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   2014| September-December  | Volume 13 | Issue 3  
    Online since November 15, 2014

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Excellence is the enemy of good
John Buscombe
September-December 2014, 13(3):147-148
DOI:10.4103/1450-1147.144811  PMID:25538483
  1,563 8,064 -
Comparison of the relative renal function calculated with 99mTc-diethylenetriaminepentaacetic acid and 99mTc-dimercaptosuccinic acid in children
Tanju Çelik, Hülya Yalçin, Emel Ceylan Günay, Aynur Özen, Cahit Özer
September-December 2014, 13(3):149-153
DOI:10.4103/1450-1147.144812  PMID:25538484
The aim was to compare the relative renal functions measured with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) and technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) in children with renal diseases. Relative renal function of 128 children who applied to three hospitals from 2009 to 2011 were analyzed retrospectively. The mean value measured with 99mTc-DTPA and 99mTc-DMSA were 51.58 ± 14.95 and 51.96 ± 14.99 for the right kidney, 47.87 ± 15.27 and 47.94 ± 15.17 for the left kidney, respectively. A significant positive correlation was found between the relative renal functions (r = 0.963, P < 0.001). In Bland-Altman plots, the mean difference between two methods was 0.7 and the correlation limits were between 10.1 and-10.8. As a result, although 99mTc-DMSA is accepted as the most reliable method for the determination of relative renal function, 99mTc-DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in pediatric patients who require renogram curve and GFR calculations.
  1,612 2,612 1
Synthesis of 99m TcN-clinafloxacin dithiocarbamate complex and comparative radiobiological evaluation in Staphylococcus aureus infected mice
Syed Qaiser Shah, Mohammad Rafiullah Khan
September-December 2014, 13(3):154-158
DOI:10.4103/1450-1147.144813  PMID:25538485
Clinafloxacin dithiocarbamate (CNND) preparation and radiolabeling through [ 99m Tc ≡ N] 2+ core with the gamma (g) emitter ( 99m Tc) was assessed. The potentiality of the 99m Tc V ≡ N-CNND complex was investigated as perspective a Staphylococcus aureus (S.a.) in vivo infection radiotracer in terms of radiochemical stability in normal saline (n.s.), human serum (h.s.), binding efficacy with live and heat killed S.a. and biodistribution in female nude mice model (FNMD). More than 90% stability was observed in n.s. for 4 h with the highest yield of 98.70 ± 0.26% at 30 min after reconstitution. In h.s., the 99m Tc V ≡ N-CNND complex was found stable up to 16 h with 15.35% side products. Maximum in vitro binding (68.75 ± 0.80%, 90 min) with S.a. was observed after 90 min of incubation. In FNMD, (infected with live strain) approximately six-fold higher uptakes was noted in the infected to inflamed and normal muscles. The higher stability in n.s., h.s., higher S.a. (live) up take with specific and targeted in vivo distribution confirmed potentiality of the 99m Tc V ≡ N-CNND complex as perspective S.a. in vivo infection radiotracer.
  1,999 833 1
Role of scintimammography in assessing the response of neoadjuvant chemotherapy in locally advanced breast cancer
Romeeta Trehan, Rajeev K Seam, Manoj K Gupta, Ashwani Sood, Kislay Dimri, Rohit Mahajan
September-December 2014, 13(3):163-169
DOI:10.4103/1450-1147.144816  PMID:25538487
Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients with LABC. Histologically proven 23 patients of LABC were recruited in this study. Prechemotherapy tumor size was measured clinically in all patients and technitium (Tc)-99m sestamibi test was performed before NACT for each patient. Early (10 min) and delayed (2 h) image of the breast were acquired in anterior and lateral views after Tc-99m sestamibi intravenous injections and wash out rate (WOR) was computed. After 3-4 cycles of chemotherapy, surgery in the form of modified radical mastectomy was performed in 20 out of 23 patients (3 patients lost to follow-up) with pathologic evaluation of the residual tumor size. The pretherapy Tc-99m sestamibi WOR ranged from 8.3% to 68% with mean ± SD of 34.5% ±16.5%. The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients. When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1. Tc-99m sestamibi WOR is a reliable test for predicting tumor response to NACT. WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.
