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EDITORIAL:
Whither Nuclear Medicine Training in Pakistan?
Durr-e-Sabih
Pak J Nucl Med, 2016;6(1):1-2.
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REVIEW ARTICLE:
Estimation of time for release of patients after the administration of I-131 to thyrotoxicosis patients
Muhammad Akhtar, Jawad Akhtar Hussain, Akbar Ali, Sheraz Akhtar
Pak J Nucl Med, 2016;6(1):3-10
Radioactive iodine (I-131) has been used for more than six decades for the treatment of thyrotoxicosis. Radiation safety is of paramount importance in I-131 based treatment of thyroid diseases, as treated patients become a potential radiation hazard for other individuals. The purpose of this article is estimation of the time period for radiation safety restrictions through assessments of total effective dose equivalent (TEDE) in individuals exposed to I-131 for thyrotoxicosis therapy, by incorporating into the calculations, various factors such as relevant socioeconomic conditions.
For performing patient-specific dose calculations, we have used published data of uptake fractions & effective half-lives and triexponential model for total body clearance of iodine-131.
Results obtained showed that the TEDE to other individuals (especially the family members, particularly children) and general public may be much higher than the annual dose limits recommended by the International Atomic Energy Agency (IAEA) and International Commission for Radiation Protection (ICRP) in some situation especially when the administered activity is greater than 15 mCi and occupancy factor greater than 0.125 and proper precautionary measures are not taken after the release from hospital.
It is therefore suggested that a fixed dose limit of 15 mCi (550 MBq) instead of 30 mCi (1100 MBq) be recommended for release of I-131 thyrotoxicosis therapy patients in order to reduce undesired exposure to caregivers and general public in countries like Pakistan because of factors such as poor socioeconomic conditions and low literacy rates, etc.
ORIGINAL ARTICLE:
Lactate dehydrogenase (LDH) as predictive factor of the pain free syndrome duration after radionuclide treatment of bone metastases in patients with breast cancer
Nigora Rasulova, Dauranbek Arybzhanov, Vladimir Lyubshin, Abdulla Abdikhakimov, Shamsutdin Sagdullaev,Sherzod Nishonov, Gayrat Arifhodjaev,Yuliya Shakirova, Valery Krylov, Marat Khodjibekov
Pak J Nucl Med, 2016;6(1):11-18
Aims: The purpose of this study was to investigate a possible role of serum LDH as a predictor of cancer cell activity and to determine if serum LDH levels can prognosticate the duration of pain-free period after radionuclide therapy.
Methods: The We selected 62 breast cancer patients with ages ranging from 29-67 years (mean age 53.2 ± 9.5 years) who had a successful response to radionuclide therapy with 153Sm-oxabifore and had their serum LDH levels determined prior to the therapy. Patients with a history of a benign disease, which could possibly influence the serum LDH levels, or those suffering from complications such as a vertebral fracture or impending cord compression, were excluded from the study. 153Sm-oxabifore was administrated in a standard dose of 37 MBq per kg body weight. All patients were on bisphosphonate therapy, both before and after samarium-153 treatment. Group 1 comprised of 23 patients who had received combined 153Sm-oxabifore and zoledronic acid therapy. Group 2 comprised of 39 patients who had additionally received therapy for their primary tumour. For each of these two groups, the correlation between serum LDH levels and duration of the pain-free syndrome was estimated.
Results: There was a strong negative correlation (r = -0.84) between the serum LDH levels and the duration of pain-free period in Group 1, but no significant correlation (r = 0.1) was seen between the LDH levels and the duration of pain-free period in Group 2. The duration of pain-free period in the second group was longer in comparison to the first group and was statistically significant (p < 0.0001).
Conclusion: Serum LDH level can prognosticate the duration of the pain-free period after radionuclide therapy and could be useful in selecting patients who in addition to samarium-153 therapy may additionally benefit from treatment of the primary tumour.
ORIGINAL ARTICLE:
Assessment of renal parenchymal damage by DMSA after PCNL procedure in children using adult-sized equipment
Mohammad Sohaib, Manoj U Shenoy, Michael J Kellett, Patrick G Duffy, Isky Gordon
Pak J Nucl Med, 2016;6(1):19-24
Aims: Percutaneous nephrolithotomy (PCNL) is an established technique for the management of renal calculi. The recent advances in this procedure in children include miniaturizing the endoscopic instruments used for renal access. However, there is limited data on the functional effects of PCNL on the renal parenchyma, performed using adult-sized equipment in the paediatric population. This study was therefore aimed to determine the effects of PCNL on the renal parenchyma in children with renal calculi using technetium-99m labelled dimercaptosuccininc acid (99mTc-DMSA)scans.
Methods: Pre and post-surgery DMSA scans of 26 paediatric patients who had undergone PCNL over a five-year period were reviewed. The ages of the patients ranged from 1 year to 12.5 years (median: 3.75 years) at the time of PCNL. The procedures were done with 18 Fr or higher sized Amplatz sheath. DMSA scans was performed from 1 day to 47 months before the PCNL and 2 months to 27 months after the procedure and interpreted by two independent observers. Regions-of-interest around each kidney were drawn to determine differential renal function (DRF) of the kidneys.
