606 results on '"Bhagwant Rai Mittal"'
Search Results
102. Role of [68Ga]DOTANOC PET/computed tomography and [131I]MIBG scintigraphy in the management of patients with pheochromocytoma and paraganglioma: a prospective study
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Rakhee Vatsa, Harmandeep Singh, Bhagwant Rai Mittal, Anupriya Chhabra, Rajender Kumar, Deepa Singh, Uma Nahar, Rama Walia, Nandini Paul, Jaya Shukla, and Anil Bhansali
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Adult ,Male ,medicine.medical_specialty ,SDHB ,Adrenal Gland Neoplasms ,Pheochromocytoma ,Scintigraphy ,030218 nuclear medicine & medical imaging ,Metastasis ,Paraganglioma ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Germline mutation ,Positron Emission Tomography Computed Tomography ,medicine ,Organometallic Compounds ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Prospective cohort study ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,3-Iodobenzylguanidine ,030220 oncology & carcinogenesis ,Mutation ,Histopathology ,Female ,Radiology ,business - Abstract
Purpose The primary aim of study was to compare role of iodine-131 (I-131)-labeled metaiodobenzylguanidine ([I]MIBG) and gallium-68 (Ga-68)-labeled DOTA-l-Nal3-octreotide ([Ga]DOTANOC) PET/computed tomography (CT) in patients with pheochromocytoma (PCC) and paraganglioma (PGL), subsequent follow-up to see management. The secondary aim was to see association of germline mutation in histopathologically proven patients. Procedures We performed [Ga]DOTANOC PET/CT and [I]MIBG in 106 patients (61 men; age: 38.5 ± 16.2 years) of known or suspected PCC/PGL. Following scans, 16 histopathologically proven patients were screened for germline mutations. Results [I]MIBG detected 41 lesions in 34 patients and [Ga]DOTANOC PET/CT detected more than 79 lesions in 55 patients. The mean duration of follow-up was 20.6 ± 16.5 months. Management following scans: surgery in 35 patients (positive histopathology in 34 patients, negative in 1 patient); lutecium-177 (Lu-177)-labeled DOTA-0-Tyr-3 octreotate ([Lu]DOTATATE) therapy in 2 patients; chemotherapy in 1 patient; conservative therapy in 34 patients; no therapy in 17 patients; 2 patients have died and 3 were lost to follow-up. Among 12 previously operated, 2 patients showed metastatic disease and 1 showed residual disease. Out of 16 patients who underwent genotypic analysis (15 operated), 8 were positive for germline mutations. Mutations were seen in SDHB, RET, VHL, MDH2 and SDHA genes, including two germline mutations in two patients. Deletion was observed in one patient in SDHB gene and substitution in all other mutations. Four novel mutations in MDH2 (c.1005G>C, c.916G>A, c.580G>A) and SDHB (c.378_380delAAT) were observed (SRA accession: PRJNA551457). Conclusions [Ga]DOTANOC PET/CT should be considered as a first-line investigation in PCC/PGL especially at high risk of metastasis and screening of persons with familial syndrome.
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- 2020
103. Diagnostic values of
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Rajender, Kumar, Kousik, Vankadari, Bhagwant Rai, Mittal, Deepak, Bansal, Amita, Trehan, Jitendra K, Sahu, and Naveen, Sankhyan
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Male ,Opsoclonus-Myoclonus Syndrome ,Positron Emission Tomography Computed Tomography ,Positron-Emission Tomography ,Organometallic Compounds ,Humans ,Female ,Gallium Radioisotopes ,Child ,Tomography, X-Ray Computed ,Retrospective Studies - Abstract
Opsoclonus myoclonus ataxia (OMA) syndrome, also known as "Kinsbourne syndrome" or "dancing eye syndrome," is a rare, paraneoplastic entity which may be associated with pediatric neuroblastic tumors and carry a grave prognosis. We aimed to evaluate the role ofWe retrospectively evaluated theOf 38 patients (13 males, 25 females, aged 3-96 months), 18 (47.3%) had SSTR-expressing lesions (PET-positive), and histopathology revealed neuroblastic tumors in 17/18 lesions (neuroblastoma 14, ganglioneuroblastoma 2, and ganglioneuroma 1) and reactive hyperplasia in 1/18. The remaining 20/38 (52.6%) patients did not demonstrate SSTR-expressing lesions (PET-negative) and had an uneventful follow-up. The average SUVmax of the PET-positive lesions was 10.3 (range 2.8-34.5). The PET/CT results revealed 17 true-positive, one false-positive, 20 true-negative, and zero false-negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 95.2%, 94.4%, 100%, and 97.3% respectively.• Opsoclonus myoclonus ataxia (OMA) syndrome or "dancing eye syndrome" is a rare paraneoplastic entity which may be associated with pediatric neuroblastic tumors with a grave prognosis. •
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- 2020
104. Reversible perfusion pattern in hypertrophied papillary muscles evident on myocardial perfusion imaging with CZT-based cardiac-specific camera
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Bhagwant Rai Mittal, Ajay Bahl, Uma Debi, Madan Parmar, Prashant Panda, Mohamed Yaser Arafath, Ashwani Sood, and Shelvin Kumar Vadi
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Adult ,Male ,medicine.medical_specialty ,Cardiomegaly ,Cohort Studies ,Myocardial perfusion imaging ,Internal medicine ,Coronary Circulation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Middle Aged ,Papillary Muscles ,Zinc ,Cardiology ,Female ,Tellurium ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Cadmium - Published
- 2020
105. Necrolytic Acral Erythema in Association With Hypothyroidism
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Bhagwant Rai Mittal, Ashwani Sood, Garima Dabas, Bishan Dass Radotra, Dipankar De, Ashwin Singh Parihar, and Abhiram Jois
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Adult ,Male ,medicine.medical_specialty ,business.industry ,Foot ,Necrolytic acral erythema ,Dermatology ,Hepatitis C ,Middle Aged ,medicine.disease ,Hand ,Necrosis ,Hypothyroidism ,Erythema ,Medicine ,Humans ,Female ,medicine.symptom ,business ,Acral erythema ,Skin - Published
- 2020
106. Dose Optimization in
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Nivedita, Rana, Manpreet, Kaur, Harmandeep, Singh, and Bhagwant Rai, Mittal
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Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Positron-Emission Tomography ,Humans ,Whole Body Imaging ,Body Mass Index - Abstract
The present study aimed to optimize the injected dose of
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- 2020
107. Molecular Imaging Targeting Corticotropin-releasing Hormone Receptor for Corticotropinoma: A Changing Paradigm
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Harmandeep Singh, Rajender Kumar, Apinderpreet Singh, Anil Bhansali, Bhagwant Rai Mittal, Rosario Pivonello, Chirag Kamal Ahuja, Rajesh Chhabra, Rakhee Vatsa, Naresh Sachdeva, Jaya Shukla, Sivashanmugam Dhandapani, Sanjay Kumar Bhadada, Nivedita Rana, Rama Walia, Uma Nahar, Sushant Sahoo, Rahul Gupta, Pinaki Dutta, Walia, Rama, Gupta, Rahul, Bhansali, Anil, Pivonello, Rosario, Kumar, Rajender, Singh, Harmandeep, Ahuja, Chirag, Chhabra, Rajesh, Singh, Apinderpreet, Dhandapani, Sivashanmugam, Sahoo, Sushant, Rana, Nivedita, Vatsa, Rakhee, Dutta, Pinaki, Bhadada, Sanjay Kumar, Sachdeva, Naresh, Mittal, B R, Nahar, Uma, and Shukla, Jaya
