Ag Pandit

Promising role of single photon emission computed tomography/computed tomography in Meckel's scan

Meckels scan is a common procedure performed in nuclear medicine. Single-photon emission computed tomography/computed tomography (SPECT/CT) in a suspected case of heterotopic location of gastric mucosa can increase the accuracy of its anatomic localization. We present two suspected cases of Meckels diverticulum in, which SPECT/CT co-registration has helped in better localization of the pathology.

Extensive tumor thrombus in a case of carcinoma lung detected by F18-FDG-PET/CT

Tumor thrombus is a rare complication of solid cancers, mainly seen in cases of renal cell carcinoma, wilms tumor, testicular carcinoma, adrenal cortical carcinoma and hepatocellular carcinoma.[1] Tumor thrombus in inferior vena cava is a rare complication of primary carcinoma lung. It should be identified so as to rule out venous thromboembolism and avoiding unnecessary anticoagulant therapy. We describe a case where F18-Fluorodeoxyglucose (FDG) positron emission tomography - computed tomography (PET/CT) helped to identify extensive tumor thrombus.

FDG PET/CT in a rare case of multiple cutaneous metastases in carcinoma larynx

Distant metastases in squamous cell carcinoma of the larynx have an incidence of 6.5-7.2% and most commonly involves the lungs, liver, and bone. Metastases to the skin are very rare, but, when present, they are usually considered a poor prognostic sign. This most often affect the supradiaphragmatic area, i.e., the head, neck, thorax, or upper extremities. We have reported 18F-fluorodeoxyglucose positron emission tomography computed tomography (FDG PET/CT) scan of a patient with squamous cell carcinoma of the larynx showing multiple subcutaneous nodules all over the body, which was helpful in the assessment as well as staging of the disease.

Tc-99m MDP bone scintigraphy in a case of Touraine-Solente-Gole syndrome

Pachydermoperiostosis is a form of primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Gole syndrome. It is a rare disease. In this report, we present the case of a 29-year-old man with this rare disorder, having significant findings on Tc-99m methylene diphosphonate bone scan.

Comparative study of (18)F-DOPA, (13)N-Ammonia and F18-FDG PET/CT in primary brain tumors.

Aim: To determine the diagnostic reliability of 18F-FDOPA, 13N-Ammonia and F18-FDG PET/CT in primary brain tumors. We evaluated the amino acid and glucose metabolism of brain tumors by using PET with 18F-FDOPA, 13N-Ammonia and F18-FDG PET/CT. Materials and Methods: Nine patients undergoing evaluation for brain tumors were studied. Tracer uptake was quantified by the use of standardized uptake values and the ratio of tumor uptake to normal identical area of contra lateral hemisphere (T/N). In addition, PET uptake with 18F-FDOPA was quantified by use of ratio of tumor uptake to striatum uptake (T/S). The results were correlated with the patients clinical profile. Results: Both high-grade and low-grade tumors were well visualized with 18F-FDOPA. The sensitivity for identifying tumors was substantially higher with 18F-FDOPA PET than with F18-FDG and 13N-Ammonia PET as determined by simple visual inspection. The sensitivity for identifying recurrence in low grade gliomas is higher with 13N-Ammonia than with F18-FDG. Conclusion: 18F-FDOPA PET is more reliable than F18-FDG and 13N-Ammonia PET for evaluating brain tumors.

Spontaneously ruptured choledochal cyst: Rare diagnosis on hepatic scintigraphy.

A 47-day-old female infant presented with congenital inguinal hernia, seizure on the 2nd day of life, fever, progressive jaundice, acholic stools and distension of abdomen. She was suspected to have choledochal cyst with extrahepatic biliary atresia (EHBA) and referred for an Hepatobiliary Tc-99m iminodiacetic acid (HIDA) scan. On HIDA scan, a functional diagnosis of ruptured choledochal cyst was made which was not possible on anatomical imaging like ultrasound (USG)/computed tomography (CT) scan. This was supported thereafter by bilious aspirate on abdominal paracentesis. Immediate laparotomy with T-tube insertion was done. The child improved dramatically after the procedure. Biliary peritonitis secondary to cyst perforation or rupture is a rare complication reported to occur in 1–2% cases of choledochal cyst. Early diagnosis and management is the key to reduce the morbidity and mortality.

Role of 99mTc MDP bone scan in delineation of ischaemic zone in cases of severe frostbite

Frostbite or cold burn is the medical condition in which localized damage is caused to exposed skin and subcutaneous tissue due to freezing. Frostbite most likely involves body parts farthest from the heart and those with large exposed areas. At or below 0 °C (32 °F), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities via the physiological feedback action of glomus bodies. This peripheral vasoconstriction helps to conserve core body temperature. In extreme cold, or when certain parts of the body are exposed to cold conditions for long periods, this protective mechanism can reduce blood flow in some areas of the body to dangerously low levels. This is followed by crystallisation of water in the tissue and subsequent death of tissues in the affected areas. In this case series, we highlight the importance of a 99mtechnetium methylene diphosphonate (99mTc MDP) triple phase bone scan in cases of severe frostbite to precisely delineate the ischaemic and reperfusion zones, so as to help the surgeons in carefully deciding if amputation is required and the level of amputation in such cases.