Fatma Berk

EVALUATION OF ANTHRACYCLINE-INDUCED EARLY LEFT VENTRICULAR DYSFUNCTION IN CHILDREN WITH CANCER: A Comparative Study with Echocardiography and Multigated Radionuclide Angiography

The study aimed to compare diastolic and systolic dysfunctions detected by echocardiography (ECHO) and multigated radionuclide angiography (MUGA) in patients with cancer in the first 3 months after anthracycline-comprising chemotherapy. Children with leukemia and solid tumors who had anthracycline-comprising chemotherapy were enrolled in the study. ECHO and MUGA were performed in all patients before the first chemotherapy course and in the first 3 month of completing anthracycline-comprising chemotherapy. Cumulative anthracycline doses per body surface were calculated. Left ventricular systolic and diastolic functions were measured by both techniques. Twenty-one patients with a median age of 6.9 ± 3.6 years were enrolled in the study. Mean cumulative anthracycline doses were equivalent to 276 ± 83 mg/m2 doxorubicin. After anthracycline chemotherapy, cardiac dysfunction was detected in 14 and 48% of the patients by ECHO and MUGA, respectively. All dysfunctions detected by ECHO were systolic, whereas 29% of the patients had diastolic and 38% of the patients had systolic dysfunction in MUGA study. Although the study group is small, MUGA seems more sensitive in detecting anthracycline-induced systolic and diastolic cardiac dysfunctions compared to ECHO.

Diagnosis of complete ectopic lingual thyroid with Tc-99m pertechnetate scintigraphy

The authors present four cases of ectopic lingual thyroid disease diagnosed by Tc-99m pertechnetate scanning, which is an efficient diagnostic tool that yields high-quality images in this clinical setting.

Evaluation of post-stress left ventricular dysfunction and its relationship with perfusion abnormalities using gated SPECT in patients with cardiac syndrome X.

ObjectiveCardiac syndrome X defines patients with typical angina, a positive exercise ECG stress test and angiographically documented normal coronary arteries. In previous studies, post-stress prolonged left ventricular dysfunction (PLVD) using gated SPECT (G-SPECT) had been well correlated with myocardial perfusion abnormalities and degree of stenotic vessels in CAG in patients with coronary artery disease. However, evaluation of left ventricular myocardial perfusion, wall motion and left ventricular ejection fraction (LVEF) in patients with cardiac syndrome X, using G–SPECT had not been studied yet. Thus, the aim of this study was to analyse PLVD using 99mTc-MIBI GSPECT in patients with cardiac syndrome X. MethodsOf the patients in whom G-SPECT was performed in our institution between 2004 and 2006, 17 patients with anginal chest pain, positive exercise ECG stress test and normal coronary angiograms were retrospectively included to the study (group I). Fifteen patients with normal myocardial perfusion and another 15 patients with ischaemia on G-SPECT were selected as control groups (groups II and III). 99mTc-MIBI G-SPECT was performed for all patients according to 2 day (stress–rest) protocol. Stress and rest LVEF were derived automatically (SLVEF and RLVEF). Difference LVEF (DLVEF) (stress–rest) was calculated. Semiquantitative analyses were made both for myocardial perfusion and wall motion (WM), using a 20-segment model and a 5-point scoring system. DLVEF, perfusion and WM scores of all groups were compared among three groups and relationship between DLVEF, perfusion and WM scores were evaluated. ResultsAbnormal perfusion were detected in eight (47.1%) of patients, while the remaining nine (52.9%) had normal myocardial perfusion, in group I. Six of 17 (35.3%) patients in group I had post-stress WM abnormalities. Mean of DLVEF values were −3.1±3.0%, 4.4±2.0% and −6.0±5.1% in groups I, II and III, respectively (P<0.05 for group II vs. group I and group III; P>0.05 for group I vs. group III). LVEF response impairment (≤5% increase from rest to post-stress images) was found in 17 (100%), seven (46.6%), 14 (93.3%) of patients in groups I, II and III, respectively. ConclusionAbnormal myocardial perfusion, concordant transient segmental WM abnormalities and LVEF response impairment are not uncommon in patients with cardiac syndrome X of this cohort of the study population. Therefore, post-stress prolonged stunning may be attributed to these findings in some of cardiac syndrome X patients as in true ischaemic patients. However, further studies with larger number of subjects and long-term follow-up are necessary to support these findings.