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Diagnostic Imaging ,Adenoma ,Adult ,Male ,endocrine system ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Corticotropin-releasing hormone receptor ,India ,Gallium Radioisotopes ,Petrosal Sinus Sampling ,Biochemistry ,Receptors, Corticotropin-Releasing Hormone ,Diagnosis, Differential ,Young Adult ,Endocrinology ,BIPSS ,Anterior pituitary ,Adrenocorticotropic Hormone ,In vivo ,Pituitary adenoma ,Internal medicine ,Medicine ,Humans ,Receptor ,Cushing Syndrome ,medicine.diagnostic_test ,business.industry ,Biochemistry (medical) ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Molecular Imaging ,68Ga CRH PET-CT ,ACTH Syndrome, Ectopic ,medicine.anatomical_structure ,ACTH-Secreting Pituitary Adenoma ,Cushing' ,Female ,business ,hormones, hormone substitutes, and hormone antagonists ,Hormone ,MRI - Abstract
Background Corticotrophin-releasing hormone (CRH) is the major regulator of adrenocorticotrophic hormone (ACTH) secretion from the anterior pituitary and acts via CRH-1 receptors (CRH-1R). Corticotropinoma though autonomous, still retain their responsiveness to CRH and hence, we hypothesize that in vivo detection of CRH-1 receptors on pituitary adenoma using Gallium-68 (68Ga)-tagged CRH can indicate the functionality of adenoma, and combining it with positron emission tomography-computed tomography (PET-CT) can provide requisite anatomical information. Methods Subjects with ACTH-dependent Cushing’s syndrome (CS) (n = 27, 24 with Cushing’s disease [CD], 3 with ectopic CS [ECS]) underwent 68Ga CRH PET-CT. Two nuclear medicine physicians read these images for adenoma delineation and superimposed them on magnetic resonance imaging (MRI) sella. The information provided was used for intraoperative navigation and compared with operative and histopathological findings. Findings 68Ga CRH PET-CT correctly delineated corticotropinoma in all the 24 cases of CD, including the 10 cases with adenoma size < 6mm (4 cases were negative on MRI). Corticotropinoma location on 68Ga CRH PET fusion images with MRI were concordant with operative findings and were further confirmed on histopathology. There was no tracer uptake in the pituitary in 2 patients with ECS, while, in another, the diffuse uptake in pituitary suggested ectopic CRH production. Conclusion 68Ga CRH PET-CT represents a novel, noninvasive molecular imaging, targeting CRH receptors that not only delineate corticotropinoma and provides the surgeon with valuable information for intraoperative tumor navigation, but also helps in differentiating a pituitary from an extra-pituitary source of ACTH-dependent CS. Funding None.
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- 2020
108. Efficacy and safety of concomitant 177Lu-DOTATATE and low-dose capecitabine in advanced medullary thyroid carcinoma: a single-centre experience
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Naresh K. Panda, Swayamjeet Satapathy, Ashwani Sood, Roshan K. Verma, and Bhagwant Rai Mittal
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Male ,medicine.medical_specialty ,Endpoint Determination ,Octreotide ,Gastroenterology ,030218 nuclear medicine & medical imaging ,law.invention ,Capecitabine ,Thyroid carcinoma ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Interquartile range ,Internal medicine ,medicine ,Organometallic Compounds ,Humans ,Radiology, Nuclear Medicine and imaging ,Thyroid Neoplasms ,Neoplasm Metastasis ,Aged ,Retrospective Studies ,Dose-Response Relationship, Drug ,business.industry ,Cumulative dose ,Cancer ,General Medicine ,medicine.disease ,Carcinoma, Neuroendocrine ,030220 oncology & carcinogenesis ,Concomitant ,Radionuclide therapy ,Safety ,business ,medicine.drug - Abstract
Aims Peptide receptor radionuclide therapy (PRRT) has been shown to be useful in inoperable/metastatic medullary thyroid carcinoma (MTC). However, the role of concomitant PRRT and low-dose capecitabine therapy has not yet been studied in these patients. This study was conducted to evaluate the efficacy and safety of this combination approach in advanced MTC. Materials and methods This was a retrospective, single-centre study. Data of consecutive patients of advanced inoperable/metastatic MTC treated with concomitant Lu-DOTATATE+capecitabine, from January 2014 to August 2018, were collected and analysed for radiological, molecular and biochemical responses and treatment-related toxicity. Results Eight patients with advanced MTC received a median cumulative dose of 20.9 GBq (interquartile range 8.9-27.7 GBq) Lu-DOTATATE over 1-4 cycles and 1250 mg/m capecitabine from days 0 to 14 of each PRRT cycle. Radiological response according to Response Evaluation Criteria in Solid Tumours 1.1 criteria could be assessed in seven patients. Six out of seven patients (86%) had stable disease, while disease progression was observed in 1/7 (14%) patients. However, molecular response, as per the European Organization for Research and Treatment of Cancer criteria, was observed in all the seven patients. Biochemical response with reduction in serum calcitonin levels was observed in 3/5 (60%) patients. With the exception of grade 2 anaemia in one patient, no other significant toxicity was observed in this cohort. Conclusion Our results indicate the efficacy and safety of concomitant Lu-DOTATATE and capecitabine in advanced MTC. Larger randomized controlled trials are, however, required to establish the role of capecitabine as a radiosensitizer along with PRRT in these patients.
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- 2020
109. Duration of proton pump inhibitor abstinence before MPI
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Bhagwant Rai Mittal, Harpreet Singh, and Ashwani Sood
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medicine.drug_class ,business.industry ,media_common.quotation_subject ,Stomach ,MEDLINE ,Myocardial Perfusion Imaging ,Proton-pump inhibitor ,Proton Pump Inhibitors ,Abstinence ,Duration (music) ,Anesthesia ,medicine ,Gastroesophageal Reflux ,Humans ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,media_common - Published
- 2020
110. Axillary Lymph Nodal Metastases from Thyroid Carcinoma: Report of 2 Cases with Review of Literature
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Manish Rohilla, Swathy Krishnan, Swayamjeet Satapathy, Bhagwant Rai Mittal, Shashank Singh, Ashwani Sood, Nitheeshraj K Tigapuram, and Sindhu Tanigassalam
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medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,General Medicine ,Disease ,medicine.disease ,Carcinoma, Papillary ,Thyroid carcinoma ,Locoregional disease ,Lymphatic Metastasis ,Axilla ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,Lymph ,Lymph Nodes ,Thyroid Neoplasms ,NODAL ,business ,Thyroid cancer - Abstract
Thyroid carcinoma has an excellent long-term outcome for locoregional disease if adequately treated, but the outcome declines sharply if distant metastatic disease is present. Axillary lymph nodal metastases are unusual in thyroid carcinoma and have a poorer outcome, as they are usually associated with aggressive histopathologies, extensive locoregional disease, and distant metastatic disease. We report 2 cases of thyroid carcinoma with axillary lymph nodal metastases and their management, and we review the literature on such cases.