  2,292 520 4
99m Tc diethylenetriaminepentacetic acid angiotension-coverting enzyme inhibitor renography as screening test for renovascular hypertension in unilateral small kidney: A prospective study
Masood ul Hassan, Shoukat H Khan, Mohd Ashraf, Saleem Najar, Feroz Shaheen
September-December 2014, 13(3):159-162
DOI:10.4103/1450-1147.144815  PMID:25538486
To know the probability of renal artery stenosis (RAS) in unilateral small kidney and function of the unilateral small kidney, which includes glomerular filtration rate, differential function, uptake, Tmax by 99m Tc diethylenetriaminepentacetic acid (DTPA) base and 99m Tc DTPA angiotensin converting enzyme (ACE) inhibition scan. All our patients were subjected to 99m Tc DTPA ACE inhibition renal scintigraphy. All the patients underwent either computed tomography (CT) angiography and magnetic resonance (MR) angiography was done in those patients in which kidney function test was deranged. Renal angiography was subsequently performed in cases with the suggestion of RAS on CT or MR angiography. The quantitative data was expressed as the arithmetic mean, standard deviation and percentages. The intergroup comparisons for parametric data were done by Student's t-test, whereas non-parametric data was compared with Mann-Whitney U-test. The intergroup comparisons were made by paired t-test and Wilcoxon sign rank test. P <0.05 was considered to be significant, and data was analyzed by Statistical package for social sciences(SPSS-20) software. Out of 47 patients, 25 patients were in the low probability group out of which none was positive for RAS on CT/MR angiography. Out of 47 patients, 12 were in the intermediate group out of which none was positive for RAS. Ten, out of 47 patients were suspected of high probability for RAS by ACE inhibition scan out of which 4 were positive for RAS by CT/MR angiography including one with bilateral RAS. 99m Tc DTPA angiotension-coverting enzyme inhibitor renography is a safe, non-invasive, sensitive, specific, and cost-effective test for excluding renovascular hypertension in patients who have normal or nearly normal renal function in unilateral small kidney.
  1,895 619 -
Correlative 99m Tc-labeled tropane derivative single photon emission computer tomography and clinical assessment in the staging of parkinson disease
Ajit S Shinto, Joppy Antony, Koramadai Kamaleshwaran, Krishnan Vijayan, Arul Selvan, Aruna Korde, Mythili Kameshwaran, Grace Samuel
September-December 2014, 13(3):178-183
DOI:10.4103/1450-1147.144818  PMID:25538489
Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by a selective loss of dopamine in the striatum. Problems remain in the accurate diagnosis of PD. The diagnosis of idiopathic PD is based on the interpretation of clinical signs and symptoms could be incorrect at the time of initial presentation. In vivo imaging of the dopaminergic system has the potential to improve the diagnosis of PD in its early stages. The imaging of dopamine transporter (DAT) with 99m Tc-labeled tropane derivative (TRODAT-1) single photon emission computer tomography/computer tomography (SPECT/CT) has been proposed to be a valuable and feasible means of assessment of the integrity of dopamine neurons. The purpose of this study was to investigate the potential usefulness of 99m Tc-TRODAT-1 imaging in the evaluation of patients with PD and classify into different stages of the disease. SPECT imaging with 99m Tc-TRODAT-1 was conducted in 16 consecutive PD patients (9 men; 7 women) and in 6 age matched healthy volunteers (4 men; 2 women). The images were obtained 3 h after the intra-venous injection of the tracer. Specific uptake in the striatum and its sub-regions, including the putamen and caudate nucleus was calculated and the ratios of specific striatal binding to nonspecific occipital binding were calculated. ANOVA with Dunnett C post-hoc analysis was conducted using SPSS 20. A stepwise reduction in specific striatal uptake of 99m Tc-TRODAT-1 with increasing disease severity between healthy control versus Stage I versus Stage II versus Stage III was found in PD patients (i.e., 3.77 vs. 2.56 vs. 1.57 vs. 0.63, P < 0.05). The changes were magnified by measurement of specific putaminal uptake (1.43 vs. 0.79 vs. 0.54 vs. 0.19, P < 0.05) and specific caudate uptake (1.90 vs. 1.47 vs. 0.73 vs. 0.27, P < 0.05). No remarkable adverse reactions were found in either healthy volunteers or PD patients during or after imaging. 99m Tc-TRODAT-1 is accurate and widely available for the assessment of DAT activity, which might shed light on the integrity of the presynaptic nigrostriatal function. Our preliminary study results confirm the potential of using 99m Tc-TRODAT-1 for DAT measurement, which is clinically important for the staging of PD.
  2,075 310 6
False negative 99m Tc-hydroxymethane diphosphonate three-phase bone scintigraphy and 99m Tc-besilesomab scan in detecting tibia osteomyelitis concomitant with necrotizing fasciitis
Teik Hin Tan, Boon Nang Lee
September-December 2014, 13(3):190-192
DOI:10.4103/1450-1147.144820  PMID:25538491
We described a case of 51-year-old female patient presented with a right calf necrotising fasciitis (NF) where osteomyelitis (OM) was suspected. 99m Tc-hydroxymethane diphosphonate three-phase bone scintigraphy and 99m Tc-besilosomab scan failed to demonstrate classical features of OM. The final diagnosis was only made by isolating Acinetobacter sp. in both intra-operative bone and tissue cultures from below-knee amputation. As conclusions, the detection of lower limb OM by 99m Tc-besilosomab scan is not easy when there is concurrence overlying NF. The unusual three-phase bone scan finding of pericortical accumulation of tracer as an early sign of OM is highlighted in this case.
