Sabahat Inanir

Tc-99m sestamibi gated SPECT in patients with left bundle branch block.

Purpose The purpose of this study was to assess the diagnostic role of a Tc-99m sestamibi gated SPECT technique in patients with left bundle branch block (LBBB) without known coronary artery disease. Materials and Methods Twenty consecutive patients with constant complete LBBB were included. A same-day rest-stress protocol was used, and dipyridamole stress (14 patients) or treadmill exercise (6 patients) was applied. Electrocardiograph (ECG)-gated SPECT images were acquired 15 minutes after the administration of 0.31 mCi/kg Tc-99m sestamibi at peak stress. Regional myocardial perfusion was analyzed in relation to the cardiac cycle. Results Eleven of 14 patients who underwent a dipyridamole stress test had hypoactivity in the left anterior descending (LAD) artery territory in the ungated (summed) stress–rest images (abnormality ratio, 78%). On the ungated images, the abnormality was completely reversible in one patient (9%), partially reversible in five patients (46%), irreversible in two patients (18%), and reverse perfusion was identified in three patients (27%). Abnormality ratios of end-systolic and end-diastolic data were 93% and 29%, respectively. Conversely, the ungated rest-stress and end-systolic images of all the patients who performed treadmill exercise were abnormal despite the presence of normal or nearly normal end-diastolic myocardial perfusion. The angiographic findings correlated best with those of end-diastolic images. In 13 patients without coronary artery disease, normal or nearly normal regional perfusion was observed on end-diastole, but four patients with abnormal end-diastolic perfusion, which involved the LAD territory in all but one, had substantial coronary artery disease. The number of the involved segments was similar on the end-systolic and ungated data. Most of these artifactual defects were localized to the anteroseptal, septal, and inferoseptal segments. Conclusions These preliminary data indicate that end-diastolic images can significantly reduce artifactual defects in patients with LBBB. The resolution of an LBBB pattern on end-diastolic data would significantly improve the diagnostic role of myocardial perfusion studies in these patients.

Contradictory supranormal function in hydronephrotic kidneys: fact or artifact on pediatric MAG-3 renal scans?

Objectives: Contradictory supranormal renal function (SRF) in unilateral hydronephrosis is a debatable subject resulting from the methodology of nuclear renography or the characteristics of the patient. In this study, we aimed to investigate the frequency and comparison of SRF with MAG-3 scans by 8 different technical analyses in pediatric hydronephrosis. Methods: We reviewed Tc-99m MAG-3 scans in 82 children with unilateral hydronephrosis (52 male, 30 female, mean age: 47.7 ± 64.5 months). Of 82, 34 also had Tc-99m DMSA scans. Data were reprocessed with 4 different regions of background activity (subrenal, perirenal C-type, perirenal ring, and lateral) at 2 different time intervals (1–2 and 2–3 minute), and 8 different estimates of MAG-3 differential renal function (DRF) were obtained in 67 patients. SRF was defined as DRF greater than 55% in the hydronephrotic kidney. Results: The routine processing protocol showed only 3 renal units with SRF, and all were on the right side (3.6%). After reprocessing, a total of 10 dilated kidneys had SRF in 1 or more of DRF estimates (5.2% of all estimations). These cases were significantly younger (8.1 ± 6.7 vs. 42.5 ± 52.5, P < 0.05) and had a larger renal area ratio (1.25 ± .24 vs. 1.07 ± .21, P < 0.05). There was no SRF with DMSA. In comparison between MAG-3 and DMSA DRF in 20 children who underwent both tests within 3 months, the best correlation was obtained when C-type correction was used for both agents at 2 time intervals (r: .86 and .84 for early and late time intervals, P < 0.00001, respectively). Conclusions: SRF in unilateral hydronephrosis is, at least, in part, technical in origin in this particular pediatric patient population with tubular immaturity (ie, physiological high background activity) and asymmetric kidney size.