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- 2020
111. Real Time F-18 FDG PET-CT-Guided Metabolic Biopsy Targeting Differential FDG Avidity in a Pulmonary Blastoma
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Tarun Kumar Jain, Ashwani Sood, Bhagwant Rai Mittal, Amanjit Bal, Rajender Kumar, and Harmandeep Singh
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Pleural effusion ,Chest pain ,medicine.disease ,Malignancy ,030218 nuclear medicine & medical imaging ,Pulmonary Blastoma ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Biopsy ,medicine ,Radiology, Nuclear Medicine and imaging ,Histopathology ,Avidity ,Interesting Image ,Radiology ,medicine.symptom ,business - Abstract
Pulmonary blastoma (PB) is a rare thoracic malignancy and preoperative diagnosis is challenging. A young man presented with dyspnea and chest pain for 3–4 months and chest-computed tomography (CT) revealed large mass in the left lung upper lobe and pleural effusion. Repeated CT-guided fine-needle aspiration cytology from the lesion and pleural fluid aspiration was negative for malignancy. F-18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed heterogeneous tracer avidity in left lung mass with areas of necrosis. Real-time PET-CT-guided biopsy from metabolically active component of the lesion revealed biphasic PB on histopathology.
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- 2020
112. 225Ac-PSMA-617 Radioligand Posttherapy Imaging in Metastatic Castrate-Resistant Prostate Cancer Patient Using 3 Photopeaks
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Komalpreet Kaur, Madan Parmar, Chandan Krushna Das, Ashwani Sood, Bhagwant Rai Mittal, Rakhee Vatsa, and Shelvin Kumar Vadi
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Oncology ,Actinium ,Male ,medicine.medical_specialty ,Castrate-resistant prostate cancer ,urologic and male genital diseases ,Ligands ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Prostate cancer ,Heterocyclic Compounds, 1-Ring ,0302 clinical medicine ,Internal medicine ,Radioligand ,Medicine ,Distribution (pharmacology) ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,business.industry ,General Medicine ,Dipeptides ,Prostate-Specific Antigen ,medicine.disease ,Alpha Particles ,Prostatic Neoplasms, Castration-Resistant ,030220 oncology & carcinogenesis ,business - Abstract
PSMA-based radioligand therapies have shown the beneficial effect in metastatic castrate-resistant prostate cancer (mCRPC) patients when they become refectory to the established treatments with associated potential toxicities and high mortality rate. Ac-PSMA therapy is known to be remarkably effective in substantially pretreated mCRPC patients. However, posttherapy imaging is usually not performed as alpha emitters are really difficult to image. We presents a patient of mCRPC treated with Ac-PSMA-617, and his posttherapy whole-body scans acquired by using 3 different photopeaks (78, 218, and 440 keV) fairly demonstrated the tracer's distribution and the efficacy of targeted alpha therapy.
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- 2020
113. Impact of
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Harmandeep, Singh, Vaishnavi, Dasagrandhi, Rajender, Kumar, Rupesh, Kumar, and Bhagwant Rai, Mittal
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18F-fluorodeoxyglucose positron emission tomography-computed tomography ,Interesting Image ,pericardial hemangioma ,cavernous hemangioma - Abstract
Hemangiomas are extremely rare tumors of the heart that may present with pericardial effusion, dyspnea, chest discomfort, palpitations, or syncope. Few published reports have highlighted the utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in the evaluation of cardiac lesions. We report a case demonstrating the utility of 18F-FDG PET-CT in a young man who presented with gross pericardial effusion and suspicion of metastatic carcinoma on fluid cytology.
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- 2020
114. Radioactive Iodine as a Single-Modality Treatment in a Tumor Thrombus Arising from Follicular Thyroid Carcinoma
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Sharath B. Kumar, Deepa Singh, Swayamjeet Satapathy, Anwin Joseph Kavanal, Bhagwant Rai Mittal, and Ashwani Sood
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endocrine system ,medicine.medical_specialty ,030218 nuclear medicine & medical imaging ,Thyroid carcinoma ,Iodine Radioisotopes ,03 medical and health sciences ,0302 clinical medicine ,Tumor thrombus ,Follicular phase ,Adenocarcinoma, Follicular ,medicine ,Endocrine system ,Humans ,Radiology, Nuclear Medicine and imaging ,Thyroid Neoplasms ,Radiological and Ultrasound Technology ,business.industry ,Thyroid ,Mediastinum ,Radioiodine therapy ,Thrombosis ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Radionuclide therapy ,cardiovascular system ,Female ,Radiology ,business - Abstract
Differentiated thyroid carcinoma rarely involves great veins with tumor thrombosis. Multimodality treatment with surgery, radioiodine therapy and targeted therapies are used for management of tumor thrombus associated with thyroid malignancies, though no established guidelines exist. Authors present a woman of post-operative follicular thyroid carcinoma (FTC) thyroid with tracer avid tumor thrombus in right brachiocephalic vein, treated with 131-iodine (131I) as a single modality for both remnant and tumor thrombus. Her subsequent follow-ups revealed excellent response to treatment.