Comparison of gated SPECT, echocardiography and cardiac magnetic resonance imaging for the assessment of left ventricular ejection fraction and volumes

BACKGROUND Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) can be determined non-invasively by two-dimensional echocardiography (ECHO), gated single photon emission computed tomography (GSPECT) and cardiac magnetic resonance imaging (CMRI). This study was designed to analyze the concordance between LVEF, EDV and ESV values derived from ECHO, GSPECT and CMRI. METHODS ECHO, GSPECT and CMRI were performed in a group of 21 patients with suspected coronary artery disease. LVEF, EDV and ESV values were calculated. RESULTS The mean LVEF measured with GSPECT, ECHO and CMRI were 55.9±17.8%, 55.7±16.4% and 56.4±15.7%, respectively. The mean EDV measured with GSPECT, ECHO and CMRI were 109.2±42.4 mL, 127.5±42.2 mL and 91.1±38.0 mL, respectively. The mean ESV measured with GSPECT, ECHO and CMRI were 54.2±41.2 mL, 59.9±37.6 mL and 41.8±26.9 mL, respectively. The results of linear regression analysis showed very good correlation between LVEF and ESV values derived from GSPECT, ECHO and CMRI (r=0.91, r=0.92, r=0.97 for LVEF and r=0.86, r=0.91, r=0.91 for ESV, P<0.01). Good correlations were found between EDV values obtained from GSPECT, ECHO and CMRI (r=0.71, r=0.68, r=0.73, P<0.01). Agreement between these techniques in LVEF values was also good, but not in LV volumes, according to Bland-Altman plots. CONCLUSIONS This study showed good overall correlations between LVEF, EDV and ESV values derived from GSPECT, ECHO and CMRI. LVEF obtained from any of these three imaging modalities could be used interchangeably. However, care should be taken in comparing LV volumes.

Hepatic and splenic uptake of Tc-99m HDP in multiple myeloma: Additional findings on Tc-99m MIBI and Tc-99m sulfur colloid images

The authors present a case of multiple myeloma with intense hepatic and spienie uptake on Tc-99m HDP bone scan and discuss its clinical implications and possible uptake mechanisms. Tc-99m MIBI and Tc-99m sulfur colloid were used to demonstrate bone marrow involvement and focal lesions of multiple myeloma.

Sentinel lymph node biopsy with a gamma probe in patients with high-risk cutaneous squamous cell carcinoma: follow-up results of sentinel lymph node-negative patients.

ObjectiveLymphoscintigraphy (LS) and sentinel lymph node biopsy have become the standard of care for melanoma and breast cancer. However, the data on patients with cutaneous squamous cell carcinoma (SCC) are limited. We aimed to evaluate and identify the role of LS and sentinel lymph node biopsy in patients with high-risk cutaneous SCC. MethodsNineteen patients (13 men, six women; 47–87 years of age, mean age 67.5±12.3) with SCC were included in the study. LS was performed on all patients after intracutaneous injection of Tc-99m nanocolloid. Primary lesions and sentinel lymph nodes (SLNs) were excised with the help of a gamma probe. ResultsA total of 26 SLNs and 32 secondary lymph nodes were imaged on LS and were marked. During surgery, 29 SLNs, 21 secondary lymph nodes and three nonactive lymph nodes were excised. In total, 53 lymph nodes were removed surgically. A histopathological study revealed that all lymph nodes were negative for metastasis. Patients were followed up for an average of 41.1±22.2 months (7–80 months). Until the time of data collection, 14 patients were alive and had no regional lymph node or distant metastasis. Local recurrence was seen in only one patient. He was reoperated upon 38 months ago. ConclusionThe feasibility of determining SLNs using LS and an intraoperative gamma probe in patients with cutaneous SCC was shown. Unnecessary elective lymph node dissection and possible complications could be avoided in 19 patients.

