NUCLEAR MEDICINE REVIEW最新文献

A 31-year-old woman who had multiple orthopedic surgeries on the left lower limb and recently suffered from pain and redness in the lateral left lower thigh was referred to the hospital to rule out osteomyelitis by [99mTc]UBI scintigraphy. Except soft tissue inflammation in the mentioned region, the scan showed significant and diffuse both lungs uptake incidentally. The patient had experienced symptoms of COVID-19 disease recently. Chest HRCT scan also revealed multiple segmental ground-glass opacities (GGOs) which were typical features for lung involvement of COVID-19 associated pneumonia.

SARS-CoV-2 (COVID-19) infection is a current public health problem that has been shown to cause multiple complications, including pulmonary thromboembolism. The first presented case is a 59-year-old woman with a history of COPD, paroxysmal atrial fibrillation and COVID-19 infection in September 2020, consultation in December 2020 for atypical chest pain with suspected PE, AngioCT of pulmonary vessels was performed negative for emboli, subsequently [99mTc]Tc MAA SPECT/CT was indicated with a report of multiple triangular defects concerning acute pulmonary thromboembolism. A second case is a 70-year-old man with a history of dyslipidaemia, presented COVID-19 infection in September 2020 with a complication of PE with involvement of the left pulmonary artery, followed by [99mTc]Tc MAA SPECT/CT report multiple triangular and not triangles defects concerning pulmonary thromboembolism with signs of reperfusion.

Background: Cerebral blood flow abnormalities are supposed to be potential risk factors for developing cognitive dysfunction in the general population. Aging, obesity and type 2 diabetes mellitus are associated with perfusion abnormalities leading to cognitive impairment, neurodegeneration and future development of dementia. In our study, we aimed at identifying independent factors that contribute to the appearance of regional brain perfusion changes besides those that are already known.

Material and methods: Forty-three type 2 diabetic and twenty-six obese patients were enrolled. After the intravenous administration of 740 MBq 99mTc-hexamethylpropylene amine oxime (HMPAO), all subjects underwent brain perfusion SPECT imaging applying AnyScan S Flex dual-head gamma camera (Mediso, Hungary). Using Philips Achieva 3T scanner brain resting-state functional MRI was also performed. The SPECT and MRI images were co-registered and transformed to the MNI152 atlas space so that data of the following standard volumes of interest (VOIs) could be obtained: frontal lobe, parietal lobe, temporal lobe, occipital lobe, limbic region, cingulate, insula, basal ganglia, cerebrum, limbic system and brain stem. Using the SPSS 25 statistical software package, general linear regression analysis, Student's t-test, and Mann-Whitney U-test were applied for statistical analyses.

Results: Multivariate linear analysis identified that BMI and age are significantly (p < 0.0001) associated with perfusion, and patient group was slightly above threshold (p = 0.0524). We also found that the presence of diabetes was an independent significant predictor of normalized regional brain perfusion only in the insula (p < 0.001). Other independent predictors of normalized regional brain perfusion were: age in the insula (p < 0.001) and in the limbic region (p < 0.01), and BMI in the brain stem (p < 0.01).

Conclusions: Age and BMI proved to be general, and diabetes regional predictor of brain hypoperfusion. BMI appeared to be a novel factor affecting brain perfusion. In one specific region, the insula, we detected a difference between the obese and the diabetic group. These findings may be significant in the understanding of the development of cognitive impairment in metabolic diseases.

Background: To evaluate the diagnostic performance of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG-PET/CT) scan in detecting local recurrences in patients with surgically treated oral tongue squamous cell cancer (OTSCC).

Material and methods: Eighty-seven patients who had undergone surgery for OTSCC were monitored clinically and [¹⁸F]FDGPET/CT and magnetic resonance (MR). PET uptakes were classified as functional (Type A), suspicious (Type B), or highly suggestive of local recurrence (Type C). A multidisciplinary team (MDT) evaluated case-by-case the surveillance strategy based on PET uptake.

Results: Fifty-nine patients presented FDG-PET uptake during follow-up: this report was significantly more frequent in patients who received flap reconstruction than in those without (73% vs 50%; p = 0.05). In 13 patients with Type A (n = 1), Type B (n = 9), and Type C (n = 3) uptakes an additional MR was considered preferable and discovered recurrence in 12.PET-CT had 9 true positives, 17 false positives, 71 true negatives, and no false-negative, resulting in sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%, 80.7%, 34.6%, and 100%.

Conclusions: The present results demonstrated a change in diagnostic strategy, as decided by the MDT, in about one-fifth of patients. The results should prompt in designing a rational surveillance schedule in surgically treated OTSCC.

[99mTc]MIBI thyroid scintigraphy is a useful tool to differentiate benign from malignant thyroid nodules. This report aims to show the diagnostic performance of [99mTc]MIBI scintigraphy used in an 83-year-old woman who had a thyroidectomy about 7 years ago. She had a mass of thyroid which was very large, non-homogenous and painless. [99mTc]MIBI scintigraphy could be a pre-surgical method to investigate the follicular nodules and predicting the malignant form of thyroid nodules. Also, it will provide tissue information for [99mTc]MIBI images in thyroid lesions.