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- 2020
115. Differentiating benign and malignant pancreatic masses: Ga-68 PSMA PET/CT as a new diagnostic avenue
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Venkata Subramanian Krishnaraju, Rajender Kumar, Bhagwant Rai Mittal, Amanjit Bal, Harjeet Singh, Ritambhra Nada, Vishal Sharma, Manish Rohilla, Surinder Singh Rana, and Harmandeep Singh
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Adult ,Male ,medicine.medical_specialty ,Gallium Radioisotopes ,urologic and male genital diseases ,Malignancy ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Cytology ,Positron Emission Tomography Computed Tomography ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neuroradiology ,Aged ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,General Medicine ,Middle Aged ,medicine.disease ,Cytopathology ,030220 oncology & carcinogenesis ,Positron-Emission Tomography ,Pancreatitis ,Histopathology ,Radiology ,medicine.symptom ,Radiopharmaceuticals ,business ,Tomography, X-Ray Computed - Abstract
Differentiation of malignant and benign pancreatic lesions on anatomical imaging is difficult in some cases with overlapping features. Prostate-specific membrane antigen (PSMA) is overexpressed during angioneogenesis in many tumors. We aimed to evaluate the PSMA expression in pancreatic lesions to differentiate these lesions and explore the performance of Ga-68 PSMA-PET/CT vis-a-vis F-18 FDG-PET/CT. Patients with pancreatic lesions on conventional imaging were prospectively recruited. All the patients underwent a whole-body F-18 FDG-PET/CT and a regional abdominal Ga-68 PSMA-PET/CT. Focal tracer uptake (FDG or PSMA) on PET images was considered positive. Histopathology and/or cytopathology were considered the reference standard. A total of forty patients (27 males, mean age 55.3 ± 9.8, range 37–71 years) were enrolled. Of these, 19 were diagnosed as malignant on histopathology/cytology. Patients with benign lesions showed no worsening of symptoms for at least 6 months on follow-up. FDG-PET/CT revealed 17 true-positive (TP), 9 false-positive (FP), 12 true-negative (TN), and 2 false-negative (FN) findings, whereas PSMA-PET/CT had 18 TP, 2 FP, 19 TN, and 1 FN finding. The sensitivity, specificity, PPV, NPV, and accuracy for FDG-PET/CT were 89.5%, 57.1%, 65.4%, 85.7%, and 72.5%, respectively, while for PSMA-PET/CT were 94.7%, 90.5%, 90%, 95%, and 92.5%, respectively. ROC curve analysis showed that the SUVmax value of 4.8 on PSMA-PET/CT could predict the malignant potential of a lesion with a specificity of 90.5% and a sensitivity of 84.2%. Ga-68 PSMA-PET/CT imaging helped in establishing a non-invasive pre-operative diagnosis of primary pancreatic malignancy with a higher degree of specificity and accuracy compared with FDG-PET/CT. • Conventional imaging such as CT and MRI are unable to reliably differentiate localized malignant pancreatic lesion from benign lesions mimicking malignancy such as mass-forming pancreatitis. • FDG PET/CT helps in detecting malignant foci in view of their increased glucose metabolism. However, it may be falsely positive in inflammatory lesions which may occasionally hinder its ability to differentiate between benign and malignant lesions. • Apart from prostatic malignancy, PSMA is overexpressed in neovasculature of many non-prostatic malignancies. The present study highlights that Ga68 PSMA PET/CT performed better in diagnosing malignancy non-invasively than FDG-PET/CT with a higher PPV (90.5% vs. 65.4%) and accuracy (92.5% vs. 72.5%).
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- 2020
116. 18F-FDG PET/CT Brain in a Case of Agrammatic/Nonfluent Variant of Primary Progressive Aphasia (Broca's Aphasia)
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Bhagwant Rai Mittal, Vankadari Kousik, Harmandeep Singh, Rajender Kumar, and Manoj Kumar Goyal
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medicine.medical_specialty ,Audiology ,Left inferior frontal gyrus ,030218 nuclear medicine & medical imaging ,Primary progressive aphasia ,03 medical and health sciences ,Fluency ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Aphasia ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Broca's Aphasia ,Stroke ,Aphasia, Broca ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Lobe ,medicine.anatomical_structure ,Aphasia, Primary Progressive ,030220 oncology & carcinogenesis ,Fdg pet ct ,Female ,medicine.symptom ,Radiopharmaceuticals ,business - Abstract
Primary progressive aphasia is a neurodegenerative variant of frontotemporal lobe degeneration presenting with isolated selective impairment of language domain, not secondarily due to stroke. We present a case of middle-aged female patient who underwent F-FDG PET of the brain for evaluating progressively declining speaking ability associated with altered fluency of speech and occasional mutism. F-FDG PET revealed asymmetric hypometabolism involving the left inferior frontal gyrus along with left anterior cingulate gyrus suggestive of Broca's aphasia.
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- 2020
117. Correction of Positron Emission Tomography Maximum Intensity Projection Image Artifact Using Retro Reconstruction Method
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Rakhee Vatsa, Harmandeep Singh, Ankit Watts, Nivedita Rana, and Bhagwant Rai Mittal
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Fluorodeoxyglucose ,Artifact (error) ,reconstruction ,Uninterpretable ,medicine.diagnostic_test ,business.industry ,Image processing ,artifact correction ,positron emission tomography/computed tomography ,Optics ,Positron emission tomography ,Maximum intensity projection ,Artifact ,medicine ,Technical Note ,Radiology, Nuclear Medicine and imaging ,Tomography ,business ,Emission computed tomography ,medicine.drug - Abstract
Artifacts in positron emission tomography (PET)/computed tomography imaging can result from a number of factors. Presence of imaging artifacts affects interpretation and can sometimes render the image uninterpretable. Correction of artifacts can be attempted by reprocessing of data. In the present study, one PET maximum intensity projection image artifact was corrected by employing the method of retro-reconstruction.
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- 2020
118. Utility of Imaging of Nigrosome-1 on 3T MRI and Its Comparison with 18F-DOPA PET in the Diagnosis of Idiopathic Parkinson Disease and Atypical Parkinsonism
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Chirag Kamal Ahuja, Sahil Mehta, Vivek Lal, Bhagwant Rai Mittal, Paramjeet Singh, Sucharita Ray, Kamalesh Chakravarty, and Heena Kathuria
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0301 basic medicine ,medicine.medical_specialty ,Parkinson's disease ,medicine.diagnostic_test ,Imaging biomarker ,business.industry ,Parkinsonism ,Magnetic resonance imaging ,Neurological examination ,030105 genetics & heredity ,medicine.disease ,Progressive supranuclear palsy ,nervous system diseases ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Neurology ,Positron emission tomography ,Medicine ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Research Articles - Abstract
Background Loss of nigrosome-1 on 3T and 7T magnetic resonance imaging (MRI) is a recently explored imaging biomarker in the diagnosis of neurodegenerative parkinsonism. Objectives This study was undertaken to evaluate the utility of imaging of nigrosome in the diagnosis of neurodegenerative parkinsonism on 3T MRI. Methods An institution-based prospective case-control study was conducted at a tertiary care center in North India. 3T venous blood oxygen level-dependent (VenoBOLD) and high-resolution susceptibility-weighted imaging (SWI) imaging sequences in MRI were performed in 100 patients with parkinsonism (56 with idiopathic Parkinson's disease [IPD], 30 with young onset Parkinson's disease [YOPD], 12 with progressive supranuclear palsy, and 2 patients with multiple system atrophy) and 15 controls. Grading of nigrosome was done in both the sequences. Each patient underwent 18F-DOPA positron emission tomography (PET), detailed neurological examination including Hoen and Yahr (H&Y) staging and Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) scoring. Results The diagnostic sensitivity and specificity of the detection of loss of nigrosome-1 on VenoBOLD and SWI sequence at 3T MR imaging were 90% and 66.7% and 94% and 80%, respectively. A weak negative correlation was found between the grading of the nigrosome and clinical parameters (H&Y and UPDRS III). There was no correlation between the side of nigrosome loss and clinical asymmetry. However, nigrosome imaging was not able to differentiate between Parkinson's disease and atypical parkinsonism. Conclusions The loss of nigrosome-1 on 3T MRI on SWI and VenoBOLD sequences may serve as a potential imaging marker in the diagnosis of degenerative parkinsonian syndromes. However, it cannot differentiate between idiopathic Parkinson's disease and atypical parkinsonian syndromes.