  2,150 224 1
The accuracy of integrated [ 18 F] fluorodeoxyglucose-positron emission tomography/computed tomography in detection of pelvic and para-aortic nodal metastasis in patients with high risk endometrial cancer
Nikhil Shirish Gholkar, Subhas Chandra Saha, GRV Prasad, Anish Bhattacharya, Radhika Srinivasan, Vanita Suri
September-December 2014, 13(3):170-177
DOI:10.4103/1450-1147.144817  PMID:25538488
Lymph nodal (LN) metastasis is the most important prognostic factor in high-risk endometrial cancer. However, the benefit of routine lymphadenectomy in endometrial cancer is controversial. This study was conducted to assess the accuracy of [ 18 F] fluorodeoxyglucose-positron emission tomography/computed tomography ([ 18 F] FDG-PET/CT) in detection of pelvic and para-aortic nodal metastases in high-risk endometrial cancer. 20 patients with high-risk endometrial carcinoma underwent [ 18 F] FDG-PET/CT followed by total abdominal hysterectomy, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with or without para-aortic lymphadenectomy. The findings on histopathology were compared with [ 18 F] FDG-PET/CT findings to calculate the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [ 18 F] FDG-PET/CT. The pelvic nodal findings were analyzed on a patient and nodal chain based criteria. The para-aortic nodal findings were reported separately. Histopathology documented nodal involvement in two patients (10%). For detection of pelvic nodes, on a patient based analysis, [ 18 F] FDG-PET/CT had a sensitivity of 100%, specificity of 61.11%, PPV of 22.22%, NPV of 100% and accuracy of 65% and on a nodal chain based analysis, [ 18 F] FDG-PET/CT had a sensitivity of 100%, specificity of 80%, PPV of 20%, NPV of 100%, and accuracy of 80.95%. For detection of para-aortic nodes, [ 18 F] FDG-PET/CT had sensitivity of 100%, specificity of 66.67%, PPV of 20%, NPV of 100%, and accuracy of 69.23%. Although [ 18 F] FDG-PET/CT has high sensitivity for detection of LN metastasis in endometrial carcinoma, it had moderate accuracy and high false positivity. However, the high NPV is important in selecting patients in whom lymphadenectomy may be omitted.
  2,060 262 2
Gallium-68 Dota-Tate positron emission tomography/computed tomography: Scintigraphic changes of adrenal glands following management of ectopic cushing's syndrome by steroidogenesis inhibitors
Yu-Ting Huang, Shaikh Irfan Aziz, Aravind S Ravi Kumar
September-December 2014, 13(3):201-204
DOI:10.4103/1450-1147.144823  PMID:25538494
In the era of emerging functional imaging techniques, an understanding of the effects of hormonal therapies on the scintigraphic appearance of endocrine organs is desirable to minimize the erroneous scan interpretation. The mechanisms by which changes in the scintigraphic appearance of endocrine organs occur however sometimes remain ambiguous. This case demonstrates the gallium-68 (Ga-68) DOTA-TATE positron emission tomography/computed tomography (CT) appearance of adrenal glands following management with steroidogenesis inhibitors. The potential mechanisms underlying this change are discussed. A 17-year-old boy with adrenocorticotropic hormone (ACTH) dependent Cushing's syndrome secondary to ectopic ACTH secretion underwent pre- and post-metyrapone and dexamethasone treatment Ga-68 DOTA-TATE scans 4 months apart. Pretreatment, both adrenals demonstrated normal symmetrical prominent Ga-68 DOTA-TATE uptake and normal CT appearance. The posttherapy scan revealed marked symmetrical suppression of Ga-68 DOTA-TATE uptake, but with bilateral adrenal hypertrophy on CT.
  1,999 209 2
99m Tc dtpa renogram indentifies bochdalek hernia with an intra thoracic kidney as its content
Subramanyam Padma, Shantanu R Pande, Palaniswamy Shanmuga Sundaram
September-December 2014, 13(3):193-196
DOI:10.4103/1450-1147.144821  PMID:25538492
Congenital diaphragmatic hernia (CDH) is a rare anomaly with reported incidence of 1 in 16,000 and is associated with herniation of stomach, intestinal loops, spleen, and kidney through a chest wall defect. We report a case of 1-year-old male child with history of recurrent fever and non-visualization of left kidney on ultrasonogram. Patient was referred to us to look for ectopic left kidney. 99m Tc-diethylenetriaminepentaacetic acid renogram was performed. An ectopically placed intrathoracic left kidney was identified. Subsequently a chest X-ray was done that showed bowel loops and diagnosis of CDH was confirmed. The patient underwent thoracoscopic repair of CDH and hernial contents were found to be left kidney, intestinal loops and spleen.
