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   2016| May-August  | Volume 15 | Issue 2  
    Online since March 3, 2016

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Unusual false positive radioiodine uptake on 131 I whole body scintigraphy in three unrelated organs with different pathologies in patients of differentiated thyroid carcinoma: A case series
Rohit Ranade, Shwetal Pawar, Abhishek Mahajan, Sandip Basu
May-August 2016, 15(2):137-141
DOI:10.4103/1450-1147.176884  PMID:27134566
Three cases with unusual false positive radioiodine uptake in three different organs and pathologies (infective old fibrotic lesion in the lung, simple liver cyst, and benign breast lesion) on iodine-131 ( 131 I) whole body scintigraphy. Clinicoradiological correlation was undertaken in all three cases and the pathologies were ascertained. In all the three cases, single-photon emission computerized tomography-computed tomography (SPECT-CT) and ancillary imaging modalities were employed and were helpful in arriving at the final diagnosis.
  3,275 440 4
18 F sodium fluoride PET/CT in patients with prostate cancer: Quantification of normal tissues, benign degenerative lesions, and malignant lesions
Jorge D Oldan, A Stewart Hawkins, Bennett B Chin
May-August 2016, 15(2):102-108
DOI:10.4103/1450-1147.172301  PMID:27134560
Understanding the range and variability of normal, benign degenerative, and malignant 18 F sodium fluoride ( 18 F NaF) positron emission tomography/computed tomography (PET/CT) uptake is important in influencing clinical interpretation. Further, it is essential for the development of realistic semiautomated quantification techniques and simulation models. The purpose of this study is to determine the range of these values in a clinically relevant patient population with prostate cancer. 18 F NaF PET/CT scans were analyzed in patients with prostate cancer (n = 47) referred for evaluation of bone metastases. Mean and maximum standardized uptake values [SUVs (SUV mean and SUV max )] were made in normal background regions (n = 470) including soft tissues (liver, aorta, bladder, adipose, brain, and paraspinal muscle) and osseous structures (T12 vertebral body, femoral diaphyseal cortex, femoral head medullary space, and ribs). Degenerative joint disease (DJD; n = 281) and bone metastases (n = 159) were identified and quantified by an experienced reader using all scan information including coregistered CT. For normal bone regions, the highest 18 F NaF PET SUV mean occurred in T12 (6.8 ± 1.4) and it also showed the lowest coefficient of variation (cv = 21%). For normal soft tissues, paraspinal muscles showed very low SUV mean (0.70 ± 0.11) and also showed the lowest variability (cv = 16%). Average SUV mean in metastatic lesions is higher than uptake in benign degenerative lesions but values showed a wide variance and overlapping values (16.3 ± 13 vs 11.1 ± 3.8; P < 0.00001). The normal 18 F NaF PET uptake values for prostate cancer patients in normal background, benign degenerative disease, and osseous metastases are comparable to those reported for a general population with a wide variety of diagnoses. These normal ranges, specifically for prostate cancer patients, will aid in clinical interpretation and also help to establish the basis of normal limits in a semiautomated data analysis algorithm.
  3,182 355 15
A 3D Monte Carlo method for estimation of patient-specific internal organs absorbed dose for 99m Tc-hynic-Tyr 3 -octreotide imaging
Mehdi Momennezhad, Shahrokh Nasseri, Seyed Rasoul Zakavi, Ali Asghar Parach, Mahdi Ghorbani, Ruhollah Ghahraman Asl
May-August 2016, 15(2):114-123
DOI:10.4103/1450-1147.174700  PMID:27134562
Single-photon emission computed tomography (SPECT)-based tracers are easily available and more widely used than positron emission tomography (PET)-based tracers, and SPECT imaging still remains the most prevalent nuclear medicine imaging modality worldwide. The aim of this study is to implement an image-based Monte Carlo method for patient-specific three-dimensional (3D) absorbed dose calculation in patients after injection of 99m Tc-hydrazinonicotinamide (hynic)-Tyr 3 -octreotide as a SPECT radiotracer. 99m Tc patient-specific S values and the absorbed doses were calculated with GATE code for each source-target organ pair in four patients who were imaged for suspected neuroendocrine tumors. Each patient underwent multiple whole-body planar scans as well as SPECT imaging over a period of 1-24 h after intravenous injection of 99m hynic-Tyr 3 -octreotide. The patient-specific S values calculated by GATE Monte Carlo code and the corresponding S values obtained by MIRDOSE program differed within 4.3% on an average for self-irradiation, and differed within 69.6% on an average for cross-irradiation. However, the agreement between total organ doses calculated by GATE code and MIRDOSE program for all patients was reasonably well (percentage difference was about 4.6% on an average). Normal and tumor absorbed doses calculated with GATE were slightly higher than those calculated with MIRDOSE program. The average ratio of GATE absorbed doses to MIRDOSE was 1.07 ± 0.11 (ranging from 0.94 to 1.36). According to the results, it is proposed that when cross-organ irradiation is dominant, a comprehensive approach such as GATE Monte Carlo dosimetry be used since it provides more reliable dosimetric results.
