LD imaging). The presence of intestinal activity on the both the early and delayed images did not differentiate between the IH and EH pathology groups. Subdividing the groups into ED imaging and LD imaging was also not predictive of determining location of obstructive pattern on the initial 1 h of imaging. This data suggests that delayed hepatobiliary scintigraphy has little or no role in determining the cause of obstructive pathology.
  - 1,772 216
REVIEW ARTICLE
Nuclear Accident Crisis and Liver Disease: A Summary on Evidences
Viroj Wiwanitkit
May-August 2013, 12(2):52-53
DOI:10.4103/1450-1147.136691  PMID:25125994
The present global concern is on the adverse effect due to exposure to nuclides expelled from the disrupted nuclear power plant accident in Japan. The exposure can induce several adverse effects. In this specific brief review, the author summarizes the evidences on the effect on liver. Discussion is focused on several liver diseases.
  - 1,061 132
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