Yuh-Feng Wang

Chronic edema from protein-losing enteropathy: scintigraphic diagnosis

Yi-Chun Chen, Shang-Jyh Hwang, Jainn-Shiun Chiu, Mei-Hua Chuang, Mei-Ing Chung and Yuh-Feng Wang Division of Nephrology, Department of Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China; Department of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China; Department of Pharmacy, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, Republic of China and Graduate Institute of Pharmaceutical Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China Correspondence: Yuh-Feng Wang, Department of Nuclear Medicine, Buddhist Dalin Tzu Chi General Hospital, No. 2, Minsheng Rd., Dalin Township, Chiayi County 622, Taiwan-Republic of China. E-mail: chenyichun0320@yahoo.com.tw

In vivo bio-distribution of intravenously injected Tc-99 m labeled ferrite nanoparticles bounded with biocompatible medicals

Superparamagnetic nanoparticles have been widely utilized for in vivo or in vitro biomedical applications. Knowledge on the distribution of injected particles in organs is necessary to gain access to diagnosis or therapeutics. Thus, an in vivo study on the bio-distribution of the directly Tc-99m-labeled ferrite nanoparticles which were intravenously injected into tail vein of Wistar rats is performed. The dynamic bio-distribution was monitored by gamma camera. The scintigrams show that the injected dose are taken up by liver and lung. From dynamic scintigraphic image, it is observed that the uptake of particles by the organ is very fast and completed within first few minutes after intravenous injection. To investigate to what extent the Tc-99m labeled ferrite beads can be further conjugated with therapeutic drug, poly(ethylene glycol) (PEG) and two types of herb medicines, i.e. the Gentiana comnination and Trionyx sinensis with a function for chronic hepatitis, were sequentially conjugated with the ferrite adio-beads. It is demonstrated that the relative radioactivity of liver compared to that by lung and heart is lowered by the PEG modification. We also have performed in vivo study by applying the commercially available Nd-Fe-B magnet onto the site before intravenous injection into rat. The result implies that the directly Tc-99m labeled ferrite nanoparticles, conjugated with biocompatible medicals, may implicate for diagnostic and therapeutic applications.

Outcome of surgical resection for protein-losing enteropathy in systemic lupus erythematosus

Protein-losing enteropathy (PLE) is an uncommon manifestation associated with systemic lupus erythematosus (SLE). Here, a case with SLE and concomitant hypoalbuminemia is reported. Technetium-99m albumin scintigraphy demonstrated a localized lesion in the ascending colon, and the diagnosis of SLE-related PLE was established. Due to a poor response to medical treatment, this patient received surgical resection, but relapse still developed later on. Recurrent protein-lose from the remaining of the colon was documented by repeated images. This report discusses the management of SLE-related PLE and the role of nuclear medicine scintigraphy in the investigation of PLE.

CHADS2 Scores in the Prediction of Major Adverse Cardiovascular Events in Patients with Cushing’s Syndrome

Vascular events are one of the major causes of death in case of Cushings syndrome (CS). However, due to the relative low frequency of CS, it is hard to perform a risk assessment for these events. As represented congestive heart failure (C), hypertension (H), age (A), diabetes (D), and stroke (S), the CHADS2 score is now accepted to classify the risk of major adverse cardiovascular events (MACEs) in patients with atrial fibrillation. In this study, participants were enrolled from the National Health Research Institute Database (NHIRD) of Taiwan, and we reviewed 551 patients with their sequential clinically diagnosed CS data between 2002 and 2009 in relation to MACEs risk using CHADS2 score. Good correlation could be identified between the CS and CHADS2 score (AUC = 0.795). Our results show that patients with CS show significantly higher risk of vascular events and the CHADS2 score could be applied for MACEs evaluation. Adequate lifestyle modifications and aggressive cardiovascular risks treatment are suggested for CS patients with higher CHADS2 score.

Pulmonary carcinosarcoma: 18F-FDG PET/CT imaging.

We present a case of pulmonary carcinosarcoma. The patient is a 31-year-old man with a history of infectious mononucleosis in whom a right lung mass was found. His age is lower than the mean age at which pulmonary carcinosarcoma is usually reported. Chest CT scan showed a lobulated 29-mm mass in the right upper lung and multiple hypervascular liver nodules. FDG PET/CT showed increased FDG uptake in the right upper lung nodule (SUVmax, 4.1). However, the hepatic radiouptake showed only background activity. The liver nodules were stable at the 1-year follow-up period and were suggestive of hemangiomas.

Prediction of target range of intact parathyroid hormone in hemodialysis patients with artificial neural network

The application of artificial neural network (ANN) to predict outcome and explore potential relationships among clinical data is increasing being used in many clinical scenarios. The aim of this study was to validate whether an ANN is a useful tool for predicting the target range of plasma intact parathyroid hormone (iPTH) concentration in hemodialysis patients. An ANN was constructed with input variables collected retrospectively from an internal validation group (n = 129) of hemodialysis patients. Plasma iPTH was the dichotomous outcome variable, either target group (150 ng/L<or= iPTH <or=300 ng/L) or non-target group (iPTH< 150 ng/L or iPTH hormone >300 ng/L). After internal validation, the ANN was prospectively tested in an external validation group (n = 32) of hemodialysis patients. The final ANN was a multilayer perceptron network with six predictors including age, diabetes, hypertension, and blood biochemistries (hemoglobin, albumin, calcium). The externally validated ANN provided excellent discrimination as appraised by area under the receiver operating characteristic curve (0.83 +/- 0.11, p = 0.003). The Hosmer-Lemeshow statistic was 5.02 (p= 0.08 > 0.05) which represented a good-fit calibration. These results suggest that an ANN, which is based on limited clinical data, is able to accurately forecast the target range of plasma iPTH concentration in hemodialysis patients.

