A. Erdogan

Unusual extraosseous tumoral accumulation of 99mTc-MDP in non-Hodgkin's lymphoma in two cases

The authors describe a rare pattern of soft tissue uptake observed in a (99m)Tc-MDP bone scintigraphy of two patients with the diagnosis of non-Hodgkins lymphoma. Both patients had abdominal masses and bone scintigraphy revealed unusual (99m)Tc-MDP uptake in the abdominal region. The possible mechanisms of soft tissue uptake of bone seeking agents are discussed.

Asymmetrically increased uptake in upper extremities on 99mTc-MDP bone scintigraphy caused by intra-arterial injection: Different uptake patterns in three cases

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 ((99m)Tc-MDP) on the antecubital region and discuss the findings and differential diagnosis.

Prone imaging allows efficient radiopharmaceutical usage by obviating the necessity of a rest study in Tc-99m-methoxyisobutylisonitrile myocardial perfusion scintigraphy.

ObjectiveIn myocardial perfusion single-photon emission computed tomography studies, diaphragmatic attenuation of the inferior wall is a common artifact, which can be minimized by prone imaging. The aim of this retrospective study was to validate the impact of stress–prone imaging on the necessity of a rest perfusion study with a final goal of effective radiopharmaceutical usage. MethodsThe findings of 98 patients who had been examined by a combined supine and prone imaging were retrospectively evaluated. Prone acquisition was performed only when reduced perfusion was observed in the inferior wall on the stress supine images. The reconstructed images were evaluated both visually and quantitatively. Rest myocardial single-photon emission computed tomography study was omitted in patients with complete normalization of uptake in the prone images. Results obtained were also compared with the clinical data and follow-up. ResultsProne imaging obviated the necessity of a rest perfusion study in 76 of 98 patients (77.5%). Among normally reported patients (n=89), 76 (85.4%) were saved from a rest study due to the prone study results. Prone study provided improved results in quantitative analysis as well. The difference between the mean summed stress scores of supine and prone studies was statistically significant in normally reported patients (P=0.013). However, no significant difference was observed in scores of ischemic patients (P=0.341). ConclusionAdding prone imaging to a post-stress Tc-99m-methoxyisobutylisonitrile myocardial perfusion study not only minimizes the inferior wall attenuation, but also reduces the need for a rest test, particularly in low-risk or intermediate-risk patients. Thus, prone imaging seems to be both safe and effective.

Radioiodine Contamination Artifacts and Unusual Patterns of Accumulation in Whole-body I-131 Imaging: A Case Series

Introduction: Radioactive iodine has been used for more than 50 years for the treatment of thyroid diseases. Differentiated thyroid cancers have the ability to trap iodine. Therefore, radioiodine can be used both diagnostically and therapeutically. In the follow-up of patients, it is critical to interpret radioiodine scans correctly. Case Presentation: Non-physiological Iodine-131 (I-131) extra-thyroidal uptake detected on post-therapy or diagnostic I-131 scanning are not always interpreted as functioning metastatic thyroid cancer. Conclusions: This study provides detailed information and case samples of radiodine contamination artifacts and non-physiological, non-metastatic extra-thyroidal I-131 accumulation in whole-body I-131 imaging.

Testicular torsion in the left inguinal canal in a patient with inguinal hernia: a difficult case to diagnose.

A 8 month old boy suffering from inconsolable cry and tenderness presented to our hospital. Ten hours had passed from the onset of his symptoms. Physical examination showed a tender mass on the left groin. Patient was evaluated with Doppler ultrasound and Technetium-99m pertechnetate testicular scintigraphy Differential diagnosis of torsion and inflammatory disease could not be made by adjunctive tests. The patient underwent surgery based on clinical findings and necrotic inguinal left gonad was shown. In this study, we discussed the scintigraphic pattern in a patient with torsion in undescended inguinal testicle Conflict of interest:None declared.

Gated Myocardial Perfusion Scintigraphy in Children with Sickle Cell Anemia: Correlation with Echocardiography

OBJECTIVES The heart is one of the organs affected by sickle cell anemia (SCA). This prospective study has aimed to evaluate myocardial perfusion and left ventricle (LV) function in children with SCA by gated myocardial perfusion scintigraphy (G-MPS) and to compare the results with echocardiographic parameters. METHODS Forty-three patients with SCA were evaluated by G-MPS and echocardiography. Myocardial perfusion and motion with thickening function were analyzed both visually and quantitatively. End-diastolic (EDV), end-systolic volumes (ESV), ejection fraction (EF), lung-to-heart (L/H) ratio were also calculated. RESULTS None of the patients showed stress perfusion impairment in G-MPS. LV dilatation in 15 patients was observed both by G-MPS and echocardiography. EF values were within normal limits. Correlation between EF values calculated by two methods was not statistically significant. However, LV dilatation detected by both methods and EDV-ESV values in G-MPS were correlated to end-diastolic and end-systolic diameters calculated in echocardiography (p<0.05). M-Mode echocardiography revealed higher myocardial performance index (LV-MPI) in patients with LV dilatation. There was also a significant relationship between LV dilatation and frequent blood transfusions (>5/years) and acute chest syndrome (p<0.05). CONCLUSION Myocardial perfusion impairment in children with SCA is not frequently observed. Thus, performing the scintigraphy only in patients with cardiac symptoms should be considered. Since EF values of the children with SCA are not deteriorated in early stages, LV-MPI and LV dilatation should be considered as a significant parameter other than EF or perfusion data.

Clinical noteAsymmetrically increased uptake in upper extremities on 99mTc-MDP bone scintigraphy caused by intra-arterial injection: Different uptake patterns in three casesAumento asimétrico de la captaciónen las extremidades superioresde 99mTc- MDP gammagrafía ósea causada por la inyección intra-arterial: diferentes patrones de captación en tres casos

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.

Ring sign over left kidney in 99mTc DTPA renal scintigraphy

The authors report a case of Tc diethylenetriaminepentaacetic acid renal scintigraphy in which an abnormal ring-shaped uptake above left kidney on posterior projection images has been detected. On previous ultrasonography there was no abnormality in the abdomen except ectasia in right renal collecting system. Presence of free technetium which accumulates in the stomach was suspected to be the reason of confusing uptake above left kidney. This finding was subsequently supported by following neck images showing thyroid uptake.