A 33-year-old female with a history of total thyroidectomy for papillary thyroid carcinoma was referred to the nuclear medicine department for ablative radioiodine therapy. Post ablation scan showed an area of intense iodine uptake on the left side of the pelvic region, corresponding to the large well-defined heterogeneous mass in the left ovary in the SPECT/CT images. The radiologic features of this lesion were compatible with a dermoid cyst, previously unrecognized. Eventually, the lesion was laparoscopically removed, and a typical dermoid cyst was confirmed through histopathologic assessment.

A 69 y/o woman with a history of primary diffuse large B cell lymphoma in the right thigh muscle was referred for recurrence evaluation with 18F-FDG PET/CT. After routine courses of chemoradiation, MRI was done in order to evaluate treatment response with inconclusive findings. 18FDG PET/CT revealed abnormal uptake in the primary site of the disease as well as secondary involvement of stomach, pancreas, pelvic lymph nodes, and both tibiae. Our case showed the importance of 18F-FDG PET/CT in the detection of unusual soft tissue extension of lymphoma.

Background: In the follow-up of patients with inflammatory bowel disease (IBD), Tc-99m-HMPAO labelled leukocytes scintigraphy (leukocyte scan; LS) has long been established as a valuable diagnostic tool. The aim of this study was to estimate the relationship between scintigraphic results, inflammatory markers (IM) (including white blood cells (WBCs) and C-reactive protein (CRP)), clinical parameters and clinical indices of the disease activity (CI), in order to determine clinical settings in which LS is indicated.

Materials and methods: A total of 147 patients who underwent LS, (79 males, 68 females, median age 36), were examined from April 2010 until December 2017 at the University Hospital Centre Zagreb, Croatia. Among these, 126 (86%) had Crohn's disease (CD) and 21 (14%) had ulcerative colitis (UC). Either increased IM (either WBCs ≥10x109/L and/or CRP ≥7.4 mg/L) and/or CI, Crohn's disease activity index (CDAI) score ≥220 points, Harvey-Bradshaw index (HBI) score ≥8 points, and severe colitis defined according to Truelove and Witts' criteria (TWC) for UC, respectively, were considered consistent with active disease.

Results: Eighty-two patients (56%) had negative scans, while in 65 (44%) the scans were positive. Positive correlations were found between LS and all of the 3 parameters, WBCs, CRP and CI. When combined, the 3 parameters demonstrated even stronger positive correlation with the LS results with the correlation coefficient 0.76 (p<0.0001, 95% CI [0.68-0.82]). Using endoscopy and histological study findings of the obtained specimens as a composite reference standard, the overall sensitivity, specificity, positive predictive value and negative predictive value of IM and CI for LS were determined, being 91%, 85%, 83%, and 92%, respectively. IM and CI were both negative in 76 (52%) out of the total subjects. Of these, 70 had negative LS as well.

Conclusion: In the presence of normal IM with CI pointing to no active or mildly active disease, LS is not necessarily indicated.

Background: Every exposure of human to ionizing radiation increases the likelihood of deterministic sequelae. At the same time, it is associated with the risk of stochastic effects. Consequently, this can lead to cancer, mainly of the hematopoietic system. Organs or tissues show a different affinity for gamma radiation. There are many technical and organizational measures which minimize the impact of this radiation on people and especially on the staff of the nuclear medicine laboratory.

Materials and methods: The study was based on 208 referrals to the scintigraphic laboratory, which were executed between 26.09.2018 and 13.11.2018 in the Department of Nuclear Medicine of Military Medical Academy Memorial Teaching Hospital of the Medical University of Lodz - Central Veterans` Hospital. Referrals concerned scintigraphic tests of bones, salivary glands, parathyroid glands, myocardial perfusion, somatostatin receptor analogues, renoscintigraphic and lymphoscintigraphic tests. In case of each referral, radiation power was measured at a distance of approx. 10 cm with the use of a calibrated Geiger-Muller detector. Measurements were performed immediately after the end of the last examination each day. Daily measurement of the background radiation dose was also a standard procedure. For calculations, this value was averaged to 0.18µSv/h. Based on the above measurements, a statistical analysis of all data was performed. Obtained data was also analysed after it was ascribed to the person complexing radiopharmaceuticals on a given day. The annual dose for a radiopharmacist is 0.12 mSv, for a technician 0.35 mSv and for a doctor 0.45 mSv.

Results: The average radiation dose received every working day by the staff was 11.49 µSv/h. After considering the average distance from the potential source of exposure (50 cm), this power decreased to 0.46µSv/h. In order to calculate the quarterly and annual radiation dose, it was assumed that the employee worked 250 days a year.

Conclusions: Medical records may pose an additional personnel exposure to ionizing radiation. Physicians are the most vulnerable group of employees. The way of radiopharmacists work contributes to the contamination of medical records.