Trabecular Bone Score Reflects Trabecular Microarchitecture Deterioration and Fragility Fracture in Female Adult Patients Receiving Glucocorticoid Therapy: A Pre-Post Controlled Study

A recently developed diagnostic tool, trabecular bone score (TBS), can provide quality of trabecular microarchitecture based on images obtained from dual-energy X-ray absorptiometry (DXA). Since patients receiving glucocorticoid are at a higher risk of developing secondary osteoporosis, assessment of bone microarchitecture may be used to evaluate risk of fragility fractures of osteoporosis. In this pre-post study of female patients, TBS and fracture risk assessment tool (FRAX) adjusted with TBS (T-FRAX) were evaluated along with bone mineral density (BMD) and FRAX. Medical records of patients with (n = 30) and without (n = 16) glucocorticoid treatment were retrospectively reviewed. All patients had undergone DXA twice within a 12- to 24-month interval. Analysis of covariance was conducted to compare the outcomes between the two groups of patients, adjusting for age and baseline values. Results showed that a significant lower adjusted mean of TBS (p = 0.035) and a significant higher adjusted mean of T-FRAX for major osteoporotic fracture (p = 0.006) were observed in the glucocorticoid group. Conversely, no significant differences were observed in the adjusted means for BMD and FRAX. These findings suggested that TBS and T-FRAX could be used as an adjunct in the evaluation of risk of fragility fractures in patients receiving glucocorticoid therapy.

Predicting Bone Metastasis in Prostate Cancer Patients: Value of Prostate Specific Antigen

Abstract Objective Serum prostate specific antigen (PSA) concentration has been widely applied as a biomarker to diagnose and monitor prostate cancer. Technetium-99m methylene diphosphate (Tc-99m MDP) whole body bone scintigraphy is currently a well-accepted diagnostic procedure for bone metastasis in malignancy. The aim of this study was to establish a useful serum PSA cut-off value to predict the presence of bone metastasis in men with prostate cancer. Materials and Methods Consecutive male patients diagnosed with prostate cancer were retrospectively analyzed. All of the subjects had received both Tc-99m MDP whole body bone scintigraphy and had their serum PSA concentration measured within 1 month. The proper cut-off value was established based on statistical analysis in order to predict the possibility of bone metastasis among prostate cancer patients. Results In total, 101 consecutive male patients (age, 71.92 ± 0.76 years) with prostate cancer were enrolled, and 57 patients (56%) were confirmed by scintigraphic findings to have bone metastases. A serum PSA concentration of 13 ng/mL gave the best sensitivity (96.43%) and specificity (84.09%). The area under the receiver operating characteristics curve revealed excellent discriminatory power (0.93 ± 0.02; p = 0.001). The positive predictive value, negative predictive value and likelihood ratios for positive and negative test were 88.52%, 94.87%, 6.06 and 0.04, respectively. The resulting diagnostic accuracy and odds ratio were 73.87% and 142.76. Conclusion A cut-off value of 13 ng/mL appears to be an appropriate benchmark for stratifying metastatic bone disease in prostate cancer patients such that if a patient with newly diagnosed prostate cancer and without any skeletal symptoms has a serum PSA concentration of less than 13 ng/mL, we suggest that they would not need to undergo bone scintigraphy.

Application of Upper Extremity Radionuclide Venography as a Diagnostic Approach for Port-A Catheter Thrombosis

Background: To investigate the role of upper extremity radionuclide venography as a potential diagnostic modality in the assessment of venous thrombosis associated with a Port‐A catheter. Methods: Fourteen symptomatic patients who had received Port‐A catheter implantation were enrolled. A dynamic nuclear medicine flow study was performed with intravenous administration of Technetium‐99m macroaggregated albumin to both upper extremities. Imaging patterns of the venous system were categorized as patency, partial obstruction, and total occlusion. Results: The findings of the dynamic images clearly demonstrated clinical problems. Three patients were free of a definite venous flow change. Three patients had partial obstruction of venous return. A significant cut‐off of venous return was demonstrated in 8 patients, and total occlusions were hence diagnosed. All patients underwent this procedure smoothly without any complication. Conclusion: These results suggest that upper extremity radionuclide venography is an easily performed and effective method for diagnosing Port‐A catheter thrombosis in clinical practice.

Colon Visualization on Bone Scan: A Special and Interesting Case

Several causes of bowel visualization on bone scintigraphy have been discussed. Tc-99m MDP whole-body bone imaging was performed on a 38-year-old woman for clinical staging of breast cancer. The bone scintigraphy demonstrated no skeletal abnormality. However, extensive accumulation of radioactivity in the colon was noted. This resulted from the patient drinking her own urine, because some people believe that it is a way to improve their health. To avoid such misleading conditions, thorough history taking, including administration of traditional remedies, special habits, and the habitat of the patient, are necessary before imaging.