Human ; Radionuclide Imaging ; Nuclear Medicine

Congenital cystic adenomatoid malformation is a rare bronchopulmonary malformation resulting from an arrest in lung development between 4th and 7th week of fetal life. It typically presents as respiratory distress in the neonatal period and recurrent pulmonary infections in adults; and is sometimes associated with other congenital abnormalities [especially CCAM Type II]. Chest roentgenograms and CT scan are the usual modalities of choice in its initial evaluation and histopathology done post-operatively establishes the diagnosis. Ventilation-Perfusion [VQ] scintigraphy is of paramount importance in the routine assessment of CCAM patients but is often disregarded. This paper presents the incremental value of doing a lung perfusion scintigraphy and aims to emphasize the significance of performing a VQ scan in such cases.
Human ; Female ; Adult ; RADIONUCLIDE IMAGING ; SCINTIGRAPHY ; DIAGNOSTIC IMAGING ; CYSTIC ADENOMATOID MALFORMATION OF LUNG, CONGENITAL ; CONGENITAL CYSTIC ADENOMATOID MALFORMATION OF LUNG ; LUNG DISEASES ; TOMOGRAPHY SCANNERS, X-RAY COMPUTED

The study aims to determine the relationship of body mass index (BMI) and related anthropometric measurements on the image quality of Tl-201 and Tc-99m sestamibi myocardial perfusion scans (MPS). A total of 163 scans were analyzed. A blinded experienced physician performed visual analysis on the scans image quality on two different occasions. Quantitative parameter used was the heart-to-lung ratio (HLR). Regression analysis was done to determine the association of HLR with BMI and myocardial tracer uptake, ROC curves were generated to establish BMI and HLR cut-off points. Increasing BMI was associated with visually poorer images in the Tl-201 MPS group (p 0.003) but not for the Tc-99m MPS group (p 0.065). It was also associated with decrease HLR and myocardial tracer upatake for both tracers (p <0.001). ROC curves revealed BMI cut-off points of 28 (Tl-201 p 0.000; Tc99m sestamibi p 0.004) for both procedures; HR cut-off values of 3.0 for Tl-201 )p 0.295) and 2.5 for Tc-99m sestamibi (p 0.875). the image quality of Tl-201 scans begins to deteriorate at a BMI of 28 and HLR of 3.0 with myocardial count density reduction (less than or equal to 6000 counts) translating to visually poorer images. On the other hand , image quality of Tc-99m sestamibi scans also tend to deteriorate similarly at a BMI of 28. However, in contrast to Tl-201, the lower HLR cut-off of 2.5 suggests a relatively higher myocardial count density (greater than or equal to 9000 counts) rendering the image quality to be still satisfactory for subjective assessment.
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; MYOCARDIAL PERFUSION IMAGING ; MYOCARDIAL SCINTIGRAPHY ; DIAGNOSIS ; DIAGNOSTIC TECHNIQUES AND PROCEDURES ; DIAGNOSTIC IMAGING ; CARDIAC IMAGING TECHNIQUES ; BODY MASS INDEX

The aim of this study is to determine the diagnostic accuracy of antithyroglobulin antibodies in predicting recurrent differentiated thyroid carcinoma. We searched PubMed (1990-2010) and Google Scholar (1990-2010). Citation searches, manual searches and screening of references of f included studies were done. Diagnostic studies that utilized antithyroglobulin antibodies as a predictor of recurrent differentiated thyroid carcinoma. The authors searched citations that correlated with the criteria using a data collection form generated in Review Manager 5 (REVMAN 5). The methodological quality was then assessed using Quality Assessment of Studies of Diagnostic Accuracy (QUADAS). Hierarchical summary receiver operating characteristic (HSROC) mete-analytical tool was used to estimate summary receiver operating characteristic (ROC) curves. Eight studies with 2116 participants with 182 patients with recurrent differentiated thyroid carcinoma were included. Pooled sensitivity and specifically were 63% and 79% respectively. SROC shows an overall are under the curve (AUC) of 0.712. Antithyroglobulin antibody has ability to predict recurrent differentiated thyroid carcinoma.
THYROID NEOPLASMS ; NEOPLASMS ; NEOPLASMS BY SITE ; ENDOCRINE GLAND NEOPLASMS

This paper presents a clinical situation in which a Technetium 99m sestamibi myocardial perfusion scintigraphy (MPS) with dipyridamole was used as part of the preoperative evaluation in a 15 year old female with Tetralogy of Fallot. MPS revealed no evident inducible myocardial ischemia, depressed LV wall function and RVH but with good RV function. There are many different techniques for imaging and studying patients with Tetralogy of Fallot (TOF). Echocardiography, ventriculography and invasive angiography remain the mainstay in its evaluation. However, the presence of coronary anomalies in these patients is very common and has negative effect on myocardial perfusion, either preoperatively or postoperatively. Hence, MPS plays an essential role in providing complete assessment in this group of patients.

