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   2013| September-December  | Volume 12 | Issue 3  
    Online since July 14, 2014

 
 
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CASE REPORTS
An Unusual Appearance of Meckel's Diverticulum as a Site of Bleed on Gastrointestinal Bleeding Scan
Madhuri Shimpi Mahajan
September-December 2013, 12(3):111-115
DOI:10.4103/1450-1147.136735  PMID:25165421
Lower gastrointestinal (GI) hemorrhage is a frequently encountered and challenging clinical problem. GI bleeding scans are extremely useful for localizing the source of GI bleeding before interventional radiology procedures. It is essential that physicians understand the numerous possible pitfalls when interpreting these scans. Understanding the potential causes of false-positive scan interpretation eliminates unnecessary procedures for the patient and minimizes costs. We report a rare case of an 8-year-old boy who presented with GI bleeding. Upper and lower GI endoscopy did not reveal a source of bleeding. We emphasize case of Meckel's diverticulum appearing as a proximal jejunum false-positive site of bleed on bleeding scan. In addition, we reinforce the criteria needed for diagnosis of GI bleeding site on the nuclear bleeding scan. A high index of suspicion is the most important diagnostic aid that can prevent the nuclear medicine physicians from misdiagnosing the site of lower GI hemorrhage.
  6,461 359 -
Chronic Recurrent Multifocal Osteomyelitis in Children: A Multidisciplinary Approach is needed to establish a Diagnosis
Alshaima Alshammari, Sharjeel Usmani, AH Elgazzar, Rasha A Ashkanani
September-December 2013, 12(3):120-123
DOI:10.4103/1450-1147.136737  PMID:25165423
Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disease of unknown cause. In general, CRMO follows a characteristic clinical course and is regarded at present as a distinct entity. It affects bone and occurs predominantly in children and adolescents. The clinical, radiologic and pathologic findings are non-specific. The recognition of this rare entity is often delayed and difficulties in patient management sometimes emerge from its usual protracted course. We present a 6-year-old girl diagnosed with CRMO involving tibia and lumbar vertebra where a multidisciplinary approach was essential in making the diagnosis.
  4,067 578 8
ORIGINAL ARTICLES
Kinetic Modeling Application to 18 F-fluoroethylcholine Positron Emission Tomography in Patients with Primary and Recurrent Prostate Cancer Using Two-tissue Compartmental Model
Mustafa Takesh
September-December 2013, 12(3):101-110
DOI:10.4103/1450-1147.136734  PMID:25214813
Although 18 F-fludeoxyglucose-positron emission tomography (PET) is the most applied diagnostic method in tumor staging, its role in prostate cancer (PCA) is limited because glucose metabolism tends to be low unless PCA has high Gleason score. Alternatively, choline PET was introduced as a valuable imaging method. Kinetic analysis of PET acquisition has increasingly gained momentum as an investigative tool because it provides a non-invasive approach to obtain kinetic and metabolic data from tissues of interest including transport and metabolism of the administered material. In this regard, we sought to apply it in 18 F-fluoroethylcholine (FECH)-PET/computed tomography (CT) in patients with PCA. 64 patients, the mean age 69 (range: 47-87 years) with primary/recurrent PCA were encompassed. They underwent 18 F-FECH-PET started with a dynamic acquisition using a 20-frame each 30 s over the prostate region and followed at 1 h post-injection by a static whole body imaging. The kinetic evaluation of the data was performed using the software package PMOD (PMOD Technologies Ltd., Zürich, Switzerland). Significant increase in mean values for K1, K3, FD, standardized uptake value (SUV) and global influx in tumor tissue versus normal tissue (P < 0.05). Moderate but significant correlation (r: 0.28, P = 0.023) between SUV and K1. By contrast, no correlation between SUV and K3 (r: −0.08, P = 0.79). In patients with recurrent tumors, there is no significant difference in all kinetic parameters and SUV (P > 0.1) between the different types of recurrences. The kinetic analysis of dynamic FECH-PET provides a novel method in primary PCA diagnosis and could be of potential value in the delineation of tumor focus.
  4,068 379 11
CASE REPORTS
Technetium-99m-methylene Diphosphonate Uptake in Hepatic Necrosis Secondary to Respiratory Failure
Madhuri Shimpi Mahajan, Negi S Digamber, Rajkumar Sharma
September-December 2013, 12(3):116-119
DOI:10.4103/1450-1147.136736  PMID:25165422
Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. On one hand, there is a need for awareness of the pathophysiologic basis underlying such uptake, as it may be of critical clinical relevance in the evaluation of the patient. On the other hand, some alterations in biodistribution may be of little clinical significance, but have deleterious consequences on the quality of the bone study. Recognition of these abnormalities will reduce errors and provide important clinical information. We described a case of 57-year-old male patient with history of carcinoma base of tongue, where a 99mTc-MDP bone Scintigraphy was performed for metastasis survey. It revealed avascular necrosis of head of right femur. In addition incidentally demonstrated diffuse increased pathologic uptake of Tc-99m-MDP in the liver and multiple foci in bilateral lungs. This article reviews several possible reasons for such diffuse hepatic uptake. In the present case diffuse hepatic necrosis secondary to respiratory failure due to bilateral miliary pulmonary metastasis is considered to be the cause of the diffuse liver uptake of 99mTc-MDP.
  4,056 340 1
Inflammatory Myofibroblastic Tumor of the Lung: Unusual Imaging Findings
K Pavithran, P Manoj, G Vidhyadharan, P Shanmughasundaram
September-December 2013, 12(3):126-128
DOI:10.4103/1450-1147.136739  PMID:25165425
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm, most commonly seen in children and adolescents. It can occur in nearly every part of the body. Imaging properties and the clinical presentation of IMT can mimic malignant process. A 41-year-old female presented with cough of 3 months duration. Chest X-ray showed a coin shadow in the right upper lobe. Positron emission tomography/computed tomography scan showed a 3.2 × 2.4 cm lesion with homogeneous appearance with a very high fluorodeoxyglucose uptake value, suggesting a neoplastic process. She underwent lobectomy and the final diagnosis was IMT.
  3,356 360 9
ORIGINAL ARTICLES
The Role of Salivary Gland Scintigraphy in the Evaluation of Salivary Gland Dysfunction in Uncontrolled Type II Diabetic Patients
B Senthilkumar, S Sathasivasubramanian
September-December 2013, 12(3):94-100
DOI:10.4103/1450-1147.136733  PMID:25214812