Results: Twenty patients (77 %) showed no change or showed improvement in postprocedure scans. Mean ± SD DRF was 44.1 ± 9.7% before and 44.6 ± 10.6% after the procedure (p=0.52, n=21).
Conclusion: We conclude that the PCNL procedure in children undertaken with adultsized equipment may show renal defects in nearly one-fourth of children but there is no significant change in their global renal function.
ORIGINAL ARTICLE:
Vitamin B12 deficiency: prevalence and evaluation of a reversible co-morbidity in hypothyroid patients
Aniqa Jabeen, Sumaira Mushtaq, Hassan Raza, Mohammd Ali Memon
Pak J Nucl Med, 2016;6(1):25-31
Aims: The study aimed at assessing the prevalence and clinical features of vitamin B12 deficiency in hypothyroid patients and to evaluate clinical response to vitamin B12 replacement therapy.
Methods: A total of 204 vitamin B12 deficient patients with primary hypothyroidism who attended the thyroid clinic at the nuclear medicine department of Atomic Energy Medical Centre Karachi, were included in the study. Signs and symptoms, haemoglobin (Hb), mean corpuscular volume (MCV), thyroid function tests and B12 levels were recorded. Patients with low levels of B12 or who had symptoms suggestive of B12 deficiency were given oral vitamin B12 treatment and monitored for improvement.
Results: A total of 204 hypothyroid patients (197 females, 7 males) were evaluated. 92 of 204 patients (45.09%) had low vitamin B12 levels. Depression (p value 0.000082), weakness (p value 0.0018), numbness (p value 0.022), paraesthesia (p value 0.018), and impaired memory (p value 0.027) were statistically significant in B12-deficient hypothyroid patients. B12-deficient patients had increased prevalence of anaemia than the sufficient group (32.6% vs. 22.02%). 92 B12-deficient and 70 B12-sufficient patients with symptoms of B12 deficiency were started on oral vitamin B12 and improvement noted.
Conclusion: There is a high (45%) prevalence of B12 deficiency in hypothyroid patients. Screening of vitamin B12 levels should be undertaken in all hypothyroid patients in the early course of the disease as it is a potentially reversible condition. Weakness, numbness and neuropsychiatric symptoms point towards B12 deficiency. Replacement of B12 leads to improvement in symptoms; however, placebo effect should be taken into consideration.
ORIGINAL ARTICLE:
Validation of Ottawa ankle rule utilizing radionuclide skeletal scintigraphy
Shagufta Zafar Qureshi, Fida Hussain Shah, Mohammad Amin Waqar
Pak J Nucl Med, 2016;6(1):32-41
Aims: Ankle and foot injuries, especially among teenagers and young adults, are frequently encountered by the primary care physicians. Most common ankle injuries are sprains due to inversion injuries to the lateral ankle ligaments. It has been observed that the overall number of ankle radiographs in the ER is around 15-20%, which includes about 30-40% unnecessary radiographs. Ottawa Ankle Rule (OAR) was first established in 1992, to reduce that unnecessary load on x-ray departments. In light of the current universal practice of evidence-based medicine it is important to undertake verification of the subjective OAR. Bone scintigraphy by merit of its high sensitivity was chosen as the imaging modality of choice to validate the accuracy of OAR.
Methods: The study population comprised of 50 OAR-positive cases and 10 normal controls. Each case was scanned using 3-phase bone scintigraphy (TPBS), following a preliminary radiograph.
Results: Out of 50 OAR-positive cases, x-rays showed frank fractures in only 12 cases, whereas bone scan was positive in 45 cases, out of which 43 had active bone lesions, the remaining 2 had a soft-tissue injury. By considering the TPBS bone scan as the gold standard, we found the sensitivity of OAR was 95% and specificity 61.5% with PPV and NPV at 90% and 80% respectively.
Conclusion We conclude that there is a high concordance between the OAR and the bone scan and that the OAR is evidence-based as determined by the successful verification of the OAR by the TPBS in 95% of the cases. Based on our findings we recommend the routine practice of the OAR in all emergency departments. In patients with acute ankle/foot injuries, with a positive OAR, even with a negative x-ray, the injury should not be taken lightly and if required, a bone scan should be performed for confirmation of lesion. Bone scintigraphy rather than plain radiography appears to be the modality of choice in this situation being cost- and time-effective without compromising the quality of medical care.
CASE REPORT:
Radiosynoviorthesis in pigmented villonodular synovitis using Re-188 labelled tin colloid: a case report
Aakif U Khan, Hameedullah, Abdul Saeed Shah, Muhammad Rauf Khattak
Pak J Nucl Med, 2016;6(1):42-47
Radiosynoviorthesis (RSO) is an attractive alternative to surgical synovectomy for controlling symptoms of rheumatoid arthritis and many other chronic proliferative joint diseases. The procedure is not widely used in our country because of the non-availability of suitable radionuclides and radiopharmaceuticals. The production of rhenium-188 (188Re) from 188W/188Re generator and by labelling it with particles of appropriate size, has a promise to offer. We labelled 188Re with tin colloid and analyzed its biodistribution and clinical efficacy after injecting it to a patient with recurrent pigmented villonodular synovitis. Gamma camera imaging performed after 1, 24 and 48 hrs showed no leakage of the radiopharmaceutical from the injected joint. The clinical outcome of this study was also excellent, which suggests that 188Re labelled tin colloid is a potentially effective radiopharmaceutical for recurrent PVNS and can be used for other chronic inflammatory joint diseases.
