Seniha Naldoken

Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment

ObjectivesTo clarify cerebral perfusion distribution and cognitive functions in patients with chronic obstructive pulmonary disease (COPD) according to the hypoxia levels and to assess if there is a relationship between cognitive impairment and cerebral perfusion index.Patients and MethodsEight patients with stable hypoxemic COPD (HC), 10 patients with stable nonhypoxemic COPD (NHC), and 10 age-matched healthy volunteers participated in the study. All subjects underwent a complete neuropsychological assessment with the mental deterioration battery (MDB), Wechsler memory scale-revised (WMS-R), color trail test (CCT), and grooved pegboard test (GPT). SPECT examination with Tc-99m HMPAO was performed in all patients and controls. Quantitative analysis was performed by a region of interest (ROI)-based method.ResultsThe scores of verbal memory, delayed recall and attention were significantly lower in COPD patients (p < 0.01). The scores of other subtests were similar in patients and controls. Comparing NHC patients to HC groups showed that verbal memory was impaired in both groups, but delayed recall and attention scores were significantly worse in HC patients than NHC patients. Perfusion indexes on frontal ROIs in NHC patients and frontal and parietal ROIs in HC patients showed significant decreases. Our scintigraphic findings were correlated with the results of neuropsychological tests.ConclusionsOur results demonstrate that cerebral perfusion is significantly altered in COPD patients. Hypoxemic patients showed more deterioration in cerebral perfusion and cognitive performance than nonhypoxemic patients. The relationship between decreased perfusion and cognitive impairment and the clinical significance of these results require further studies in larger populations.

Differential renal function in the prediction of recovery in adult obstructed kidneys after pyeloplasty

Aim: Pyeloplasty is a widely accepted method for the treatment of ureteropelvic junction obstruction (UPJO). Surgery has long been thought to affect postoperative renal function. However, controversies still exist on the functional studies that can be used to indicate which renal units will benefit from surgery. In this study, the correlation between differential renal function (DRF) and other preoperative parameters was examined to determine which parameter more accurately predicts recovery of renal function in adult obstructed kidneys.Materials &Methods: In this study, the authors evaluated 32 patients with UPJO. In all patients, standart diuretic Tc-99m DTPA renal scans were performed preoperatively and 6 months after surgery. Patients were divided into two groups according to the preoperative DRF (≥ 30%, n = 22, group I and < 30%, n = 10, group II). Second type classification was made according to the postoperative DRF improvement as improved (group A, n = 13) and not improved (group B, n = 19). These groups were then compared regard to variables which were defined as symptoms, age at operation and ultrasonographic findings. We also evalulated whether preoperative parenchymal function is important to predict improvement in drainage half-time (Tl/2).Results: While preoperative drainage half-time was 39.6 ± 15.9 minutes, postoperative half-time decreased to 16.9 ± 6.8 minutes (p < 0.001). The mean DRF did not improved significantly after surgery compared with preoperative values (32.03 ± 9.42% versus 36.16 ± 9.60%). When comparing the patients with preoperative DRF ≥ 30% (group I, DRF 38 ± 0.8%) to those who had an initial DRF below 30% (group II, DRF 22.8 ± 5.2%), postoperative DRF was 41.22 ± 5.72 in group I and 25.00 ± 6.22 in group II. The difference was significant (p < 0.01 ). The patients in group I and II showed improvement in 50% and 20%, respectively. Age, clinical presentation and ultrasonographic findings did not affect functional outcome after pyeloplasty. We could not find any correlation between preoperative DRF and the degree of improvement in Tl/2.Conclusion: Renal function improves after pyeloplasty with regard to the initial level of split renal function in adult obstructed kidneys. Improvement may not be observed especially in patients with DRF less than 30%.

Multiple brown tumors simulating bone metastases: a case of parathyroid adenoma coexisting with papillary carcinoma of the thyroid.

A 55-year-old man with multiple brown tumors who initially was thought to have multiple bone metastases is described. He had elevated parathyroid hormone levels and was referred to the nuclear medicine department, where a parathyroid adenoma was diagnosed. At surgery, abnormal lymph nodes were seen, which were found to contain metastatic thyroid papillary carcinoma cells. On further exploration, the patient’s bone scintigraph revealed multiple sites of increased uptake but no bone abnormalities on whole-body iodine and Tc-99m MIBI scans.

Subclinical neurological involvement in Behcet's disease

CONTEXT Behçets disease (BD) is a multisystem inflammatory disorder with unknown etiology characterized by recurrent oral and genital aphthous ulcers and uveitis. Behçets disease can affect the central nervous system. AIMS We aimed to investigate subclinical neurological involvement in patients who were suffering from BD and who had no neurological symptoms. SETTINGS AND DESIGN A total of 49 patients were included in the study. For the investigation of subclinical neurological involvement, the patients received imaging and/or neurophysiologic evaluations. MATERIALS AND METHODS The evaluation techniques were as follows: single photon emission computed tomography, 33 patients; cranial magnetic resonance imaging (MRI), 25 patients; brainstem auditory evoked potential examination, 36 patients; and electroencephalography (EEG), 30 patients. STATISTICAL ANALYSIS USED The Mann-Whitney U test and Wilcoxon Rank-Sum W test were used. RESULTS Patients in the MRI and EEG groups showed significantly more abnormalities than did age- and gender-matched controls. CONCLUSIONS Early diagnosis of neurological involvement in BD is important in reducing or preventing complications. Cranial MRI and EEG were found to be useful for detecting subclinical neurological abnormalities in patients with Behçets disease.

