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   2014| January-April  | Volume 13 | Issue 1  
    Online since August 12, 2014

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Lacrimal Outflow Mechanisms and the Role of Scintigraphy: Current Trends
Efstathios T Detorakis, Athanassios Zissimopoulos, Konstantinos Ioannakis, Vassilios P Kozobolis
January-April 2014, 13(1):16-21
DOI:10.4103/1450-1147.138569  PMID:25191107
Lacrimal outflow can be compromised by anatomical obstructions or stenoses (nonfunctional epiphora) or by defective lacrimal "pump" function (functional epiphora). Although classic imaging modalities, such as X-ray dacryocystography, computed tomography, or magnetic resonance imaging can effectively evaluate the former, their success is much less in the evaluation of the latter. This is largely due to the fact that forced diagnostic injection of fluid into the canalicular system can overcome partial obstruction sites. On the other hand, lacrimal scintigraphy mimicks "physiological" lacrimal outflow, being performed under pressure gradients present in everyday life. This is why it is considered more suitable for the study of functional epiphora. Furthermore, quantitative lacrimal scintigraphy (with time-activity curves) enables the accurate measurement of lacrimal clearance from the conjunctival fornices and may be used to study the physiology of the lacrimal "pump." Data obtained from the scintigraphic study of lacrimal outflow may be used to design more effective procedures in the management of functional and nonfunctional epiphora. This is a review article, based on a literature search with emphasis on recent publications and on those supporting interdisciplinary cooperation between ophthalmology and nuclear medicine.
  16 6,326 729
Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnostic Evaluation of Carcinoma Urinary Bladder: Comparison with Computed Tomography
Dhritiman Chakraborty, Bhagwant Rai Mittal, Raghava Kashyap, Utham Kumar Mete, Vikram Narang, Ashim Das, Anish Bhattacharya, Niranjan Khandelwal, Arup K Mandal
January-April 2014, 13(1):34-39
DOI:10.4103/1450-1147.138572  PMID:25191110
Bladder carcinoma is the most frequent tumor of the urinary tract and accounts 7% of all malignancies in men and 2% of all malignancies in women. This retrospective study was carried out to assess the diagnostic utility of F18-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the imaging evaluation of bladder carcinoma. Seventy-seven consecutive patients diagnosed to have carcinoma urinary bladder referred for F18-FDG PET/CT were included in this study. Thirty-four patients were for initial staging after transurethral biopsy and remaining 43 patients were for restaging. All patients also underwent CT scan of the abdomen and pelvis. PET/CT findings were correlated with diagnostic CT scan and histopathological findings. In 30 of the 34 patients for initial staging, both PET/CT and CT confirmed the primary lesion in the bladder. Histopathology report was available in 23 patients. Lymph nodes FDG uptake reported to be metastatic in 10/23 patients while CT detected lymph node metastasis in 12 patients. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy have been calculated to be 87.5%, 80%, 70%, 92%, 82% for PET/CT and 66%, 57%, 50%, 72%, 60% for CT respectively. PET/CT detected metastatic disease in 8 patients whereas CT detected in 4 patients. Of the 43 patients for restaging, local recurrence was detected in 24 patients on both PET/CT and CT. Histopathology report was available in 17 patients. Sensitivity, specificity, PPV, NPV and accuracy were 85%, 60%, 60%, 85%, 70% for PET/CT and 80%, 50%, 40%, 85%, 58% for CT respectively. Nineteen patients were detected to have metastatic disease by PET/CT, whereas CT detected metastases in 11 patients. F-18 FDG PET/CT is a very useful modality in pre-operative staging and monitoring after surgery, chemotherapy or radiotherapy of patients with carcinoma urinary bladder.
