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EDITORIAL:
Birth of the Pakistan Journal of Nuclear Medicine
Qaisar Hussain Siraj
Pak J Nucl Med, 2011;1(1):1-3
REVIEW ARTICLE:
A review of the current status of radionuclide bone scanning
Ali Nawaz Khan
Pak J Nucl Med, 2011;1(1):4-32
Radionuclide bone scanning (RNBS) using technetium-99m-labelled diphosphonates (MDP) is a frequently performed technique in nuclear medicine. It is widely regarded as the most cost-effective and widely available whole-body screening test for the assessment of bone metastases and other focal bone lesions. The technique is often combined with conventional radiography to improve the diagnostic accuracy.
Recently, this role has been challenged by newer imaging modalities such as CT, MRI and PET-CT. These techniques have limited worldwide availability, are expensive and have their own limitations but can complement RNBS. For example, CT scanning is useful in guiding needle biopsy, particularly in vertebral lesions. MRI is helpful in determining the extent of local disease in planning surgery or radiation therapy.
RNBS, although non-specific, has an excellent sensitivity, which makes it a useful tool for characterizing some conditions that are not clearly depicted on anatomic images. Bone metastases generally appear as multiple 'hot' lesions, although occasionallythey may be 'cold'.
ORIGINAL ARTICLE:
Correlation between visual interpretation and quantification of 123I-ioflupane SPECT imaging
A Nafati, John R Buscombe
Pak J Nucl Med, 2011;1(1):33-41
Aims: 123I-ioflupane (DaTSCAN™) is used for the differentiation of Parkinson's Syndrome (PS) from parkinsonism without nigrostriatal degeneration in patients with symptoms suggestive of PS. However, there remains some controversy as to the best method to report the resulting images and therefore the aim of this study was to retrospectively compare the visual assessment of 123I-ioflupane with Specific Binding Indices (SBIs) as calculated using quantitative analysis to see if there was a good correlation between what was reported visually and the objective measurements of uptake measured by SBIs.
Methods: The study reviewed the images thirty-one patients with parkinsonism (19 males, mean age 55.3±15 years). Three nuclear medicine consultants visually rated the images, grade 0 for normal to grade 3 for severe abnormality, according to the classification reported by Catafau et al. SBIs were calculated for the striatum and striatal subregions (head of caudate and putamen) quantitatively from two summed consecutive transaxial slices with the most intense striatal binding.
Results: 11 patients (35%) were reported as normal. Of the abnormal scans 3 (15%) were reported as grade 1, 14 (70%) as grade 2 and 3 (15%) as grade 3. The mean nigrostriatal SBI was 3.20±0.91 in the visually assessed normal scans, and reduced to 1.97 ± 0.79 in grade 1, 1.47±0.51 in grade 2 and 0.51±0.27 in grade 3 scans with a similar decrease in all nigrostriatal subregions. The visual assessment grades showed a highly significant negative correlation with SBIs from both the striatum and subregions (mean Spearman’s correlation coefficient -0.815, P < 0.0001).
Conclusion: There is a highly significant correlation between semi-quantitative 123I-ioflupane image analysis and visual assessment of the severity of PS.
ORIGINAL ARTICLE:
A clinical and angiographic correlation of myocardial perfusion scintigraphy in the assessment of isolated apical/peri-apical reversible perfusion defects
Iulia Heinle, Andre Conradie, Frank Heinle
Pak J Nucl Med, 2011;1(1):42-48
Aims: A retrospective study was conducted to correlate the results of myocardial perfusion G-SPECT with clinical evaluation and coronary angiography in the assessment of isolated apical and/or peri-apical reversible perfusion defects.
Methods: Coronary angiography was performed in 14 patients (eight males, six females) with isolated apical and/or peri-apical reversible perfusion defects documented on stress myocardial perfusion scintigraphy.
Results: Of the eight male patients, seven had > 70% LAD stenosis and one patient had 30% LAD stenosis seen on coronary angiography. Only two of the six female patients (33.3%) had a positive angiogram. In all of the positive angiograms, including those with single, double or triple-vessel disease, the most significant lesion was seen in the LAD artery. Where in addition to the apex, the inferoapical or apicolateral segments were also affected, the culprit stenosis was seen to involve the LAD artery with either normal angiographic appearance or associated less severe stenosis of the right coronary or left circumflex arteries. There was a good correlation between the angiographic and G-SPECT determination of the left ventricular systolic function.
Conclusions: Caution should be exercised in the interpretation of isolated apical and/or peri-apical mild reversible perfusion defects in women without stress-induced symptoms and ECG changes, as there is a higher incidence of false-positive MPS studies in this group of patients. In patients with reversible perfusion defects affecting the apex and/or the periapical segments, the most significant stenosis revealed on coronary angiography was found in the LAD artery, independent of the number of diseased coronary arteries.
ORIGINAL ARTICLE:
The incidence of hyperprolactinaemia and associated hypothyroidism: local experience from Lahore
Affia Tasneem, Ismat Fatima, Adeela Ali, Nasir Mehmood, Muhammad Khaqan Amin
Pak J Nucl Med, 2011;1(1):49-55
Aims: The aim of the study was to determine the incidence of hyperprolactinaemia, document the underlying causes and consequences of hyperprolactinaemia, and to investigate the correlation between hyperprolactinaemia and hypothyroidism in a group of patients referred for hormonal profile assessment from local hospitals and clinics.