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- 2020
119. Autologous stem cell transplant for high‐risk neuroblastoma: Achieving cure with low‐cost adaptations
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Richa Jain, Prateek Bhatia, Rekha Hans, Deepak Bansal, Bhagwant Rai Mittal, Amita Trehan, Neelam Marwaha, Sidharth Totadri, Rakesh Kapoor, Ratti Ram Sharma, Nandita Kakkar, Neelam Varma, Akshay Kumar Saxena, Radhika Srinivasan, Arvind Rajwanshi, Prema Menon, and Ram Samujh
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Male ,Oncology ,Melphalan ,medicine.medical_specialty ,Transplantation Conditioning ,Transplantation, Autologous ,Cryopreservation ,Neuroblastoma ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Humans ,High risk neuroblastoma ,Retrospective Studies ,Radiotherapy ,business.industry ,Plerixafor ,Hematopoietic Stem Cell Transplantation ,Hematology ,Prognosis ,medicine.disease ,Combined Modality Therapy ,Survival Rate ,Apheresis ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,Stem cell ,business ,Follow-Up Studies ,030215 immunology ,medicine.drug - Abstract
Background The majority of patients in low- and middle-income countries (LMIC) are unable to receive optimal therapy, including autologous stem cell transplant (ASCT) for high-risk neuroblastoma. Management is intensive and multidisciplinary; survival is often poor. We report a single-center outcome of high-risk neuroblastoma, with adaptations optimized for LMIC. Procedure The study was retrospective. Patients were treated on the backbone of the high-risk neuroblastoma study-1 of SIOP-Europe (HR-NBL1/SIOPEN) protocol with ASCT. Adaptations incorporated to decrease cost, requirement for inpatient admission, infections, and faster engraftment included (a) optional outpatient administration for rapid-COJEC, (b) two sessions of stem-cell apheresis, (c) storing stem cells at 2-6°C without cryopreservation for up to 7 days, (d) no central lines, (e) no antibacterial/antifungal/antiviral prophylaxis, (f) omitting formal assessment of cardiac/renal/pulmonary functions before ASCT, and (g) administration of pegylated granulocyte colony-stimulating factor on Day +4. Results Over 5 years 9 months, 35 patients with high-risk neuroblastoma were treated. Rapid-COJEC was administered over a median duration of 80 days (interquartile range: 77, 83). Conditioning regimen included melphalan (n = 7), oral busulfan-melphalan (Bu/Mel; n = 6), or intravenous Bu/Mel (n = 22). The median viability of stem cells stored for 6 days (n = 28) was 93% (range: 88-99). Two (5.7%) patients had ASCT-related mortality. The 3-year overall and event-free survival was 41% and 39%, respectively. A relapse occurred in 20 (57%) patients. Treatment abandonment was observed in one (3%) patient. Conclusions Administration of therapy in a disciplined time frame along with low-cost adaptations enables to manage high-risk neuroblastoma with low abandonment and an encouraging survival in LMIC. Stem cells can be stored safely without cryopreservation for up to 7 days.
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- 2020
120. 18F-FDG PET/CT in Tuberculosis: Can Interim PET/CT Predict the Clinical Outcome of the Patients?
- Author
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Nivedita Rana, Rajender Kumar, Apurva Sood, Rajesh Chhabra, Manish Modi, Bhagwant Rai Mittal, Ashwin Singh Parihar, Roshan K. Verma, and Swayamjeet Satapathy
- Subjects
Adult ,Male ,Treatment response ,Tuberculosis ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Interim pet ct ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Aged ,business.industry ,Complete Metabolic Response ,Disease progression ,General Medicine ,Middle Aged ,medicine.disease ,Interim pet ,Treatment Outcome ,030220 oncology & carcinogenesis ,Fdg pet ct ,Female ,Radiopharmaceuticals ,business ,Nuclear medicine - Abstract
Purpose of the report Tuberculosis (TB) is a major health problem. Activated macrophages in TB lesions show high metabolic activity and can be assessed using F-FDG PET/CT. This retroprospective study was done to evaluate the utility of F-FDG PET/CT in initial assessment and therapeutic response in patients with TB. Materials and methods Eighty-seven patients (male-to-female ratio, 46:41) diagnosed with pulmonary TB and extrapulmonary TB underwent whole-body F-FDG PET/CT for initial assessment and a follow-up scan 3 to 4 months after initiation of antitubercular therapy (ATT). Visual and semiquantitative (SUVmax) analyses were used for scan assessment. Treatment responses on interim scans were categorized as complete metabolic response (CMR), favorable response to therapy (FRT), stable disease (SD), and disease progression (DP). CMR, FRT, and SD cases were considered as responders and DP cases as nonresponders. Treatment response was correlated with clinical outcome (mortality) and ATT duration. Results Baseline F-FDG PET/CT scans were positive in all the patients and detected additional disease sites than suspected clinically in 72% patients. On interim PET/CT, 13 patients showed CMR, 43 showed FRT, 8 showed SD, and 23 showed DP. A longer duration of ATT was seen in nonresponders (P ≤ 0.001) than responders. During follow-up, 9/87 patients died, out of which 8 patients were of DP group and 1 patient belonged to SD. Nonresponders showed 35% mortality compared with 1.6% in the responder group (P ≤ 0.001). Conclusions F-FDG PET/CT is a valuable imaging modality for disease mapping and assessing therapeutic response. Treatment response in the interim PET/CT done at 3 to 4 months predicted the duration of ATT and clinical outcome of the patients.
- Published
- 2020
121. 99mTc Tamoxifen for Imaging Estrogen Receptor Expression in Metastatic Breast Cancer Patient
- Author
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Rajender Kumar, Ishita Laroiya, Rakhee Vatsa, Amanjit Bal, Bhagwant Rai Mittal, Gurpreet Singh, Anupriya Chhabra, and Jaya Shukla
- Subjects
Oncology ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Estrogen receptor ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Internal medicine ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,skin and connective tissue diseases ,Estrogen Receptor Status ,business.industry ,Technetium ,Hormone replacement therapy (menopause) ,General Medicine ,Middle Aged ,Antiestrogen ,medicine.disease ,Metastatic breast cancer ,Tamoxifen ,Receptors, Estrogen ,Estrogen ,030220 oncology & carcinogenesis ,Female ,Radiopharmaceuticals ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
Estrogen receptor-expressing breast cancer exhibits better prognosis due to responsiveness to antiestrogen treatment. Therefore, knowledge of the estrogen receptor status of a tumor is an important prognostic and predictive indicator in breast cancer. We present noninvasive imaging of estrogen receptors with Tc tamoxifen that can identify the active tumor and approachable sites for biopsy. It may help in selection of patients for hormone replacement therapy and in assessment of receptor status in recurrent disease and also in response evaluation.