  2,929 345 8
The influence of antithyroid drug discontinuation to the therapeutic efficacy of 131 I in hyperthyroidism
A Hussein Sundawa Kartamihardja, Stepanus Massora
May-August 2016, 15(2):81-84
DOI:10.4103/1450-1147.167584  PMID:27134556
The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended.
  2,678 532 1
Effect of radionuclide activity concentration on PET-CT image uniformity
Francis Hasford, Bronwin Van Wyk, Thulani Mabhengu, Mboyo Di Tamba Vangu, Augustine Kwame Kyere, John Humphrey Amuasi
May-August 2016, 15(2):91-95
DOI:10.4103/1450-1147.167578  PMID:27134558
Assessment of radionuclide activity concentration on positron emission tomography-computedr tomography (PET-CT) image uniformity has been carried out quantitatively. Tomographic PET-CT images of cylindrical phantom containing F-18 fluorodeoxyglucose (FDG) activity concentration was acquired and used for the assessment. Activity concentrations were varied and PET-CT images were acquired at the constant acquisition parameters of time, matrix size, and reconstruction algorithm, respectively. Using midtransaxial image slices, quantitative index of nonuniformity (NU), and coefficient of uniformity variation were estimated for the different activity concentrations. Maximum NUs of 17.6%, 26.3%, 32.7%, 36.2%, and 38.5% were estimated for activity concentrations of 16.87 kBq/mL, 14.06 kBq/mL, 11.25 kBq/mL, 8.43 kBq/mL, and 5.62 kBq/mL, respectively. The coefficient of uniformity variation established an inverse quadratic relationship with activity concentration. Activity concentrations of 16.87 kBq/mL, 14.06 kBq/mL, 11.25 kBq/mL, 8.43 kBq/mL, and 5.62 kBq/mL produced uniformity variations of 1.47%, 2.52%, 4.23%, 5.12%, and 4.98%, respectively. Increasing activity concentration resulted in decreasing coefficient of uniformity and hence, an increase in image uniformity. The uniformity estimates compared well with the standards set internationally.
  2,737 357 -
18F-sodium fluoride PET-CT hybrid imaging of the lumbar facet joints: Tracer uptake and degree of correlation to CT-graded arthropathy
Marc C Mabray, Marcel Brus-Ramer, Spencer C Behr, Miguel H Pampaloni, Sharmila Majumdar, William P Dillon, Jason F Talbott
May-August 2016, 15(2):85-90
DOI:10.4103/1450-1147.174698  PMID:27134557
We aim to evaluate 18F-NaF uptake by facet joints with hybrid PET-CT technique. Specifically, we evaluate NaF uptake in the facet joints of the lower lumbar spine, and correlate with the morphologic grade of facet arthropathy on CT. 30 consecutive patients who underwent standard vertex to toes NaF PET-CT for re-staging of primary neoplastic disease without measurable or documented bony metastases were identified. Maximum (SUVmax) and average (SUVavg) standardized uptake values were calculated for each L3-4, L4-5, and L5-S1 facet joint (n = 180) and normalized to average uptake in the non-diseased femur. A Pathria grade (0-3) was assigned to each facet based upon the CT morphology. Spearman's rank correlation was performed for normalized SUVmax and SUVavg with Pathria grade. ANOVA was performed with Tukey-Kramer pairwise tests to evaluate differences in uptake between Pathria groups. Facet normalized SUVmax (r = 0.31, P < 0.001) and SUVavg (r = 0.28, P < 0.001) demonstrated a mild positive correlation with CT Pathria grade. There was a wide range of uptake values within each Pathria grade subgroup with statistically significant differences in uptake only between Pathria grade 3 as compared to grades 0, 1, and 2. In conclusion, NaF uptake and morphologic changes of the facet joint on CT are weakly correlated. Physiologic information provided by NaF uptake is often discrepant with structural findings on CT suggesting NaF PET may supplement conventional structural imaging for identification of pain generating facet joints. Prospective investigation into the relationship of facet joint NaF uptake with pain and response to pain interventions is warranted.
