Seyhan Karacavus

Hepatobiliary function assessed by 99mTc-mebrofenin cholescintigraphy in the evaluation of fibrosis in chronic hepatitis: histopathological correlation.

PurposeAlthough liver biopsy remains the gold standard in the staging of liver fibrosis in chronic hepatitis C virus (HCV) infection, several noninvasive methods are under evaluation for clinical use. The aim of this study was to evaluate the utility of hepatobiliary function through technetium-99m-N-(-3-bromo-2,4,6-trimethylacetanilide) iminodiacetic acid (99mTc-mebrofenin) scintigraphy in evaluating liver fibrosis in patients with chronic HCV infection. MethodsWe studied 62 patients with HCV (18 men, 44 women). The patients were allocated into three groups according to histopathological score: group 1: portal/periportal fibrosis (21 patients; eight men, 13 women); group 2: bridging fibrosis (23 patients; seven men, 16 women); and group 3: incomplete/complete cirrhosis (18 patients; three men, 15 women). As a control group, 20 healthy volunteers (six men and 14 women) were studied. Hepatocyte mebrofenin uptake rate, the time required for maximal hepatic activity (Tmax), and the time required for peak activity to decrease by 50% (T1/2max) were calculated using 99mTc-mebrofenin cholescintigraphy. Scintigraphic parameters were correlated with biochemical parameters and liver histopathology. ResultsThe uptake rates were significantly decreased in all groups with fibrosis compared with the controls (P<0.05). The correlation between the severity of fibrosis and 99mTc-mebrofenin uptake rate was strongly significant (r2=−0.81, P<0.0001). Tmax and T1/2max were significantly prolonged in groups 2 and 3 compared with the controls. Histopathology score was correlated moderately with Tmax and T1/2max (r2=0.61, P<0.0001 and r2=0.52, P<0.0001, respectively). ConclusionThe assessment of hepatobiliary function by 99mTc-mebrofenin scintigraphy may be a good choice for assessing the severity of liver fibrosis in patients with HCV.

Can left ventricular parameters examined by gated myocardial perfusion scintigraphy and strain echocardiography be prognostic factors for major adverse cardiac events

Assessment of left ventricular (LV) function in patients with myocardial infarction (MI) provide useful diagnostic and prognostic information. Up to date, single photon emission tomography (SPET), positron emission tomography (PET), multidetector computed tomographic angiography, echocardiography (EC) and magnetic resonance imaging (MRI), have been used to examine LV parameters. However, due to limitations of some imaging methods, new studies are directed to improve myocardium function evaluation. In conclusion, SEC and GSPET can be applied to semi-quantitatively assess LVEF and regional wall motion abnormalities in a noninvasive manner. These techniques can provide strong diagnostic and prognostic information related to anterior myocardial infarction. In addition to this, nitrate enhanced GSPET allows to identify stunning and hibernating myocardium. New methods of reconstruction on GSPET systems will better improve image quality using lower count rates.

Evaluation of the diagnostic and prognostic use of gated myocardial perfusion single-photon emission computed tomography in patients with acute chest pain: comparison with the SYNTAX score.

ObjectiveThe aim of this study was to evaluate the diagnostic and prognostic efficacy of gated single-photon emission computed tomography (GSPECT) in patients with acute chest pain and to compare quantitative GSPECT parameters and the coronary angiographic SYNTAX score. Materials and methodsA total of 168 patients who presented with clinical symptoms of acute chest pain were enrolled in the study. Study participants were divided into two groups according to the risk of acute coronary syndrome (ACS): low-intermediate and high risk. All participants underwent rest or stress-GSPECT (R/S-GSPECT). Coronary angiography was performed in all high-risk patients and the SYNTAX score was determined. All patients were followed for 24±3 months and monitored for the occurrence of major adverse coronary events (MACE). ResultsAmong patients with low-intermediate ACS risk, R-GSPECT and S-GSPECT were associated with 100 and 86% sensitivity, 99 and 98% specificity, 100 and 98% negative predictive value, 80 and 86% positive predictive value, and 98 and 97% accuracy, respectively. At follow-up, MACE occurred in 16 patients. Among high-risk patients, GSPECT quantitative parameters were the most significant predictors of MACE in Cox regression analysis. ConclusionR/S-GSPECT, a noninvasive diagnostic method, is associated with an excellent safety profile and exceptional diagnostic and prognostic accuracy in cases of ACS.