- Published
- 2020
122. 18F-FDG PET/CT detects Metastatic Renal Cell Carcinoma Masquerading as Primary Breast Malignancy
- Author
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Rajender Kumar, Ashwin Singh Parihar, Kaniyappan Nambiyar, Bhagwant Rai Mittal, Shelvin Kumar Vadi, Bishan D. Radotra, and Lileswar Kaman
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Thyroid ,Mammary tissue ,Breast malignancy ,medicine.disease ,Occult ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Renal cell carcinoma ,030220 oncology & carcinogenesis ,Medicine ,Interesting Image ,Radiology, Nuclear Medicine and imaging ,Fdg pet ct ,Lymph ,Radiology ,skin and connective tissue diseases ,business ,Mastectomy - Abstract
We present the case of a 36-year-old woman who underwent (18)F-FDG PET/CT with suspicion of a primary breast malignancy. However, PET/CT detected an occult renal cell carcinoma with metastases to the thyroid, breast, lungs and lymph nodes. Thyroid and breast metastases are atypical metastatic sites of renal cell carcinoma. Breast metastases from extra mammary tissue are extremely rare, more so from renal cell carcinoma. Histopathologic confirmation of the breast lesions is imperative to avoid unnecessary mastectomy and imaging can help in raising the suspicion of metastatic involvement versus primary breast malignancy.
- Published
- 2018
123. Prognostic value of left ventricular mechanical dyssynchrony indices in long-standing type II diabetes mellitus with normal perfusion and left ventricular systolic functions on SPECT-MPI
- Author
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Dharmender Malik, Ashwani Sood, Ajay Bahl, Komalpreet Kaur, Bhagwant Rai Mittal, and Madan Parmar
- Subjects
Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Phase bandwidth ,Logistic regression ,Disease-Free Survival ,030218 nuclear medicine & medical imaging ,Cohort Studies ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Diabetes mellitus ,Internal medicine ,Phase.standard deviation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Survival analysis ,Aged ,Aged, 80 and over ,business.industry ,Spect mpi ,Myocardial Perfusion Imaging ,Middle Aged ,Prognosis ,medicine.disease ,Diabetes Mellitus, Type 2 ,Cardiology ,Female ,Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography ,Cardiology and Cardiovascular Medicine ,Phase analysis ,business ,Perfusion - Abstract
To test whether phase analysis indices from SPECT-MPI for left ventricular mechanical dyssynchrony (LVMD) are predictors of major adverse cardiac events (MACEs) in long-standing diabetes mellitus (DM). A total of 136 DM patients with normal perfusion and left ventricular systolic functions were followed up for about two years and divided into two groups according to the presence and the absence of MACEs. Thirteen (9.5%) patients experienced MACEs during follow-up. Patients experiencing MACEs showed significantly higher phase standard deviation (PSD) and wider phase bandwidth (PBW) than those who did not. Moreover, both PSD and PBW showed significant correlations (r = 0.25 and 0.27; P
- Published
- 2018
124. Diagnostic performance of real-time robotic arm-assisted 18F-FDG PET/CT-guided percutaneous biopsy in metabolically active abdominal and pelvic lesions
- Author
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Anish Bhattacharya, Rajender Kumar, Amanjit Bal, Aman Sharma, Bhagwant Rai Mittal, Harjeet Singh, Shelvin Kumar Vadi, Gaurav Prakash, Harmandeep Singh, and Ashwani Sood
- Subjects
Target lesion ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General Medicine ,Percutaneous biopsy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Orthopedic surgery ,Biopsy ,Medicine ,Radiology, Nuclear Medicine and imaging ,Histopathology ,Radiology ,Medical diagnosis ,business ,Prospective cohort study ,Pathological - Abstract
To evaluate the feasibility and diagnostic performance of 18F-FDG PET/CT-guided biopsy of abdominal and pelvic lesions with automated robotic arm (ARA) assistance. This prospective study included 114 patients (75 men, 39 women; mean age 51.3 ± 14.7 years, range: 18–90 years) who underwent PET/CT-guided biopsy of FDG-avid abdominal and pelvic lesions from October 2014 to December 2017. Of these patients, 54 had a prior inconclusive CT-guided biopsy. The biopsies were done with ARA assistance, and a real-time sample was obtained after confirming the position of the needle tip within the target lesion on PET/CT. Histopathology reports were reviewed to evaluate the diagnostic performance of the procedure. Clinical or imaging follow-up was done to confirm negative results. The lesions were successfully targeted in 110 of the 114 patients (96.5%) and yielded a pathological diagnosis. Pathological diagnoses were confirmed in 50 of the 54 patients with a prior inconclusive biopsy. Of the 110 lesions, 82 were malignant, 20 were benign, and 8 showed minimal residual FDG uptake at the end of treatment and had no active disease even on clinical and imaging follow-up of at least 3 months. Findings were true-positive in 102 lesions, false-positive in none, true-negative in eight and false-negative in four. The procedure showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.2%, 100%, 100%, 66.7 and 96.5%, respectively. No immediate complications or delayed life-threatening events were observed. Percutaneous biopsy of metabolically active abdominal and pelvic lesions with ARA assistance is a technically feasible, safe and accurate method for pathological diagnosis with high diagnostic performance. PET-guided biopsy is highly practical and useful in patients, especially in those with a previous inconclusive biopsy.
- Published
- 2018
125. Langerhans’ Cell Histiocytosis Masquerading as Metastatic Papillary Thyroid Cancer on F-18 FDG PET/CT: Diagnostic Dilemma Solved by PET/CT-Guided Biopsy
- Author
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Anish Bhattacharya, Gaurav Parkash, Rajender Kumar, Bhagwant Rai Mittal, Amanjit Bal, and Dharmender Malik
- Subjects
0301 basic medicine ,endocrine system ,medicine.medical_specialty ,endocrine system diseases ,medicine.medical_treatment ,Levothyroxine ,Papillary thyroid cancer ,03 medical and health sciences ,0302 clinical medicine ,Langerhans cell histiocytosis ,Biopsy ,medicine ,Radiology, Nuclear Medicine and imaging ,PET-CT ,medicine.diagnostic_test ,business.industry ,Thyroid ,medicine.disease ,Histiocytosis ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Interesting Image ,Thyroglobulin ,Radiology ,business ,medicine.drug - Abstract
We present a case of papillary thyroid cancer (post-thyroidectomy status) on regular treatment with suppressive Levothyroxine therapy. On follow-up at 6 months after radioactive iodine ablation for remnant thyroid tissue, her thyroglobulin, and anti-thyroglobulin levels were 0.06 ng/ml and 670 IU/ml, respectively. Low-dose whole-body I-131 scan was negative. To look for the cause of isolated increased anti-thyroglobulin level, a whole-body (18)F-FDG PET/CT was done which revealed multiple FDG-avid lytic skeletal lesions suggestive of metastases. For confirmation of diagnosis, (18)F-FDG PET/CT-guided metabolic biopsy was done, which revealed Langerhans’ cell histiocytosis on histopathological examination.