The role of Tc-99m polyclonal human immunoglobulin G scintigraphy in Graves’ ophthalmopathy

Objective: The aim of this study was to clarify whether Tc-99m HIG (Polyclonal Human Immunoglobulin G) can image and determine the severity of orbital involvement in patients with Graves’ ophthalmopathy.Materials and Methods: Twenty-six patients between 19 and 56 years old with Graves’ ophthalmopathy were examined. All patients received approximately 370 MBq Tc-99m HIG by i.v. injection. Planar and SPECT examination were performed 4 hours after the injection. Visual and semiquantitative evaluations were performed for both orbits by two independent observers,Results: Clinically active ophthalmopathy patients had noticeably increased orbital accumulation of Tc-99m HIG. In patients with inactive disease, and 14 of 19 had no uptake, whereas 5 patients had orbital radioactivity accumulation. The duration of Graves’ ophthalmopathy did not correlate with the presence of active ophthalmopathy and Tc-99m HIG grade. There was a good correlation between clinical classification and clinical activity (r=278). There was a good correlation between clinical activity and the radioactivity grade with r=0.666 (p=0.01). The clinical classification closely correlated with Tc-99m HIG grade (r=0.423, p=0.05).Conclusion: Tc-99m HIG scan can clearly identified clinically active patients, and subclinicial inflammation can be shown by this scintigraphic evaluation. The current preliminary results suggested that Tc-99m HIG SPECT might be useful for the assessment of disease activity in Graves’ ophthalmopathy.

Hemodynamic evaluation of varicocele: the role of scrotal scintigraphy and Doppler ultrasonography in the prediction of postoperative seminal improvement.

AimThe aim of this study was to evaluate the hemodynamics of varicocele using Doppler ultrasonography and scrotal scintigraphy, and to compare the value of these two methods in the prediction of seminal improvement after varicocelectomy.Materials and MethodsA total of 40 men with left sided varicocele presented for surgery because of infertility of at least one year in duration. Preoperative and postoperative sperm counts and per cent motility were obtained. Dynamic scrotal scintigraphy and Doppler ultrasonography were performed in all patients. Three perfusion patterns according to the time-activity curves (TAC) generated from scrotal perfusion images were defined. Type 1 : radioactivity shows faster accumulation and maintenance of a higher level on the left side than on the right side. Type 2: time-activity curve rises gradually to a higher level on the left than on the right. Type 3: time-activity curve increases symmetrically and slowly on both sides. The relationship between preoperative TAC patterns and postoperative seminal findings, and preoperative Doppler grades and postoperative seminal findings were investigated.ResultsImprovement in total motile sperm counts was not statistically significant (37.8% ± 3.2% versus 45.2% ± 8.5%) (p = 0.751). Following varicocelectomy, sperm concentration (million sperm per ml) increased from 16.9 ± 3.3 to 26.6 ± 8.6 (p = 0.015). According to the Doppler examinations, postoperative improvement in sperm concentration was demonstrated in patients with grade 1 varicocele (66%). Scintigraphic evaluation showed improvement in patients showing TAC-2 and TAC-3 patterns (63%).ConclusionLocal hemodynamics of varicoceles demonstrated by scintigraphy and Doppler seemed to be different. Grade 1, TAC-2 and TAC-3 patients may be better candidates for varicocelectomy. Scintigraphy and Doppler ultrasonography showed similar success rates in the prediction of improvement following varicocelectomy in the present study.

Increased bone marrow uptake on Tc-99m DMSA scintigraphy in a patient with renal osteodystrophy

A 16-year-old male patient was evaluated with Tc-99m Diethylenetriamine-pentaacetic acid (DTPA) and Tc-99m 2–3 Dimercaptosuccinic acid (DMSA) scintigraphy for renal failure secondary to renal calculi. The uptake in the renal cortex was significantly decreased both on DMSA and DTPA studies. Uptake calculation on DMSA scintigraphy in the kidneys disclosed values of less than 5 %. The activity in the liver and bone was significantly increased. A bone scan performed with Tc-99m methylene diphosphonate (MDP) revealed increased bone uptake with decreased soft tissue activity. Findings on bone scan were compatible with super scan, most likely due to renal osteodystrophy. This case illustrates the altered biodistribution of Tc-99m DMSA and a shift of the radiopharmaceutical to the bone marrow which is mot likely related to colloid formation due to changes in mineral balance in patients with renal failure.

Asymmetric limb uptake on Ga-67 citrate scintigraphy.

A 43-year-old woman was evaluated for left hip pain. She had a history of osteomyelitis involving the left hip 20 years before admission. Initially, three-phase bone scintigraphy was performed and showed minimal diffuse increased uptake in the right lower extremity on the bloodpool phase. Static images displayed significantly increased uptake in the left acetabulum. Within 3 days, a Ga-67 scan was performed to rule out infection. The left hip had no evidence of abnormal uptake. However, the uptake was significantly increased in the right leg, which was thought to be a result of continuous activity and overuse. When asked, the patient mentioned that because of marked pain in the left leg she avoided putting weight on it. The prominent asymmetry on the Ga-67 scan was most likely a result of accumulation of the radionuclide resulting from continuous physical activity during the days subsequent to injection.