Abedallatif AlSharif

Radionuclide Evaluation of the Lower Gastrointestinal Tract

This review outlines the technical aspects and diagnostic performance parameters of nuclear medicine procedures used on patients with disorders of the lower gastrointestinal tract, with the exclusion of techniques using tumor-seeking radiopharmaceuticals. Chronic disorders of the lower gastrointestinal tract often reduce the quality of life because of discomfort from constipation or diarrhea. Five classes of radionuclide procedures are used to characterize these disorders: transit scintigraphy, searches for ectopic gastric mucosa in Meckels diverticulum, scintigraphy of active inflammatory bowel disease, scintigraphic defecography, and scintigraphy to detect sites of gastrointestinal bleeding. Protocols for these procedures and their relative merit in patient management are discussed, with special emphasis on their potential for semiquantitative assessment of the pathophysiologic parameter investigated. Quantitation is particularly relevant for prognostic purposes and for monitoring the efficacy of therapy.

Evaluation of bone mineral density in children with perinatal brachial plexus palsy: Effectiveness of weight bearing and traditional exercises

PURPOSE (1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). (2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. (3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children. STUDY DESIGN Randomized single blind controlled trial. METHOD A convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period. RESULTS We detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p=0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to -1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (-1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p=0.02, p=0.03 respectively for the affected both bones BMD parameter). CONCLUSIONS BMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Standardization of quantitative single photon emission computed tomography in control individuals and in patients with condylar hyperplasia.

ObjectivesThe aim of the study was to evaluate the diagnostic accuracy of various single photon emission computed tomography (SPECT) quantitative methods in patients with condylar hyperplasia (CH) and to investigate whether normal condylar activity changes with age. Patients and methodsWe analyzed the SPECT images of 33 patients with CH and those of 16 control individuals. Regions of interest (ROIs) were drawn on whole condyle, or fixed-size ROIs were drawn on both condyles and the clivus on the slice with higher activity [a two-dimensional (2D) approach] and on the summation of five adjacent transaxial slices [a three-dimensional (3D) approach]. A percentage difference between both condyles of above 10% or a cutoff value of 1.44 or 1.88 for abnormal condyle/clivus ratio was considered abnormal. ResultsSeventeen patients with active CH, 16 with inactive CH, and 16 control individuals were evaluated. The highest sensitivity and highest specificity were observed for the whole-condyle approach (88 and 87%, respectively), followed by the percentage 2D maximum condyle/total (82.4 and 81.3%, respectively). The condyle/clivus ratio yielded low sensitivity for both 2D and 3D approaches. No effect of age on condylar activity was demonstrated. No statistically significant difference in condyle/clivus ratio was evident between patients with active and those with inactive CH. ConclusionUse of 2D maximum fixed-size ROI and percentual difference in condylar activity offers optimal diagnostic accuracy in patients with CH and should be encouraged in future studies. The condyle/clivus ratio offers suboptimal results and cannot, therefore, be recommended. No effect of age on normal condylar activity was demonstrated.

The Influence of Aging on the Association Between Adiposity and Bone Mineral Density in Jordanian Postmenopausal Women

The objective of this study was to assess the relative association between body weight, body mass index (BMI), lean mass (LM) and fat mass (FM), and bone mineral density (BMD) in a group of Jordanian postmenopausal women and investigate if this possible association changes with age. A total of 3256 patients had dual-energy X-ray absorptiometry (DXA) scan in the period from January 2009 till January 2012 at the Radiology and Nuclear Medicine Department of Jordan University Hospital. Only 584 women met the selection criteria. Age has been recorded, and patients were divided into subgroups according to age. Body weight and height were measured, and BMI was calculated. Body composition (LM, FM, percentage of android fat, and percentage of gynoid fat) was assessed by DXA. BMD of the lumbar spine (L1-L4) and femoral neck was measured by DXA. Weight, BMI, FM, LM, percentage of android fat, and percentage of gynoid fat were positively correlated to BMD at both lumbar spine and femoral neck. However, this correlation disappeared at the age of 70 yr at lumbar spine and 75 yr at femoral neck. This study suggests that both FM and LM are important determinants of BMD in Jordanian postmenopausal women, and this correlation disappears after the age of 70 yr at lumbar spine and 75 yr at femoral neck.