- Published
- 2018
126. Practical Consideration Regarding Stability of F-18 2-Deoxy-2-[
- Author
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Rakhee, Vatsa, Harmandeep, Singh, Nivedita, Rana, Rajender, Kumar, and Bhagwant Rai, Mittal
- Subjects
Letter to the Editor - Published
- 2019
127. Severe Contralateral Striatal Hypometabolism in a Case of Diabetic Nonketotic Hyperglycemic Hemichorea on 18F-FDG PET/CT Brain
- Author
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Rajender Kumar, Sahil Mehta, Naresh Tandyala, Harmandeep Singh, Bhagwant Rai Mittal, and Shelvin Kumar Vadi
- Subjects
medicine.medical_specialty ,Choreiform movement ,Striatum ,Favorable prognosis ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Chorea ,Fluorodeoxyglucose F18 ,Internal medicine ,Positron Emission Tomography Computed Tomography ,Basal ganglia ,medicine ,Diabetes Mellitus ,Humans ,Radiology, Nuclear Medicine and imaging ,Positron Emission Tomography-Computed Tomography ,Aged ,business.industry ,General Medicine ,Corpus Striatum ,030220 oncology & carcinogenesis ,Hyperglycemia ,Cardiology ,Fdg pet ct ,Female ,medicine.symptom ,Radiopharmaceuticals ,business - Abstract
Chorea induced by diabetic nonketotic hyperglycemia is a rare and poorly understood entity with a favorable prognosis after correction of the hyperglycemia. We present a case of elderly diabetic woman with poorly controlled blood glucose levels, presenting with choreiform movements limited to the right side. F-FDG PET/CT showed marked hypometabolism in the basal ganglia contralateral to the side with hemichorea. The metabolic dysfunctions lead to nonketotic hyperglycemic chorea, although poorly understood; the index case demonstrated severe glucose hypometabolism in the striatum and adds to the other reported differential diagnoses for striatal hypometabolism.
- Published
- 2019
128. Management of bladder pheochromocytoma by transurethral resection
- Author
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Ravimohan S. Mavuduru, Bhagwant Rai Mittal, Vikas Kumar Panwar, Girdhar S. Bora, Aditya Prakash Sharma, and Shrawan Kumar Singh
- Subjects
medicine.medical_specialty ,endocrine system ,endocrine system diseases ,Bladder ,030232 urology & nephrology ,Case Report ,Pheochromocytoma ,Endoscopic management ,lcsh:RC870-923 ,urologic and male genital diseases ,Resection ,Paraganglioma ,03 medical and health sciences ,0302 clinical medicine ,medicine ,neoplasms ,business.industry ,Genitourinary system ,Transurethral resection ,medicine.disease ,Hypertensive crisis ,lcsh:Diseases of the genitourinary system. Urology ,Surgery ,nervous system ,030220 oncology & carcinogenesis ,business - Abstract
Bladder pheochromocytoma is the most common extra-adrenal genitourinary tumor. Endoscopic management is feared due to the risk of intra-operative hypertensive crisis. We described a case of successful endoscopic management of a bladder pheochromocytoma and discussed its technical aspects. Keywords: Transurethral resection, Bladder, Pheochromocytoma, Paraganglioma
- Published
- 2018
129. 99mTc-TRODAT-1 SPECT/CT imaging as a complementary biomarker in the diagnosis of parkinsonian syndromes
- Author
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Ritu Shree, Priya Bhusari, Sahil Mehta, Manoj Kumar Goyal, Jaya Shukla, Manish Modi, Rakhee Vatsa, Bhagwant Rai Mittal, and Apurva Sood
- Subjects
Male ,medicine.medical_specialty ,Single Photon Emission Computed Tomography Computed Tomography ,Movement disorders ,99mtc trodat 1 ,education ,Disease ,030218 nuclear medicine & medical imaging ,Parkinsonian syndromes ,03 medical and health sciences ,0302 clinical medicine ,Parkinsonian Disorders ,Dopamine ,Basal ganglia ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,health care economics and organizations ,business.industry ,Organotechnetium Compounds ,General Medicine ,Middle Aged ,Biomarker (medicine) ,Female ,Radiology ,Ct imaging ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Tropanes ,medicine.drug - Abstract
Parkinson's disease (PD) and Parkinson plus syndromes (PPS) are neurodegenerative movement disorders caused by loss of dopamine in the basal ganglia. The diagnosis of both PD and PPS is complex as it is made solely on the basis of clinical features, with no established imaging modality to aid in the diagnosis. Technetium-99m-labeled tropane derivative (Tc-TRODAT-1) binds to the dopamine transporters present in the presynaptic membrane of the dopaminergic nerve terminal. The aim of this prospective study was to investigate the potential usefulness of Tc-TRODAT-1 imaging in the diagnosis of PD and PPS.Fifty-eight patients with a clinical diagnosis of idiopathic PD or PPS were recruited. The severity of the disease was assessed using the Hoehn and Yahr scale. Patients in stage I and II were considered as cases of Early PD. Twenty-five apparently healthy volunteers served as controls. Brain single-photon emission computed tomography/computed tomography in all the participants was performed 3-4 h after an injection of Tc-TRODAT-1. Specific uptake ratios (SURs) of striatum were calculated for both the left and right striatum, and the values were compared between PD, PPS, and healthy volunteers.A significant lower uptake of tracer activity was found in either of the striatum in PD and PPS cases compared with the control group, which showed a symmetrical comma-shaped striatal uptake. This was also reflected in the SUR values, which were significantly higher in the control group in comparison with the PD and PPS patients (P0.001). A significant difference was also found in the SUR values between the cases of early PD and control group (P0.001).No significant difference was noted among the SUR values in different Hoehn and Yahr stages.For clinical practice, both the visual analysis and the quantitative parameters of Tc-TRODAT-1 single-photon emission computed tomography/computed tomography showed usefulness in distinguishing cases of PD and PPS from the healthy individuals.