CASE REPORT:
Unusual spinal metastases from an adenoid cystic carcinoma of the maxillary sinus seen on a bone scan: a case report
O Ait Sahel, I Ghfir, H Guerrouj, Y Benameur, N Benraiss
Pak J Nucl Med, 2016;6(1):48-52
Adenoid cystic carcinoma (ACC), the second most common cancer occurring in the sinonasal tract, is an aggressive malignancy that presents itself insidiously and is generally advanced when diagnosed. Current treatment modalities include surgery and irradiation. Despite advanced successful therapies, these tumours are notoriously associated with locoregional recurrences. This report presents the original case of a patient with adenoid cystic carcinoma of the maxillary sinus with an unusual clinical course and a thoracic vertebral metastases, with spinal cord compression revealed by a bone scan, occurring only nine months after stopping treatment. The aggressive nature of the tumour and the skull base invasion at the time of diagnosis probably explains the rapid onset of this unusual site of metastases.
CASE REPORT:
SPECT/CT imaging of primary mediastinal goitre: case report and literature review
Imad Ghfir, Abdallah Achir, Hasnae Guerrouj, Salah Nabih Oueriagli, Omar Ait Sahel, N Benraïs Aouad
Pak J Nucl Med, 2016;6(1):53-58
Primary mediastinal goitre (PMG) is an ectopic thyroid in a rare location, even more so when associated with an anomaly of the native thyroid gland. It should be considered in the differential diagnosis of all mediastinal masses.
We report the case of a 74-year-old woman presenting primary anterior mediastinal goitre with a toxic multinodular goitrous thyroid gland located in the thyroid bed in the anterior neck. 99mTc pertechnetate scintigraphy (planar and SPECT/CT) confirmed the uptake of the radiotracer in the mediastinal mass, showing the mass to be separate from the cervical thyroid gland, thus confirming an ectopic PMG. A surgical resection of the cervical multinodular goitre and the intrathoracic mass was performed. Histopathology showed a multinodular adenomatous goitre without signs of malignancy. The patient has had an unremarkable postoperative recovery.
99mTc scintigraphy with SPECT-CT imaging seems to be the most important diagnostic tool for the detection of ectopic thyroid tissue and shows the absence or presence of thyroid in its normal location. The technique is not only important for establishing the diagnosis, but crucial in deciding upon the correct therapeutic strategy, including the surgical approach.
CASE REPORT:
SPECT/CT for the accurate localization of 67Ga uptake in mycotic abdominal aortic aneurysm
Nada Almenieir, Hani Hassoun, Kent MacKenzie, Vilma Derbekyan
Pak J Nucl Med, 2016;6(1):59-62
We report a case of mycotic abdominal aortic aneurysm where the use of hybrid imaging with gallium scan demonstrated increased uptake in the infected aneurysm and aided in differentiating physiological uptake in the bowel from pathological uptake.
CASE REPORT:
Functional ectopic cystic parathyroid adenomas: case reports and literature review
Nigora Rasulova, Qaisar Hussain Siraj, Amir Javaid, Anwar Al-Banna
Pak J Nucl Med, 2016;6(1):63-68
Parathyroid adenomas are the commonest cause of primary hyperparathyroidism. About 10 percent of the parathyroid adenomas are ectopic in location. Cystic degeneration in parathyroid adenomas is seen in 4% of the cases and represents 1-2% of the cases with primary hyperparathyroidism. Hence, the combination of parathyroid cysts, which are both ectopic and functional is extremely rare. Functional parathyroid cysts can be either "silent" or associated with a wide range of clinical symptoms. We present two cases of functional mediastinal parathyroid cysts, one with and the other without clinical manifestations.
IMAGING GAMUT:
Pulmonary arteriovenous malformation diagnosed on a 18F-fluorodeoxyglucose PET/CT scan
Khattab Khaled, Amir Javaid, Qaisar Hussain Siraj
Pak J Nucl Med, 2016;6(1):69-71
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IMAGING GAMUT:
Multifocal osteomyelitis on bone scan performed for mandibular mass with uncertain malignancy
Salah Oueriagli Nabih, Hassna El Guerrouj, Imad Ghfir, Nouzha Ben Raïs
Pak J Nucl Med, 2016;6(1):72-74
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IMAGING GAMUT:
Unsuspected chronic multifocal osteomyelitis diagnosed on a whole-body 18F-FDG PET/CT scan
Qaisar Hussain Siraj, Amir Javaid, Khattab Khaled, Anwar Al-Banna
Pak J Nucl Med, 2016;6(1):75-78
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