B-type natriuretic peptide levels in patients with COPD and normal right ventricular function

IntroductionEvidence suggests that elevated plasma levels of B-type natriuretic peptide (BNP) are found in patients with chronic obstructive pulmonary disease (COPD) and right ventricular dysfunction. We examined the effects of exercise on plasma BNP levels in patients with COPD who have normal right ventricular functionMethodsSeventeen patients with a diagnosis of COPD and normal right ventricular function demonstrated by radionuclide ventriculography, and 17 age-and sex-matched healthy subjects underwent a treadmill exercise test. Plasma BNP levels were measured sequentially before, immediately after, and 1 hour after the exercise testResultsThe mean plasma BNP±standard deviation levels of the COPD and control groups before exercise were 21.3±16 pg/ml and 13.4±11 pg/ml, respectively (P>0.05). Mean plasma BNP level measured immediately after exercise was 37.9±31 pg/ml in the COPD group, reflecting a statistically significant increase when compared with the initial value (P<0.05). The control group did not show any significant change in plasma BNP levels after the exercise testConclusionsExercise induces an increase in plasma BNP levels in patients with COPD who do not have right ventricular dysfunction at rest. Measurement of exercise-induced BNP levels may be a useful alternative to pulmonary artery catheterisation in identifying the patients who are likely to benefit from long-term oxygen therapy

Comparison of WHO, RECIST 1.1, EORTC, and PERCIST criteria in the evaluation of treatment response in malignant solid tumors.

AimTo compare response assessment according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria in patients diagnosed with malignant solid tumors and who had received cytotoxic chemotherapy to establish the strength of agreement between each criterion. Materials and methodsSixty patients with malignant solid tumors were included in this retrospective study. The baseline and the sequential follow-up fluorine-18-fluorodeoxyglucose PET/computed tomography (CT) of each patient were evaluated according to the WHO, RECIST 1.1, EORTC, and PERCIST criteria. PET/CT images were used for both metabolic and anatomic evaluation. The concurrent diagnostic CT and MRI images (performed within 1 week of PET/CT) were also utilized when needed. The results were compared using the &kgr;-statistics. ResultsThe response and progression rates according to the WHO criteria were 37 and 38%, respectively. The same ratios were also found for RECIST 1.1 (&kgr;=1). The response and progression rates according to the EORTC criteria were 47 and 40%, respectively. When PERCIST criteria were used, one patient with progressive disease was upgraded to stable disease (&kgr;=0.976). As we found the same results with WHO and RECIST 1.1 criteria, we used WHO criteria to compare the anatomic and metabolic criteria. When we compared the WHO and EORTC criteria, there was an agreement in 80% of the patients (&kgr;=0.711). With WHO and PERCIST criteria, there was an agreement in 81.6% of the patients (&kgr;=0.736). ConclusionSignificant agreement was detected when the WHO, RECIST 1.1, EORTC, and PERCIST criteria were compared both within as well as between each other.

False Positive FDG PET/CT Resulting from Fibrous Dysplasia of the Bone in the Work-Up of a Patient with Bladder Cancer: Case Report and Review of the Literature

Fibrous dysplasia of the bone (FDB) is a common, genetic, developmental disorder with a benign course. FDB can be seen anywhere throughout the skeleton. It is usually asymptomatic and found incidentally on imaging studies that are performed for other purposes. Although whole body 18 F-flourodeoxyglucose PET/CT (FDG PET/CT) is widely used in tumor imaging, infections and benign pathologies like FDB may cause false positive results. Herein we report the case of a 48-year-old FDB patient with transitional cell carcinoma of the urinary bladder. Restaging FDG PET/CT showed multiple mild to moderate hypermetabolic bone lesions which were initially misinterpreted as bone metastases. In this case report, we aimed to guide physicians in evaluating bone lesions in cancer patients with FDB in the light of the literature.

The clinical utility of 99mTc-HMPAO SPECT in Fahr’s disease

Fahr’s disease is a rare neurodegenerative syndrome, characterized by massive symmetrical intracerebral calcifications of the basal ganglia, dentate nuclei of the cerebellum, and the adjacent parenchyma. Computerized tomography (CT) is considerably more sensitive to detect these intracranial calcifications than other imaging modalities. The clinical, CT scan, and 99mTc-D,L-hexamethylpropylene amine oxime (99mTc-HMPAO) brain perfusion single-photon emission computerized tomography (SPECT) findings in a 42-year-old woman with Fahr’s disease are reported, and the clinical utility of 99mTc-HMPAO SPECT findings in Fahr’s disease is discussed in this article. In conclusion, 99mTc-HMPAO brain perfusion SPECT seems to be useful in the clinical approach to Fahr’s disease, and may provide more specific and clinically relevant information when compared with anatomical imaging.