  2,712 309 4
Correlation between transient ischemic dilation index and endothelin-1 level in patients with Type 2 diabetes mellitus
Achmad Hussein Sundawa Kartamihardja
May-August 2016, 15(2):109-113
DOI:10.4103/1450-1147.167576  PMID:27134561
Transient ischemic dilation (TID) is a sensitive and specific marker for detecting the severity and extent of coronary artery disease (CAD), which is closely associated with endothelial dysfunction. TID can be observed on stress-rest myocardial perfusion scan (MPS) due to subendocardial hypoperfusion. Hyperglycemia in type 2 diabetes mellitus (T2DM) could lead to micro- and macrovascular complications and begins with endothelial dysfunction. Endothelin-1 (ET-1), a potent vasocontrictor, increases in endothelial dysfunction. The aim of this study was to examine the correlation between TID index and ET​​-1 levels in T2DM patients without any sign or symptom of cardiovascular complication. An analytic-correlational cross-sectional study was done on T2DM patients who met the inclusion criteria and agreed to participate by signing an informed consent form. The TID index was calculated automatically using standard software provided by the gamma camera GE-Infinia. Stress-rest MPS was done using technetium-99m ( 99m Tc)-tetrofosmin and a pharmacological stress test using adenosine. The ET-1 level was determined by radioimmunoassay. Data distribution was analyzed using the Shapiro-Wilk normality test. The Mann-Whitney test was used to compare the average difference of the variables and Spearman's rank for correlation analysis. A total of 47 subjects consisting of 24 (51%) males and 23 (49%) females were included in this study. The age range was 37-74 years (54.3 ± 8.4). The TID index range was 0.86-1.26 (median = 1.12) and abnormal TID index was found in 23/47 (49%) subjects. ET-1 levels range 8.02-17.91 pg/mL (median = 11.08). The results showed no significant differences in age, ET-1 levels, and TID index based on age and sex (P > 0.05). There was a significant positive correlation between TID index and ET-1 level with r = 0.7 and P < 0.001. There was a positive correlation between TID index and ET-1 plasma level in patients with T2DM.
  2,581 223 1
Detection of diffuse infiltrative primary hepatic lymphoma on FDG PET-CT: Hallmarks of hepatic superscan
Sonia Mahajan, Shefali Kalra, Madhavi Chawla, Pankaj Dougall
May-August 2016, 15(2):142-144
DOI:10.4103/1450-1147.167581  PMID:27134567
Primary hepatic lymphoma (PHL) is an extremely rare entity with scarce information in evidence-based literature. Few case reports have described the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in the diagnosing and staging of PHL. We report the case of a 78-year-old man with PHL who initially presented with weight loss and nonspecific fatigue. FDG PET-CT proved to be a beneficial tool in arriving at the diagnosis of this patient with nonspecific clinical presentation and also in the staging of PHL. Physiological uptake of FDG in the liver can be a potential cause of misinterpretation in such cases. Hence, knowing the imaging hallmarks can increase the accuracy in PET image interpretation.