  1,966 211 -
Looking outside the "Cardiac" box: Incidental detection of a metastatic lung tumor on cardiac position emission tomography/computed tomography
Mohamed Shawgi, P Arumugam
September-December 2014, 13(3):197-200
DOI:10.4103/1450-1147.144822  PMID:25538493
Incidental extracardiac findings are not uncommon in patients undergoing cardiac positron emission tomography/computed tomography (PET/CT) and some of these findings can have significant clinical impact. We report a case of a 74-year-old man who presented with dyspnea and left sided chest pain. 82-rubidium PET/CT imaging showed normal myocardial perfusion. Review of the low dose CT scan performed for attenuation correction purposes (CTAC) incidentally revealed a 4 cm mass in the left lung, which was histologically shown to be a squamous cell carcinoma. A subsequent staging CT showed chest wall metastases and rib destruction in the upper left thorax, which were outside the image reconstruction field of view of the CTAC. This report illustrates the importance of vigilant review of all acquired images by the PET/CT reader to look for extracardiac abnormalities that may explain symptoms in the absence of coronary artery disease. It also raises the question as to whether a larger field of CT image acquisition should be routinely performed to scan the entire chest during cardiac PET/CT imaging. However, the latter needs to be weighed against the increase in patient dose, which we estimated to be an additional 15%.
  1,822 225 2
A comparison between quantitative gated myocardial perfusion scintigraphy and strain echocardiography as indicators of ventricular functions in patients with anterior myocardial infarction
Seyhan Karacavus, Ahmet Celik, Ahmet Tutus, Mustafa Kula, Abdurrahman Oguzhan, Ibrahim Ozdogru, Nihat Kalay
September-December 2014, 13(3):184-189
DOI:10.4103/1450-1147.144819  PMID:25538490
The purpose of this study is to compare the strain echocardiographic and scintigraphic parameters for evaluating of the left ventricular (LV) functions in patients with anterior myocardial infarction (MI). Fifty-four patients (male/female: 36/18; mean age 62 ± 13 years) with anterior MI were prospectively enrolled. All patients were performed gated myocardial perfusion scintigraphy gated single-photon emission computed tomography (GSPECT) and echocardiography (EC). GSPECT data were processed and analyzed using 4D-MSPECT (4DM, Invia Medical Imaging Solutions, Ann Arbor, MI, USA). The echocardiographic strain (S) and strain rate (SR) values were calculated. The results obtained by these techniques were compared each other. A total of 918 segments of LV wall were evaluated. In all patients, 385 segments were automatically scored as normokinetic, 206 as hypokinetic, 122 as akinetic, 205 as dyskinetic and 300 as normal thickening, 348 as decrease thickening and 270 as no thickening. The means of S and SR values in thickening and motion score groups according to GSPECT were statistically different from each other (P < 0.001). There was a negative significant correlation between LV wall thickening sum score and S and SR and between LV wall motion sum score and S and SR (P < 0.001). There was a good correlation between GSPECT and echocardiographic LV-ejection fraction (r = 0.7, P < 0.001). GSPECT and strain EC are similar in quantitative grading of the severity of regional and global myocardial dysfunction in patients with anterior MI and these techniques provide valuable diagnostic information.
  1,677 265 -
Occult prostate cancer detected with 18F-fluorocholine positron emission tomography/computed tomography
Wanying Xie, Andrew Eik Hock Tan, Christopher Cheng, Anthony Goh Soon Whatt
September-December 2014, 13(3):205-208
DOI:10.4103/1450-1147.144824  PMID:25538495
We present a case of a 63-year-old gentleman, who had an initial negative prostate needle biopsy, but persistently elevated prostate-specific antigen levels. An magnetic resonance imaging study of the prostate failed to demonstrate the presence of malignancy. 18F-fluorocholine positron emission tomography/computed tomography (PET/CT) was then acquired which revealed suspicious prostate lesions. These were confirmed by subsequent surgery and histology to represent prostatic carcinoma.
  1,745 175 2
Bone metastases treatment by Sm-153 oxabifore in combination with monoclonal antibody denosumab (Xgeva)
Beuy Joob, Viroj Wiwanitkit
September-December 2014, 13(3):209-209
DOI:10.4103/1450-1147.144825  PMID:25538496
  1,177 153 -