Methods: This study includes 1365 subjects (46 males, 1319 females) referred to the Centre for Nuclear Medicine in Lahore, for hormonal estimation to investigate the possibility of an underlying hormonal disorder based on clinical grounds. Serum Prolactin and thyroid stimulating hormone levels were measured using IRMA kits.
Results: In our study population, the incidence of hyperprolactinaemia was estimated at 4.90 percent. Menstrual irregularity appeared to be the major consequence in females.In male subjects, the major complaints observed were infertility and azoospermia. The incidence rate was the highest in the age range of 22-27 years. Hypothyroidism in hyperprolactinaemic subjects was observed to be 22.7%.
Conclusion: The incidence of hypothyroidism in hyperprolactinaemic subjects in our study population was found to be signficantly high. Based on the results of our study, we would recommend thyroid hormone estimation in all patients with abnromal serum prolactin.
CASE REPORT:
Anterior neck lipoma mimicking a massive goitre
Durr-e-Sabih, Muhammad Kashif Rahim, Ayan Sabih
Pak J Nucl Med, 2011;1(1):56-62
Anterior neck is an uncommon location for lipomas but when present these can be mistaken for thyroid masses. The few reported cases have usually described small lesions mimicking a thyroid nodule. We report here a case of a lipoma mimicking a huge goitre. Imaging of the mass was performed through thyroid scintigraphy, ultrasound and computed tomography, which together provided a clue to the diagnosis. On surgery, a large subcutaneous mass was removed from the anterior triangle of the neck, which was seen to consist of mature adipose tissue onhistopathological examination. Large lipomas in the neck can mimic a goitre but this can be easily diagnosed using imaging, particularly with ultrasound, which is the best imaging modality in this situation.
CASE REPORT:
Apical hypertrophic cardiomyopathy: Is it a conundrum for Gated SPECT MPI?
Maseeh uz Zaman, Nosheen Fatima, Inam Danish, A Samad, M Ishaq, Asif Wali, Kawish Rehman, Javeria Bano
Pak J Nucl Med, 2011;1(1):63-69
Apical hypertrophic cardiomyopathy, AHCM, is common in Japanese and Chinese populations but uncommon in western population and in IndoPak subcontinent. AHCM patients tend to have milder symptoms; however, in up to one-third cases, myocardial infarction, left ventricular aneurysm formation, atrial and ventricular arrhythmias and strokes may develop. Echocardiography and cardiac MRI are the good modalities for diagnosis. Gated SPECT myocardial perfusion imaging is a good alternative for diagnosis due to well defined scan patterns in AHC. A case of AHCM is presented and the subject is briefly reviewed.
CASE REPORT:
Liver uptake of 99mTc-MDP in metastatic breast carcinoma
Muhammad Asif Rafique, Saif ul Haque, Shazia Fatima, Javaid Irfan
Pak J Nucl Med, 2011;1(1):70-73
The radionuclide bone scan is a sensitive modality for the detection of skeletal metastases. On occasion, there is incidental detection of soft-tissue lesions, both benign and malignant. We report a case of breast carcinoma with liver metastases where the bone scan showed increased uptake of 99mTc-MDP in the liver. Abdominal ultrasound performed soon after the bone scan revealed metastases in both lobes of liver from breast carcinoma. The intense non-homogenous liver uptake on bone scan using 99mTc-MDP during evaluation of skeletal metastases indicated the presence of liver metastases.
IMAGING GAMUT:
Detection of ectopic gastric mucosa in an intestinal duplication on a Meckel's scan
M Ejaz Khan, Raheela Mahmood, Shahid Kamal, Hassan Raza, Shaheen Zareen, Hashim Zaidi
Pak J Nucl Med, 2011;1(1):74-77
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IMAGING GAMUT:
Detection of systemic pulmonary venous right-to-left shunt on a VQ Lung Scan
Kottekkattu K Balan, Qaisar H Siraj
Pak J Nucl Med, 2011;1(1):70-80
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IMAGING GAMUT:
Ventilation-Perfusion Scanning before and after surgery in a patient with a carcinoid tumour
Kottekkattu K Balan, L Sonada, Qaisar H Siraj
Pak J Nucl Med, 2011;1(1):81-84
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IMAGING GAMUT:
Utility of ventilation-perfusion scintigraphy in Swyer-James syndrome
Sharjeel Usmani, Haider Ali Khan, Fahad Marafi
Pak J Nucl Med, 2011;1(1):85-87
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IMAGING GAMUT:
Diagnosis of the Cause of Knee Pain in a Patient with a Normal MRI
Anthony D'Sa, Ben Corocan, Mazin Al-Janabi
Pak J Nucl Med, 2011;1(1):88-89
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IMAGING GAMUT:
False-positive mediastinal parathyroid adenoma on 99mTc-MIBI scanning in a patient with parathyroid carcinoma
Kashif Niyaz, Akhtar Ahmed, Javed Mehboob, Waqar Hussain,Maseeh uz Zaman, Abid Hameed
Pak J Nucl Med, 2011;1(1):90-92
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IMAGING GAMUT:
Scintigraphic presentation of the "cobra head sign" in ureterocoele
Saima Riaz, Musab Riaz, Muhammad Yousaf Chaudhry
Pak J Nucl Med, 2011;1(1):93-95
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IMAGING GAMUT:
A novel case of orthostatic myocardial ischaemia
Qaisar Hussain Siraj
Pak J Nucl Med, 2011;1(1):96-99
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