Comparison of exercise and pharmacological stress gated SPECT in detecting transient left ventricular dysfunction

ObjectiveTransient left ventricular contractile dysfunction (TLVD) is observed owing to post-exercise stunning in patients with coronary artery disease (CAD). Pharmacological stimulation differs from exercise stress because it does not cause demand ischemia. The aim of this study was to determine whether TLVD could also be seen after pharmacological stress (dipyridamole).MethodsOf the patients in whom gated single-photon emission computed tomography (GSPECT) was performed in our institution from January 2004 to April 2007, 439 subjects with known or suspected CAD were included in the study. GSPECT was performed for all patients following exercise (group I, n = 220) or pharmacological stress (group II, n = 219) according to a 2-day (stress-rest) protocol after injection of Tc-99m methoxyisobutyl-isonitrile (MIBI). Stress, rest, and difference (stress-rest value) left ventricular ejection fractions (SLVEF, RLVEF, and DLVEF) and transient ischemic dilatation (TID) ratio were derived automatically. Summed stress score, summed rest score, and summed difference score (SDS) for myocardial perfusion were calculated using a 20-segment model and a five-point scoring system. An SDS > 3 was considered as ischemic. On the basis of the perfusion findings, patients were subdivided into a normal (group A, n = 216) and ischemia group (group B, n = 223). DLVEF and perfusion scores of all groups were compared. Relationships between DLVEF and perfusion, and between TID ratio and DLVEF were also evaluated.ResultsStress-induced ischemia was observed in 223 of 439 patients (50.8%). In group A, the difference between stress and rest LVEF values was not significant (P = 0.670 and P = 0.200 for groups IA and IIA, respectively). However, LVEF was significantly decreased after stress compared with rest values for group B (P < 0.0001 for groups IB and IIB). TLVD (≤−5% for DLVEF) was observed in 20 of 216 (9%) and 81 of 223 subjects (36%) in patients in groups A and B, respectively (P < 0.0001). In group I, we found TLVD in 46 of 119 (39%) and 12 of 101 (12%) subjects, in patients with and without ischemia, respectively (P < 0.0001). On the other hand, in group II, TLVD was detected in 35 of 104 (34%) and 8 of 115 (7%) patients with and without ischemia, respectively (P < 0.0001). And also, we found significant good correlations between TID ratios and DLVEF values in four subgroups (r = −0.55, r = −0.62, r = −0.59, and r = −0.41; for groups IA, IB, IIA, and IIB, respectively, P < 0.0001 for all).ConclusionsDipyridamole is believed to be less likely than exercise to induce ischemia. However, in this study, TLVD after stress was observed following not only exercise but also pharmacological stress, consistent with ischemia.

Double imaging for the diagnostic work-up of alveolar soft part sarcoma with Tc-99m MIBI

The authors report a case of alveolar soft-part sarcoma with lung metastases demonstrated by “double imaging” with Tc-99m HDP and Tc-99m BIBI. The tumor originated in the soft tissue with direct invasion to the right scapula, which was hypoactive on bone scan and hyperactive on Tc-99m MIBI images. A focus of dense accumulation of Tc-99m MIBI in the lungs, suggesting metastasis was also demonstrated.

Evaluation of left ventricular function and volume in patients with dilated cardiomyopathy: gated myocardial single-photon emission tomography (SPECT) versus echocardiography.

BACKGROUND Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to compare the effectiveness of 2D-echocardiography and gated single-photon emission tomography (SPECT) for evaluation of these parameters in patients with DCM. PATIENTS AND METHODS Gated SPECT and 2D-echocardiography were performed in 33 patients having DCM. Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Standard technique was used for 2D-echocardiography. Regional wall motion was evaluated using both modalities and was scored by two independent observers using a 16-segment model with a 5-point scoring system. RESULTS The overall agreement between the two imaging modalities for the assessment of regional wall motion was 56% (298/528 segments). With gated SPECT, LVEF, end-diastolic volume (EDV), and end-systolic volume (ESV) were 27±9%, 217±77 mL, and 163±73 mL, respectively, and 30±8%, 195±58 mL, and 137±48 mL with echocardiography. The correlation between gated SPECT and 2D-echocardiography was good (r=0.76, P<0.01) for the assessment of LVEF. The correlation for EDV and ESV were also good, but with wider limits of agreement (r=0.72, P<0.01 and r=0.73, P<0.01, respectively) and significantly higher values were obtained with gated SPECT (P<0.01). CONCLUSIONS Gated SPECT and 2D-echocardiography correlate well for the assessment of LV function and LV volumes. Like 2D-echocardiography, gated SPECT provides reliable information about LV function and dimension with the additional advantage of perfusion data.

Subhyoid ectopic thyroid with mediolateral location in a developmentally retarded child with hypothyroidism in an iodine deficiency region

The authors present a case of subhyoid ectopic thyroid with mediolateral location diagnosed by technetium-99m pertechnetate scan. The ectopia was associated with hypothyroidism and developmental retardation.