Is there a correlation between symptoms and bone scintigraphic findings in patients with complex regional pain syndrome

BackgroundComplex regional pain syndrome (CRPS) is characterized by pain in combination with sensory, vasomotor, sudomotor, trophic and motor abnormalities. The diagnosis of CRPS is based primarily on clinical criteria and the presence of distinct signs and symptoms. The role of bone scintigraphy in the diagnosis of these patients has been limited by its variable sensitivity. In this study, we aim to look if the presence of specific symptoms or symptom subgroups in patients with clinically diagnosed CRPS correlates with scintigraphic findings in bone scan.Materials and methodsWe retrospectively reviewed clinical records of patients referred for bone scintigraphy with the clinical diagnosis of CRPS during the period December 2006 until February 2011. Patients were classified into 4 distinct subgroups according to the presence of specific symptoms namely sensory subgroup, sudomotor and/or edema subgroup, vasomotor subgroup and finally motor and/or trophic changes subgroup. We looked specifically for the correlation between these specific symptoms and scintigraphic bone findings.Results37 patients were referred for bone scintigraphy with the clinical diagnosis of CRPS and were enrolled in the study. The presence of vasomotor symptoms and (motor and/or trophic changes) was significantly higher in patients with positive bone scintigraphy (P value 0.0133, 0.018 respectively). There was no other statistically significant correlation between the presence of specific symptoms or symptom subgroups on one hand and the result of bone scintigraphy on the other hand.ConclusionsThe probability of positive bone scintigraphy increased significantly in patients with vasomotor symptoms and in patients with motor and/or trophic changes. This may contribute to the reported variability of the diagnostic performance of bone scintigraphy in CRPS patients.

Diagnostic Applications of Nuclear Medicine: Penile Cancer

Penile carcinomas are rare in most developed countries; in contrast, this cancer is not infrequent in the tropical and subtropical regions of Latin America, Asia, and Africa. In addition, penile cancer is common in regions with high prevalence of human papilloma virus infection. More than 95% of penile carcinomas are of the squamous cell type; other histologic types include basal cell carcinoma, melanoma, and sarcoma. Penile carcinoma usually spreads through lymphatic channels to the superficial and deep inguinal lymph nodes; subsequently iliac lymph nodes are involved. The presence and extent of metastatic disease in inguinal nodes is the single most important prognostic factor in patients with penile cancer. Primary evaluation of penile cancer is based on physical examination including inguinal lymph node palpation. Ultrasound and MRI can provide information on tumor invasion of the corpora cavernosa if organ preservation is planned. Ultrasound can be used to evaluate nonpalpable inguinal lymph nodes, whereas pelvic CT scan can be used to assess pelvic lymph nodes. Lymphoscintigraphy, preferably with SPECT/CT imaging, and subsequently sentinel lymph node biopsy is gaining popularity in clinical practice, especially in patients with nonpalpable lymph nodes; sensitivity reported for this local staging approach ranges from 70% to 86%.Assessment of distantmetastases should be performed in patients with positive inguinal nodes; this includes abdomen and pelvis CT, chest X-ray, or thoracic CT. [F]FDG PET/CT can be used for initial staging of penile cancer with pooled sensitivity and specificity of 80.9% and 92.4% respectively; this staging technique is particularly advocated for patients with positive lymph nodes. [F]FDG PET/CT can also be employed to monitor the efficacy of induction chemotherapy. Follow-up of penile cancer is based mainly on clinical evaluation, while radionuclide imaging techniques have rarely been used for restaging purposes during regular follow-up.

Cancer of the Prostate, Testicles and Penis

In 2009, approximately 192,000 men were diagnosed with prostate cancer (PCa) in the USA. Adenocarcinoma, originating in the peripheral zone of the gland, is the most frequent histology. The clinical outcome of PCa is highly variable. PCa is diagnosed by transrectal ultrasound (TRUS)-guided biopsies. PCa is staged using the AJCC TNM classification. A combination of transrectal MRI and CT is used to detect extracapsular disease and distant metastases. Bone scintigraphy is recommended as the first-line modality to detect skeletal metastases. Bone scintigraphy may be also used to monitor the response to therapy. Lymphoscintigraphy and radioguided sentinel lymph node (SLN) biopsy is potentially a reliable procedure for nodal staging. [18F]FDG PET/CT does not play a major role in the initial evaluation and staging of PCa. In patients with advanced metastatic disease, however, [18F]FDG PET/CT often displays high uptake, discriminating active from quiescent osseous lesions. Following radical prostatectomy, prostate-specific antigen (PSA) levels greater than 0.2 ng/mL indicate biochemical failure, whereas in patients treated with antiandrogenic therapy or radiotherapy, a PSA value greater than 2 ng/mL above the nadir after therapy represents recurrent/persistent cancer.