  11 3,044 379
Radioactive Body Burden Measurements in 131 Iodine Therapy for Differentiated Thyroid Cancer: Effect of Recombinant Thyroid Stimulating Hormone in Whole Body 131 Iodine Clearance
Ramamoorthy Ravichandran, Amal Al Saadi, Naima Al Balushi
January-April 2014, 13(1):56-61
DOI:10.4103/1450-1147.138576  PMID:25191114
Protocols in the management of differentiated thyroid cancer, recommend adequate thyroid stimulating hormone (TSH) stimulation for radioactive 131 I administrations, both for imaging and subsequent ablations. Commonly followed method is to achieve this by endogenous TSH stimulation by withdrawal of thyroxine. Numerous studies worldwide have reported comparable results with recombinant human thyroid stimulating hormone (rhTSH) intervention as conventional thyroxine hormone withdrawal. Radiation safety applications call for the need to understand radioactive 131 I (RA 131 I) clearance pattern to estimate whole body doses when this new methodology is used in our institution. A study of radiation body burden estimation was undertaken in two groups of patients treated with RA 131 I; (a) one group of patients having thyroxine medication suspended for 5 weeks prior to therapy and (b) in the other group retaining thyroxine support with two rhTSH injections prior to therapy with RA 131 I. Sequential exposure rates at 1 m in the air were measured in these patients using a digital auto-ranging beta gamma survey instrument calibrated for measurement of exposure rates. The mean measured exposure rates at 1 m in μSv/h immediately after administration and at 24 h intervals until 3 days are used for calculating of effective ½ time of clearance of administered activity in both groups of patients, 81 patients in conventionally treated group (stop thyroxine) and 22 patients with rhTSH administration. The 131 I activities ranged from 2.6 to 7.9 GBq. The mean administered 131 I activities were 4.24 ± 0.95 GBq (n = 81) in "stop hormone" group and 5.11 ± 1.40 GBq (n = 22) in rhTSH group. The fall of radioactive body burden showed two clearance patterns within observed 72 h. Calculated T½eff values were 16.45 h (stop hormone group) 12.35 h (rhTSH group) for elapsed period of 48 h. Beyond 48 h post administration, clearance of RA 131 I takes place with T½eff > 20 h in both groups. Neck and stomach exposure rate measurements showed reduced uptakes in the neck for rhTSH patients compared with "stop thyroxine" group and results are comparable with other studies. Whole body clearance is faster for patients with rhTSH injection, resulting in less whole body absorbed doses, and dose to blood. These patients clear circulatory radioactivity faster, enabling them to be discharged sooner, thus reduce costs of the hospitalization. Reduction in background whole body count rate may improve the residual thyroid images in whole body scan. rhTSH provides TSH stimulation without withdrawal of thyroid hormone and hence can help patients to take up therapy without hormone deficient problems in the withdrawn period prior to RA 131 I therapy. This also will help in reducing the restriction time periods for patients to mix up with the general population and children.
  6 3,308 445
Persistent High Grade Flurodeoxyglucose Uptake in Lipomatous Hypertrophy of the Interatrial Septum on Dual Time Point Imaging and with Ambient Warming
KK Kamaleshwaran, N Sudhakar, DK Shibu, E R R Kurup, Ajit Shinto
January-April 2014, 13(1):62-63
DOI:10.4103/1450-1147.138577  PMID:25191115
Lipomatous hypertrophy of the interatrial septum (LHIS) is a relatively uncommon disorder of the heart characterized by benign fatty infiltration of the interatrial septum that usually spares the fossa ovalis. LHIS showing flurodeoxyglucose uptake has been reported, and is presumed to be due to activated brown adipose tissue (BAT). We here report a case of a patient who had isolated mediastinal uptake in interatrial septum, mimicking metastasis. Rescanning with external warming to deactivate BAT and a delayed time point image was done, which showed persistent and progressively increasing metabolic uptake respectively, suggesting that LHIS uptake might be unrelated to activated BAT or inflammation.
