Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc-99m methylene diphosphonate(99mTc-MDP) on the antecubital region and discuss the findings and differential diagnosis.
Multiple endocrine neoplasia syndrome, type 2B (MEN 2B), is a rare entity characterized by the presence of medullary thyroid cancer in 100% of the cases. The phenotype of this syndrome consists in the presence of marfanoid features and mucocutaneous neuromas.
We describe the case of a male patient with MEN 2B syndrome who was diagnosed with medullary thyroid cancer after lung metastases was found. We analyze the role of DMSA-V and the new hybrid SPECT-CT scan systems in the extension study and monitoring of medullary thyroid cancer.
Myocardial perfusion imaging (MPI) provides highly valuable information for risk stratification and determination of optimal clinical management. The goal of the present study was to assess the prognostic value of myocardial perfusion SPECT for the prediction of future cardiac events in Asian population.
Five hundred and ten consecutive patients, who had undergone myocardial perfusion SPECT between 2005 and 2006, were prospectively followed-up. Patients’ data were collected from recorded files. Follow-ups were performed by scripted telephone interviews by a physician blinded to the patients’ MPI results and also from the hospital records. The total completed follow-ups consisted of 482 patients (follow-up rate, 94.5%).
Over the mean follow-up period of 434 ± 62 days, 14 out of 482 patients (2.9%) died from cardiac events. Also in 61 patients (12.7%), the clinical condition led to a cardiac intervention (Percutaneous coronary intervention or coronary artery bypass grafting). Those patients without cardiac events on follow-up (including cardiac death or myocardial infarction) were younger and with less severity of MPI abnormalities. Severe MPI abnormalities (Summed Stress Score > 13) were found in 42.9% of those with cardiac death, while in 17.2% of those with myocardial infarction. The rate of cardiac death had a direct relationship with the severity of scan abnormalities, however, the same association was not found between the severity of MPI abnormality and the rate of myocardial infarction.
MPI is a valuable tool for risk stratification and prediction of future fatal cardiac events in Asian population. The risk of cardiac death as a mid-term outcome of coronary artery disease increases significantly with severity of MPI abnormalities.
To establish an automated procedure for the preparation of sodium fluoride 18F injection using the resources available in our laboratory for the preparation of 18FDG and to analyze the repercussion of the conditioning column of the fluoride ion entrapment on the characteristics of the final product.
The sequence of an 18FDG synthesis module prepared so that it traps the fluoride ion from the cyclotron in ion-exchange resin diluted with 0.9% sodium chloride. The final solution was dosified and sterilized in a final vial in an automatized dispensing module. Three different column conditioning protocols within the process were tested. Quality controls were run according to USP 32 and EurPh 6, adding control of ethanol levels of residual solvent and quality controls of the solution at 8 h post-preparation.
Activation of the resin cartridges with ethanol and water was the chosen procedure, with fluoride ion trapping >95% and pH around 7. Ethanol levels were <5000 ppm. Quality controls at 8 h indicated that the solution was in compliance with the USP 32 and EurPh 6 specifications.
This is an easy, low-cost, reliable automated method for sodium fluoride preparation in PET facilities with existing equipment for 18FDG synthesis and quality control.
Elastofibroma dorsi has been described in the literature as an unusual tumor or pseudotumor. However, autopsies and imaging studies have revealed that it is a non-negligible finding.
The aim of this study has been to illustrate and become familiar with this type of lesion in order to prevent misdiagnosis.
From 3 December 2008 to 5 January 2010, 1,751 patients were evaluated with 18FDG-PET/CT. Of these, 29 cases of elastofibroma dorsi were recorded as an incidental finding. A retrospective and descriptive analysis was performed on this study series.
The study showed a prevalence of 1.66%. Out of the 29 findings, 22 (75.86%) were females and 7 (24.14%) males. Seventeen (58.62%) cases were bilateral, 12 (41.38%) unilateral and the SUVmax ranged from 1.4 to 3.2. These lesions were reported as soft tissue density images with mild or moderate diffuse metabolic activity.
The elastofibroma dorsi is a relatively common finding in PET/CT that should be known in order to avoid making wrong diagnoses.
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