Human ; Female ; Adolescent ; Angiography ; Cerebral Ventriculography ; Dipyridamole ; Echocardiography ; Heart Defects, Congenital ; Myocardial Ischemia ; Perfusion Imaging ; Technetium Tc 99m Sestamibi ; Tetralogy Of Fallot ; Tomography, X-ray Computed ; ; ; ;

Congenital lobar emphysema (CLE) is a life-threatening but potentially reversible lung abnormality of unknown etiology that can present a diagnostic dilemma. Imaging procedures are helpful for early diagnosis. This paper aims to present the scintigraphic features of CLE in a two-year-old male in correlation with other diagnostic modalities. Lung perfusion scintigraphy revealed globally diminished perfusion to the left lung. High Resolution Computed Tomography (HRCT) of the chest showed intrinsic narrowing of the distal left mainstem bronchus. CT scan of the Pulmonary Arteries (CTPA) showed a small left main pulmonary artery. Lung perfusion scintigraphy in CLE is characterized by markedly attenuated vascularity of the involved lobe with consequent decreased perfusion, and increased to normal perfusion in the unaffected lobe. It plays a vital role in the early diagnosis and management of pediatric pulmonary diseases presenting with a diagnostic dilemma, particularly in cases where it can preclude more invasive diagnostic procedures.

Human ; Male ; Child Preschool ; Bronchi ; Child ; Early Diagnosis ; Lung ; Perfusion Imaging ; Pulmonary Artery ; Pulmonary Emphysema ; Tomography, X-ray Computed

Paget's disease, also known as osteitis deformans, is characterized by rapid bone remodeling and the formation of bone that is structurally abnormal. Men are affected twice as often as women. The disease is uncommon in persons of African and Asian descent. The majority of patients with Paget's disease are usually asymptomatic, although the most frequent symptom is pain. This paper aims to present a rare case of Paget's disease in a local setting and to present the scintigraphic features of Paget's disease in correlation with other diagnostic modalities. This is a case of a 69-year-old female with a history of low back pain and difficulty in walking of one month duration. CT scan showed sclerotic changes in the right pelvic bone probably degenerative or infectious in nature, however, neoplastic process is not totally ruled out. Bone scan showed an osteoblastic lesion in the right hemipelvis. Considerations include Paget's disease and metastasis (in the presence of a primary neoplastic lesion). The alkaline phosphatase was elevated. An open bone biopsy of the right pelvis was done. Histopathologic report showed prominent cement lines with numerous large osteoclasts. This was signed-out as Paget's disease of the bone. Paget's disease is rare in the Philippines. Our case illustrated a common clinical feature of the disease seen in an elderly patient presenting with bone pain, elevated alkaline phosphatase value, and associated with cortical thickening and sclerosis of the right pelvis on radiolograph and osteoblastic lesion on bone scan.

Human ; Male ; Female ; Aged ; Alkaline Phosphatase ; Biopsy ; Bone Remodeling ; Low Back Pain ; Osteitis Deformans ; Osteoclasts ; Pelvic Bones ; Pelvis ; Philippines ; Sclerosis ; Tomography, X-ray Computed ; Walking

BACKGROUND: Blunting of coronary flow reserve (CFR) may precede overt ischemia. The study aimed to correlate CFR with perfusion findings and risk factors for coronary artery disease (CAD).
METHODS: Fifty-four consecutive patients underwent dipyridamole-rest technetium-99m sestamibi single photon emission computed tomography (SPECT) on two separate days. CFR was computed as the quotient of myocardial blood flow (MBF= global tissue perfusion divided by arterial input function) at stress and at rest.
RESULTS: CFR was significantly lower in patients with abnormal perfusion vs normals (p=0.005). Reduced CFR was noted in 83% of patients with normal SPECT. Lower CFR was seen in hypertensive patients with left ventricular hypertrophy (LVH) compared to those without LVH (p=0.029); likewise in DM vs no DM (p=0.121). Independent predictors of reduced CFR were age and extent of ischemia.
CONCLUSION: Abnormal perfusion is associated with reduced CFR. In those with normal perfusion, there is a high prevalence of reduced CFR, which may be attributed to the presence of risk factors for CAD and LVH.