The aim of the present study was to evaluate the salivary gland dysfunction in patients with uncontrolled type II diabetes using salivary gland scintigraphy and then to compare these ratios with quantitative whole salivary secretion rates. Using a gamma camera (siemens-diacam) equipped with a low energy all-purpose collimator, 32 uncontrolled type II diabetic patients and 30 normal healthy patients were studied by injecting a radio isotope (technetium 99m pertechnetate) about 5 mCi was injected intravenously in to anticubital vein and the activity was measured for the 1 st , 20 th and 40 th min. At 20 min after injection, vitamin C chewable tablet was given to stimulate the secretion and continued until the end of the study period (40 min). Before scintigraphy, salivary sampling was carried out in both diabetic and normal individuals in a quiet room, saliva was allowed to accumulate and was expectorated into the collecting vessel approximately once a minute for 15 min and the volume was recorded as Unstimulated salivary flow rate and after 5 min break vitamin C chewable tablet was given to stimulate the secretion and the patient was asked to expectorate the saliva in the collecting vessel for 5 min. The expectorated volume was recorded as stimulated salivary flow rate. The mean of the measurements of scintigraphic ratio and salivary secretion rates were compared using the paired Student's t-test. The scintigraphic mean uptake and excretory ratio (ER) and the salivary flow rates were correlated. The result shows that there was a significant correlation between salivary flow rate and scintigraphic uptake and ER. However, statistically significant result could not be derived as it may be due to smaller sample size and marginal difference in the scintigraphic values between the groups. Salivary gland scintigraphy plays a significant role in the evaluation of salivary gland dysfunction. However, its role as an independent investigative procedure in the evaluation of salivary gland dysfunction requires a study with a larger sample size, may yield a statistical significant result and it can also act as an adjunct along with salivary flow rate procedure.
  3,229 352 3
REVIEW ARTICLE
Positron Emission Tomography Imaging in Sarcoidosis
Beth Vettiyil, Nikitha Gupta, Rajesh Kumar
September-December 2013, 12(3):82-86
DOI:10.4103/1450-1147.136731  PMID:25165420
Sarcoidosis is a chronic granulomatous disease of unknown origin. There are several modalities for diagnosis, staging and therapeutic management of patients with sarcoidosis. Among these, whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography is found to useful in patients with complex and multisystem forms of sarcoidosis. Other modalities include Gallium scanning, assesment of angiotensin converting enzyme levels in blood, chest radiography, mediastinoscopy etcetera.
  2,942 630 6
EDITORIALS
Coming of Age as an Organization: WARMTH
Ajit Kumar Padhy
February 2013, 12(3):1-2
DOI:10.4103/1450-1147.107272  
  2,458 498 -
ORIGINAL ARTICLES
Assessment of Inter-modality Spatial Alignment Accuracy in Hybrid Single Photon Emission Computed Tomography in Patients with Hand and Wrist Pain
Cheng Xie, Gopinath Gnanasegaran, Hosahalli Mohan, Lefteris Livieratos
September-December 2013, 12(3):87-93
DOI:10.4103/1450-1147.136732  PMID:25214811
Single photon emission computed tomography (SPECT) and computed tomography (CT) integrated in one system (SPECT/CT) is an effective co-registration technique that helps to localize and characterize lesions in the hand and wrist. However, patient motion may cause misalignment between the two modalities leading to potential misdiagnosis. The aim of the present study was to evaluate the hardware-based registration accuracy of multislice SPECT/CT of the hand and wrist and to determine the effect of misalignment errors on diagnostic accuracy. A total of 55 patients who had multislice SPECT/CT of the hand and wrist between July 2008 and January 2010 were included. Two reviewers independently evaluated the fused images for any misalignments with six degrees of freedom: Translation and rotation in the X, Y and Z directions. The results were tested against an automated fusion tool (Syntegra). More than half of the patients had moved during SPECT scanning (Reviewer 1: 29 patients; Reviewer 2: 30 patients) and they all originated in the Y-direction translation (vertical hand motion). Five fused images had significant misalignment errors that could have led to misdiagnosis. The Wilcoxon test indicated statistically non-significant difference (P > 0.05) between reviewers and statistically non-significant difference between the reviewers and software registration. The study also showed high inter-reviewer agreement (κ = 0.87). Hand movement during the SPECT scan was common, but significant misalignments and subsequent misdiagnosis were infrequent. Future studies should investigate the use of hand and wrist immobilization devices and reductions of scan time to minimize patient motion.
  2,609 276 1
EDITORIALS
Dosimetry: Does it Really Matter?
David Chee.Eng Ng
February 2013, 12(3):3-4
DOI:10.4103/1450-1147.107273  
  2,251 567 -
CASE REPORTS
Hybrid Single Photon Emission Computed Tomography/Computed Tomography Sulphur Colloid Scintigraphy in Focal Nodular Hyperplasia
Amit Bhoil, Shankramurthy Gayana, Ashwani Sood, Anish Bhattacharya, Bhagwant Rai Mittal
September-December 2013, 12(3):124-125
DOI:10.4103/1450-1147.136738  PMID:25165424
It is important to differentiate focal nodular hyperplasia (FNH), a benign condition of liver most commonly affecting women, from other neoplasm such as hepatic adenoma and metastasis. The functional reticuloendothelial features of FNH can be demonstrated by scintigraphy. We present a case of breast cancer in whom fluorodeoxyglucose positron emission tomography/computerized tomography (CT) showed a homogenous hyperdense lesion in liver, which on Tc99m sulfur colloid single-photon emission computed tomography/CT was found to have increased focal tracer uptake suggestive of FNH.
  2,502 248 1
Case Report of Tc-99m Sulfur Colloid Single-Photon Emission Computed Tomography/Computed Tomography Study Differentiating Tumor from Accessory Spleen
Reena Aggarwal, Thomas Wagner, Shaunak Navalkissoor
September-December 2013, 12(3):129-131
DOI:10.4103/1450-1147.136740  PMID:25165426
We present a case report where Tc-99m sulfur colloid single-photon emission computed tomography (SPECT)/computed tomography (CT) scan was useful in characterizing a soft tissue abdominal mass and helped with patient management. A 63-year-old male with no previous history of trauma had an incidental finding of a soft tissue nodule adjacent to the splenic hilum, unchanged in size over 4 months and with similar enhancing features as the spleen. A Tc-99m sulfur colloid SPECT/CT scan was performed to determine the nature of the nodule. It showed no uptake of tracer within this mass, therefore excluding splenic tissue. This prompted subsequent investigations and this tissue was found to represent a pancreatic neuroendocrine tumor, which was excised.
  2,427 245 2
BOOK REVIEW
Theranostics, Gallium‑68, and Other Radionuclides: A Pathway to Personalized Diagnosis and Treatment: Proceedings of the 1st World Congress on Gallium-68 and Peptide Receptor Targeted Radiation Therapy, Bad Berka, Germany, June 2010
Michael K Schultz
February 2013, 12(3):5-6
  2,115 311 -
ABSTRACTS
Poster Presentations (Pre-Clinical)