  2 2,624 276
Development of 166 Holmium-1,2 Propylene Di-amino Tetra (Methy1enephosphonicacid) as a Possible Bone Palliation Agent
Samaneh Zolghadri, Amir Reza Jalilian, Hassan Yousefnia, Ali Bahrami-Samani, Mohammad Ghannadi-Maragheh
January-April 2014, 13(1):28-33
DOI:10.4103/1450-1147.138571  PMID:25191109
  2 2,640 234
Enhanced Accumulation of Bone Seekers at Superior Lateral Orbital Margin: Potential Origin
Cyprian Swietaszczyk, Stanisław E Pilecki
January-April 2014, 13(1):3-5
DOI:10.4103/1450-1147.138567  PMID:25191105
Enhanced accumulation of the radiotracer at superior lateral orbital margin is a common finding in bone scintigraphy. Its possible sources are discussed and illustrated with examples from own archive of the authors as well as from the literature. These sources include: Physiologically enhanced bone metabolism at frontozygomatic suture (normal variant), a metastasis at this suture (illustrated with an example of solitary metastasis from prostate cancer), lesions to the zygomatic bone or the greater wing of the sphenoid bone, deepened fossa for lacrimal gland and the gland itself.
  2 2,593 300
Current Practice and Recommendation for Presurgical Cardiac Evaluation in Patients Undergoing Noncardiac Surgeries
Subramanyam Padma, P Shanmuga Sundaram
January-April 2014, 13(1):6-15
DOI:10.4103/1450-1147.138568  PMID:25191106
The increasing number of patients with coronary artery disease (CAD) undergoing major noncardiac surgery justifies guidelines concerning preoperative cardiac evaluation. This is compounded by increasing chances for a volatile perioperative period if the underlying cardiac problems are left uncorrected prior to major noncardiac surgeries. Preoperative cardiac evaluation requires the clinician to assess the patient's probability to have CAD, severity and stability of CAD, placing these in perspective regarding the likelihood of a perioperative cardiac complication based on the planned surgical procedure. Coronary events like new onset ischemia, infarction, or revascularization, induce a high-risk period of 6 weeks, and an intermediate-risk period of 3 months before performing noncardiac surgery. This delay is unwarranted in cases where surgery is the mainstay of treatment. The objective of this review is to offer a comprehensive algorithm in the preoperative assessment of patients undergoing noncardiac surgery and highlight the importance of myocardial perfusion imaging in risk stratifying these patients.
  2 7,439 1,259
F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Rare Case of Recurrent Malignant Mixed Mullerian Tumor
Amit Bhoil, Raghava Kashyap, Anish Bhattacharya, Bhagwant Rai Mittal
January-April 2014, 13(1):64-66
DOI:10.4103/1450-1147.138578  PMID:25191116
We report a case of 66-year-old female with previous history of histopathologically proven. Malignant mixed mullerain tumor of the uterus in whom positron emission tomography/computed tomography (CT) done for characterization of soft tissue lesion in pelvis noticed on CT, showed extensive recurrent disease in the pelvis with pulmonary metastases.
  1 2,595 229
Multilocular Disseminated Tarlov Cysts: Importance of Imaging
Subramanyam Padma, P Shanmuga Sundaram
January-April 2014, 13(1):67-70
DOI:10.4103/1450-1147.138579  PMID:25191117
  1 2,876 347
Comparative Study of Radionuclide Uptake Levels between Primary and Metastatic Bone Tumors
Yigbedeck Yolande Ebele Huguette, Kyere Augustine Kwame, Wilson Isaac Kojo, Hasford Francis, Sosu Edem Kwabla, Ankrah Alfred Otoe
January-April 2014, 13(1):50-55
DOI:10.4103/1450-1147.138575  PMID:25191113
Study on 95 patients to compare radionuclide uptake levels in patients undergoing bone scintigraphy at a Nuclear Medicine Unit has been performed quantitatively using Image J software. Patients were administered with activity ranging from 0.555 to 1.110 MBq depending on their body weight, and their whole-body bone scans obtained with an installed e.cam single-photon emission computed tomography system. Matrix size of 256 × 1024 was used in acquiring the scintigrams. Quantitative analyses performed with installed Image J software revealed higher radionuclide uptake levels in metastatic tumors compared with primary tumors for all selected skeletal parts. Average normalized count of activity in metastatic tumors was 37.117 ± 27.740 cts/mm 2 /MBq and its corresponding uptake in primary tumors was 23.035 ± 19.542 cts/mm 2 /MBq. The relative higher uptake in metastatic tumors over primary tumors could be attributed to higher osteoblastic activity and blood flow in metastatic tumors.