Human ; Male ; Female ; Arteries ; Coronary Artery Disease ; Dipyridamole ; Hypertrophy, Left Ventricular ; Risk Factors ; Technetium Tc 99m Sestamibi ; Tomography, Emission-computed, Single-photon

Patients with LV dysfunction are known to have a high risk for future coronary events. This study aimed to determine the incremental prognostic value of perfusion defects in patients with scintigraphic evidence of LV dysfunction. Patients showing either transient ischemic dilatation or Tl-201 lung:heart ratio of >0.5 on exercise or dipyridamole SPECT Tl- 201 myocardial perfusion scan were included in the study. Perfusion defects were scored semiquantitatively using a 17 -segment, 5-point scale (0 = normal, 4 = absent uptake). The extent and severity of defects were quantified using number of abnormal segments (NAS) and the summed stress score (SSS). Defect reversibility was quantified using the summed difference score (SDS) between stress and rest defects. Patients were followed up for the development of coronary events over a period of 12 - 30 months. There were 6 cardiac deaths and 7 myocardial infarctions in the 65 patients included in the study (20% overall event rate). ROC curve analysis of the scores revealed the following suggested cut-off values for predicting cardiac event: NAS ~ 7 (85% sensitivity, 56% specificity), SSS ~ 19 (77% sensitivity, 67% specificity) and SDS ~ 7 (31 % sensitivity, 60% specificity). ,Event rate was significantly higher above the cut-off value in SSS «19 = 9%, >19 = 32%,p = 0.04). With NAS, the event rate was higher above the cut-off value, with the difference approaching significance (NAS 7 = 26%, P = 0.06). There was no statistically significant difference in the event rate with high or low SDS (SDS 7 = 16%, P = 0.32). The odds ratios for NAS and SSS (5.8,4.9, respectively) were higher compared with SDS (0.56). The extent and severity of stress perfusion defects provided incremental prognostic information in patients with LV dysfunction. Our data suggest that the degree of defect reversibility showed no prognostic value in this subset of patients.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Dilatation ; Dipyridamole ; Myocardial Infarction ; Tomography, Emission-computed, Single-photon ; Myocardial Perfusion Imaging ; Thallium ; Radionuclide Imaging ; Diagnosis ; Cardiac Imaging Techniques

Left ventricular mass (LV mass) is an independent prognostic indicator of cardiovascular complications, and its regression due to therapy translates to positive clinical outcomes. Good correlation of LV mass between qualitative ECG-gated SPECT (OGS) and echocardiography has been reported, and this study aims to verify if such relationship applies in the local setting. Forty-five consecutive patients with normal myocardial perfusion SPECT and recent plain echocardiograms done in the same institution were retrospectively analyzed. Results show a significant correlation (y = 0.296x + 75.962, r = 0.491, p = 0.001) between the LV mass of the two imaging modalities, which was also observed in the TI-201  group (y= 0.256x + 80.325, r_=_0.442, p = 0.006), but not in the Tc-99m sestamibi group (y= 0.402x + 63.456, r_=_0.443, p = 0.272). The mean LV mass by OGS (122.0 ± 26.9) is significantly smaller compared with the mean LV mass by echo cardiography (155.5 ± 44.6), and the difference between the two procedures (mean ± SD: 39.7 ± 32.6, p<0.001) are significantly different among all subiects, and in the TI-201 and Tc-99m sestamibi groups. In conclusion, the LV mass generated by OGS correlates with echocardiographic estimations, but are statistically different, with OGS significantly underestimating the echo cardiographic values. Age, sex and BMI do not influence the LV mass discrepancy between the two imaging modalities, but the presence of soft tissue attenuation artifacts tend to decrease the LV mass generated by OGS, contributing to further LV mass disparity.

Human ; Male ; Female ; Aged ; Middle Aged ; Artifacts ; Body Mass Index ; Echocardiography ; Electrocardiography ; Heart Diseases ; Retrospective Studies ; Technetium Tc 99m Sestamibi ; Tomography, Emission-computed, Single-photon