A comparison between quantitative gated myocardial perfusion scintigraphy and strain echocardiography as indicators of ventricular functions in patients with anterior myocardial infarction

The purpose of this study is to compare the strain echocardiographic and scintigraphic parameters for evaluating of the left ventricular (LV) functions in patients with anterior myocardial infarction (MI). Fifty-four patients (male/female: 36/18; mean age 62 ± 13 years) with anterior MI were prospectively enrolled. All patients were performed gated myocardial perfusion scintigraphy gated single-photon emission computed tomography (GSPECT) and echocardiography (EC). GSPECT data were processed and analyzed using 4D-MSPECT (4DM, Invia Medical Imaging Solutions, Ann Arbor, MI, USA). The echocardiographic strain (S) and strain rate (SR) values were calculated. The results obtained by these techniques were compared each other. A total of 918 segments of LV wall were evaluated. In all patients, 385 segments were automatically scored as normokinetic, 206 as hypokinetic, 122 as akinetic, 205 as dyskinetic and 300 as normal thickening, 348 as decrease thickening and 270 as no thickening. The means of S and SR values in thickening and motion score groups according to GSPECT were statistically different from each other (P < 0.001). There was a negative significant correlation between LV wall thickening sum score and S and SR and between LV wall motion sum score and S and SR (P < 0.001). There was a good correlation between GSPECT and echocardiographic LV-ejection fraction (r = 0.7, P < 0.001). GSPECT and strain EC are similar in quantitative grading of the severity of regional and global myocardial dysfunction in patients with anterior MI and these techniques provide valuable diagnostic information.

Lenfödemin Değerlendirilmesinde Radyonüklid Lenfosintigrafi

Lenfodem, lenf sivisini tasiyan lenf kanallari ile lenf dugumlerinin dogustan ya da sonradan hasara ugramasina bagli olarak lenfatik transportta meydana gelen yetmezlik sonucu gelisen odemle karakterize, kronik, ilerleyici, siklikla gec tani alan bir hastaliktir. Lenfatik yetmezlik sonucu cilt ve ciltalti dokuda proteinden zengin sivinin asiri birikimi mevcuttur. Klinik tani disinda lenfatik akim ve drenaj yerleri lenfosintigrafi ile degerlendirilebilir. Lenfatik goruntuleme, ekstremitede meydana gelen sisligin etyolojisinin belirlenmesinde ve tedavi basarisini ongormede onemli rol oynayabilir. Lenfosintigrafi, lenfatik sistemin temel fonksiyonlarindan biri olan, buyuk molekullerin interstisyel mesafeden vaskuler kompartmana geri tasinmasi esasina dayanir. Tc-99m ile bagli protein veya kolloid gibi radyoaktif bir madde interstisyel mesafeye enjekte edildiginde, bu madde ilk olarak lenfatik kanallara, sonra bolgesel lenf nodlarina gecer ve gama kamera ile goruntuleme yapilarak lenfatik yollar ve fonksiyonun degerlendirmesi saglanabilir. Bu nedenle lenfosintigrafinin, lenfodemin tanisinda ve lenfatik sistemin goruntulenmesinde temel yontem oldugu dusunulmektedir.

Reperfusion injury to skeletal muscle on bone scan.

We report the bone scan appearance of reperfusion injury involving the muscle groups of the lower extremities in a patient after undergoing thromboembolectomy of the bilaterally femoral artery. The patient was referred to our department with a history of colon adenocarcinoma and widespread bone pain. Bone scan demonstrated extraosseous accumulation of technetium-99m methylene diphosphonate in the muscle groups of the lower extremities, predominantly in the right extremity. Pathologic examination of the gastrocnemius muscle was suggestive of reperfusion injury and atrophic changes. There was no finding of rhabdomyolysis.