  1 2,638 286
To be "Padhied": A Neologism to Show the Pathos of Prof. Ajit Padhy for Nuclear Medicine
Savvas Frangos
January-April 2014, 13(1):1-2
DOI:10.4103/1450-1147.138566  PMID:25191104
  - 2,648 232
2011 Big Thai Floods: Problems in Nuclear Medicine
Beuy Joob, Viroj Wiwanitkit
January-April 2014, 13(1):71-71
DOI:10.4103/1450-1147.138580  PMID:25191118
  - 1,737 184
Select the Optimized Effective Dose to Reduce Nuclear Radiations in Pediatric Nuclear Medicine
Ying Bai, Dali Wang
January-April 2014, 13(1):40-45
DOI:10.4103/1450-1147.138573  PMID:25191111
Many techniques and research models on calculating and reducing the nuclear radiation dose on pediatric nuclear medicine procedure have been developed and reported in recent years. However, most those models either utilized simple shapes to present the organs or used more realistic models to estimate the nuclear dose applied on pediatric patients. The former are too simple to provide accurate estimation results, and the latter are too complicated to intensively involve complex calculations. In this study, a simple but practical model is developed to enable physicians to easily and quickly calculate and select the average optimal effective nuclear dose for the given age and body-size of the pediatric patients. This model is built based on one research result reported by Frederic Fahey, et al and it can be easily implemented in most common pediatric nuclear medicine procedures. This is the first research of using fuzzy inference system to calculate the optimal effective dose applied in the nuclear medicine for pediatric patients.
  - 2,587 320
The Role of Octreotate Scan in Discrimination of Solitary Pulmonary Nodule
Fariba Rezaeetalab, Kamran Aryana, Davood Attaran, Reza Bagheri, Farshid Nattagh, Shahrzad Mohamadzadeh Lari
January-April 2014, 13(1):46-49
DOI:10.4103/1450-1147.138574  PMID:25191112
Solitary pulmonary nodule (SPN) is one of the most controversial clinical findings in patients. The aim of this study is to use 99m Tc-ethylenediamine diacetic acid/hydrazine nicotinamide (HYNIC)-TATE scan technique to evaluate nodules. From 2008 to 2010, 21 patients with SPN underwent 99m Tc-HYNIC-TATE scan after the initial assessment with high-resolution computed tomography and then accurate histopathologic diagnosis was established by trans-thoracic needle biopsy, Video Assisted Thoracic Surgery and thoracotomy. After demographic evaluations, specificity and sensitivity of this method was studied. A total of 21 patients were included in our study, of which 12 patients were male and 9 were female. Their mean age was 45 ± 14.3 years. About 43% of the patients were symptom-free and in patients with pulmonary complaints, the most prevalent symptom was cough. Final histopathology tests and clinical follow-up proved that 14 cases (67%) were benign and 7 (33%) were malignant. The diagnostic technique used in our study had no false negative and there were only 3 cases of false positive. Sensitivity and specificity of this method are 100% and 79%, respectively and the diagnostic accuracy is 86%. 99m Tc-HYNIC-TATE scan can be helpful in evaluating patients with SPN and to reach a sensible decision on the method of treatment.
  - 2,845 328
Preparation and evaluation of Lu-177 phytate Complex for Radiosynovectomy
Hassan Yousefnia, Amir Reza Jalilian, Samaneh Zolghadri
January-April 2014, 13(1):22-27
  - 3,329 329