99mTc-MDP- and 18F-FDG-avid metastatic liver lesion: the similarities and differences between 2 modalities.

Although 99mTc-MDP uptake in the extraskeletal tissues was presented before in the literature, FDG PET/CT and conventional bone scan findings have not been discussed together yet. Herein, we presented 99mTc-MDP- and 18F-FDG-avid metastatic liver lesion in a breast cancer patient and compared 2 modal

Renal cortical involvement in children with first UTI: does it differ in the presence of primary VUR?

ObjectiveThe aim of this study was to investigate the influence of vesicoureteral reflux (VUR) on dimercaptosuccinic acid (DMSA) scintigraphic patterns in children with first symptomatic urinary tract infection (UTI).MethodsA total of 45 children with the diagnosis of first symptomatic UTI (28 girls, 17 boys, mean age 18 months, range 1 month-11 years) were reviewed. All DMSA scans were obtained within 2 months of bacteriologically proven UTI (median 21 days, mean 26 ± 21, 14). After the exclusion of the patients with bilateral cortical lesions, 82 renal units were analyzed. The scintigraphic patterns included regional and global description of renal cortical abnormality (normal or decreased differential renal function, regional renal function (RRF), and the number and severity of cortical lesions).ResultsVesicoureteral reflux was detected in 26 (32%) renal units (15 with grade 1–2, 11 with grade 3–4). Renal cortical abnormality was observed in 10 renal units without VUR (10/56, 17%) and 13 renal units with VUR (13/26: 50%). Of the 15 renal units, 5 with grade 1–2 VUR (5/15) and 8 of the 11 renal units with grade 3–4 VUR (8/11) had renal cortical involvement. The most common scintigraphic pattern in the patients without VUR was the preserved RRF (≥45%) and two or fewer photon-deficient areas. On the other hand, a decreased RRF (<45) associated with cortical lesions was the most frequent finding in patients with refluxing kidneys (8/26, 30%), especially in those with grade 3–4 disease.ConclusionsThis investigation showed that the presence of VUR affects DMSA patterns in children with first symptomatic UTI.

Evaluation of physiological FDG uptake in the skeleton in adults: Is it uniformly distributed?

AIM The aim of this study was to study whether FDG was uniformly distributed throughout the skeleton and whether age and gender affected this biodistribution. MATERIAL AND METHODS A total of 158 patients were included in this retrospective study. None of the patients had received prior treatment that had affected the bone marrow and patients with bone metastases, trauma, benign and/or malignant hematologic disorders were excluded from the study. The SUVmax from the 24 different locations in the skeleton was obtained and all the values were compared with each other. RESULTS FDG uptake in the skeleton was not uniform in both sexes. While the highest FDG uptake was seen in the L3 vertebra, the lowest glucose metabolism was observed in the diaphysis of the femur. Concerning the vertebral column, FDG uptakes were also non-uniform and the SUVmax gradually increased from the cervix to the lumbar spine. The mean skeletal SUVmax was decreased in accordance with age in both genders. CONCLUSION FDG was not uniformly distributed throughout the skeleton in both sexes. It had a tendency to increase from the appendicular to axial skeleton and from cervical to lumbar spine in the vertebral column that may be related with the normal distribution of the red bone marrow. Additionally, the glycolytic metabolism of the whole skeleton was gradually decreased in accordance with the age in both sexes.

Is The Value of FDG PET/CT In Evaluating Renal Metastasis Underestimated? A Case Report And Review of The Literature.

Contrast-enhanced CT or MRI are used as a gold standard imaging modalities in the detection and characterization of renal masses. On the other hand, the role of FDG PET/CT in evaluating primary or metastatic cancers of the kidney is limited due to the excretion of FDG through urinary tract. We reported the FDG PET/CT of a lung cancer patient with multiple metastases in both kidneys which were missed in previous PET/CT, and underestimated on sequential diagnostic abdominal CT study. Conflict of interest:None declared.