February 2013, 12(3):57-102
Full text not available  [PDF]
  1,733 339 -
22 nd Annual Scientific Meeting of Singapore Radiological Society & College of Radiologists Singapore and 6 th SGH Nuclear Medicine Update (2013)

February 2013, 12(3):103-103
Full text not available  [PDF]
  1,816 222 -
Nuclear Medicine Presentations

February 2013, 12(3):104-153
Full text not available  [PDF]
  1,734 242 -
Diagnostic Radiology and Radiation Oncology Presentations

February 2013, 12(3):154-174
Full text not available  [PDF]
  1,732 205 -
EDITORIAL
Honour the Scientist
John Richard Buscombe
September-December 2013, 12(3):81-81
DOI:10.4103/1450-1147.136730  PMID:25165419
  1,676 148 -
ABSTRACTS
2 nd World Congress On Ga-68 (Generators and Novel Radiopharmaceuticals), Molecular Imaging (PET/CT), Targeted Radionuclide Therapy and Dosimetry: On the Way to Personalized Medicine

February 2013, 12(3):7-7
Full text not available  [PDF]
  572 258 -
Abstracts of Invited Lectures

February 2013, 12(3):8-39
Full text not available  [PDF]
  547 283 -
Oral Presentations (Pre-Clinical)

February 2013, 12(3):40-56
Full text not available  [PDF]
  499 236 -
Nursing and Technologist Track

February 2013, 12(3):175-179
Full text not available  [PDF]
  446 211 -
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