  2,448 285 5
A case of lingual thyroid presenting with severe hematemesis in pregnancy
Amol Sudke, Amit Kumar Dey, Suchin Dhamanskar, Varsha Kulkarni
May-August 2016, 15(2):134-136
DOI:10.4103/1450-1147.167580  PMID:27134565
Lingual thyroid is a rare anomaly with symptoms such as upper airway obstruction, dysphagia, or hypothyroidism. However, bleeding is a very rare manifestation. This report describes a case of lingual thyroid in women with 28 weeks of amenorrhea and hematemesis, and its course of diagnosis and treatment. The pathogenesis of lingual thyroid is unknown. Although ectopic lingual thyroid is usually not managed surgically, excision of ectopic lingual thyroid can be lifesaving when it is causing bleeding or airway obstruction. However, during pregnancy, surgery is the preferred mode of treatment.
  2,379 228 1
Multimodality molecular imaging (FDG-PET/CT, US elastography, and DWI-MRI) as complimentary adjunct for enhancing diagnostic confidence in reported intermediate risk category thyroid nodules on bethesda thyroid cytopathology reporting system
Sandip Basu, Abhishek Mahajan, Supreeta Arya
May-August 2016, 15(2):130-133
DOI:10.4103/1450-1147.176883  PMID:27134564
The potential complimentary role of various molecular imaging modalities [fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), ultrasound (US)-elastography, and  diffusion weighted imaging-magnetic resonance imaging (DWI-MRI)] in characterizing thyroid nodules, which have been designated as "intermediate risk category" on the  Bethesda thyroid cytopathology reporting system (BTCRS), is illustrated in this communication. The clinical cases described (category III thyroid nodules on BTCRS) show the imaging features and  the final diagnostic impressions rendered by the interpreting physicians with the modalities that have been independently compared in a tabular format at the end; of particular note is the high negative predictive value of these (specifically FDG-PET/CT), which could aid in enhancing the diagnostic confidence in the reported "intermediate risk category" thyroid nodules, a "gray zone" from the patient management viewpoint.
  2,309 284 3
The accuracy of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of bone lesions of undetermined origin
Cuneyt Tamam, Muge Tamam, Mehmet Mulazimoglu
May-August 2016, 15(2):124-129
DOI:10.4103/1450-1147.176885  PMID:27134563
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
  2,302 212 4
Comparison between postprocessing software and repeated scanning to eliminate subdiaphragmatic activity in myocardial perfusion scintigraphy
Daris Theerakulpisut, Chanisa Chotipanich
May-August 2016, 15(2):96-101
DOI:10.4103/1450-1147.173898  PMID:27134559
Myocardial perfusion single photon emission computed tomography (SPECT) is a powerful test of evaluation for coronary artery disease, but subdiaphragmatic radiotracer activity often interferes with the interpretation of inferior wall findings. This study aims to evaluate the effectiveness of using software elimination of the subdiaphragmatic activity for the assessment of its efficacy in the correctness of image interpretation and the overall image quality of myocardial perfusion scintigraphy (MPS). MPS studies from January 2010 to October 2012 at our institution were reviewed. Thirty-two SPECT studies were included, all of which had significant subdiaphragmatic activity in the first scan and needed to be delayed to let the activity clear. Each scan was interpreted by using semiquantitative scoring in 17 segments according to the degree of radiotracer uptake. The first scan, which had interfering activity, was manipulated by masking out the unwanted activity with software native to our image processing software suite. The manipulated images were then compared with delayed images of the same patient, of which the subdiaphragmatic activity was spontaneously cleared with time. The first scan masked by software correlated with the delayed scan for myocardial regions supplied by the left circumflex (LCx) and right coronary artery (RCA), but not the left anterior descending (LAD). However, the quality of the masked scans was perceived by the observer to be better in terms of quality and ease of interpretation. Using software to mask out unwanted subdiaphragmatic activity has no detrimental effect on the interpretation of MPS images when compared with delayed scanning, but it can improve subjective scan quality and ease of interpretation.
  2,238 265 -
Selective internal radiation therapy in metastatic carcinoma of the colon: A story of nonintegrated care?
John Buscombe
May-August 2016, 15(2):79-80
DOI:10.4103/1450-1147.178010  PMID:27134555
  1,905 286 1