- Published
- 2018
130. 18F-FDG PET/CT in Diagnostic and Prognostic Evaluation of Patients With Suspected Recurrence of Chondrosarcoma
- Author
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Rajender Kumar Basher, Nandita Kakkar, Bhagwant Rai Mittal, Apurva Sood, Arun Kumar Reddy Gorla, Shelvin Kumar Vadi, Ramesh Kumar Sen, and Ashwani Sood
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Chondrosarcoma ,Bone Neoplasms ,Kaplan-Meier Estimate ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Tumor grade ,0302 clinical medicine ,Text mining ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Ct findings ,neoplasms ,Aged ,Retrospective Studies ,business.industry ,Fdg uptake ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Survival Rate ,carbohydrates (lipids) ,ROC Curve ,030220 oncology & carcinogenesis ,Female ,Fdg pet ct ,Radiology ,business ,Previously treated - Abstract
The aim of the study was to analyze the diagnostic and prognostic utility of F-FDG PET/CT to predict the disease-specific survival (DSS) with FDG uptake and tumor grade in recurrent chondrosarcoma.Retrospective analysis of FDG PET/CT findings in 31 previously treated patients (46 studies) with mean follow-up period of 40.7 ± 23.9 months (range, 3-77 months) from the date of first PET/CT study was done. Kaplan-Meier DSS analysis was made with respect to tumor grade, FDG uptake at the recurrent primary sites, and a combination of grade and FDG uptake as parameters.Recurrence (local and distant) was shown in 28 (60.8%) of 46 FDG PET/CT studies with sensitivity and specificity of 88.9% and 78.9%, respectively. The median SUVmax at the recurrent primary sites differed significantly (P = 0.008) among 3 tumor grade groups, with higher median SUVmax in higher grades. There was significant difference in median SUVmax among different grade groups except between grade II and grade III. Recurrent primary site SUVmax cutoff at 6.15 derived from the receiver operating characteristic curve yielded significant difference (P0.001) in mean DSS time. Significant difference in survival was noted between 3 different tumor grade groups (P = 0.016). The combination of SUVmax and grade improved the survival prediction than with grade alone.In recurrent chondrosarcoma, the recurrent primary site FDG uptake and grade were found to be reliable prognostic factors with respect to DSS. PET/CT in recurrence setting has the potential to predict tumor grade and survival and may assist in clinical management.
- Published
- 2018
131. Role of Tc-99m sestamibi SPECT/CT myocardial perfusion imaging in management of spontaneous coronary artery dissection: A case report
- Author
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Ajay Bahl, Madan Parmar, Ashwani Sood, Bhagwant Rai Mittal, Deepa Singh, and Shelvin Kumar Vadi
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Dissection (medical) ,030204 cardiovascular system & hematology ,medicine.disease ,Coronary arteries ,03 medical and health sciences ,Myocardial perfusion imaging ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,Medicine ,030212 general & internal medicine ,business ,Artery dissection ,Scad ,Perfusion ,Sporadic disorder - Abstract
Spontaneous coronary artery dissection (SCAD) is a rare sporadic disorder of abrupt dissection in the coronary arteries resulting in impaired perfusion to the myocardium. The authors present two cases of SCAD where myocardial perfusion imaging (MPI) done for assessment of myocardial viability helped in deciding the definitive management.
- Published
- 2018
132. 18F-fluorodeoxyglucose positron emission tomography-based evaluation of systemic and vascular inflammation and assessment of the effect of systemic treatment on inflammation in patients with moderate-to-severe psoriasis: A randomized placebo-controlled pilot study
- Author
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Sujit Rajagopalan, Sunil Dogra, Samir Malhotra, Tarun Narang, Keshavamurthy Vinay, Sharonjeet Kaur, Savita Verma Attri, Ajay Bahl, Bhagwant Rai Mittal, and Nusrat Shafiq
- Subjects
Adult ,Male ,medicine.medical_specialty ,Randomization ,Pilot Projects ,Standardized uptake value ,Dermatology ,030204 cardiovascular system & hematology ,Systemic inflammation ,Placebo ,Severity of Illness Index ,Gastroenterology ,fluorodeoxyglucose positron emission tomography/computed tomography ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Fluorodeoxyglucose F18 ,Psoriasis ,Internal medicine ,lcsh:Dermatology ,Humans ,Medicine ,Prospective Studies ,Vascular Diseases ,Inflammation ,systemic inflammation ,medicine.diagnostic_test ,business.industry ,psoriasis ,Middle Aged ,lcsh:RL1-803 ,medicine.disease ,Atherosclerosis ,Infectious Diseases ,Positron emission tomography ,Positron-Emission Tomography ,Female ,Methotrexate ,maximum standardized uptake value ,Dermatologic Agents ,medicine.symptom ,business ,Pioglitazone ,medicine.drug - Abstract
Background: Psoriasis is a systemic inflammatory disorder associated with an increased risk of cardiovascular disease. Objective: To evaluate the utility of [[18]F]-fluorodeoxyglucose positron emission tomography/computed tomography in identifying vascular and systemic inflammation in psoriasis patients with moderate-to-severe disease and to analyze its usefulness in assessing the effect of systemic treatment. Methods: This was a randomized, double-blind pilot study conducted in a tertiary care center. Baseline standardized uptake value score was estimated by18F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with moderate-to-severe psoriasis and compared with historical controls. Patients were then randomized using computer-generated randomization list into methotrexate or placebo (with or without pioglitazone) groups.18F-fluorodeoxyglucose positron emission tomography/computed tomography was repeated at 12 weeks and composite standardized uptake value score determined. The correlation between Psoriasis Activity and Severity Index and SUVmax was assessed. Results: A total of 16 patients were randomized to different treatment groups. Significant increase in mean SUVmax was observed in the ascending aorta in psoriasis patients as compared to historical controls (2.03 ± 0.53 vs 1.51 ± 0.36, P < 0.03). There was no difference in composite standardized uptake value score after 12 weeks of treatment in any of the treatment groups (P = 0.82), although an improvement in Psoriasis Activity and Severity Index score in the methotrexate arm was observed. No correlation was found between mean SUVmax and Psoriasis Activity and Severity Index scores in various aortic segments (r = 0.3–0.7). Limitations: Small sample size, short follow-up, historical controls, exclusion of patients with comorbid conditions and lack of surrogate markers of systemic inflammation. Conclusion: 18F-fluorodeoxyglucose positron emission tomography imaging showed higher vascular inflammation in ascending aorta of psoriasis patients as compared to historical controls. Systemic treatment with methotrexate and pioglitazone did not influence the vascular inflammation in the short term.
- Published
- 2018
133. F-18 Fluorodeoxyglucose Positron-Emission Tomography-Computed Tomography in a Case of Extensive Multi-Organal Extranodal Lymphoma with Cardiac Involvement Mimicking Apical Hypertrophic Obstructive Cardiomyopathy: Staging and Response Evaluation
- Author
-
Ashwin Singh Parihar, Rajender Kumar, Pankaj Malhotra, Bhagwant Rai Mittal, Shelvin Kumar Vadi, and Harmandeep Singh
- Subjects
Fluorodeoxyglucose ,medicine.medical_specialty ,Chemotherapy ,medicine.diagnostic_test ,cardiac lymphoma ,response evaluation ,business.industry ,medicine.medical_treatment ,diffuse large B-cell lymphoma ,Computed tomography ,medicine.disease ,Obstructive cardiomyopathy ,extranodal lymphoma ,Lymphoma ,Extranodal lymphoma ,medicine ,hypertrophic obstructive cardiomyopathy ,18F fluorodeoxyglucose positron-emission tomography-computed tomography ,Radiology, Nuclear Medicine and imaging ,Interesting Image ,Radiology ,Tomography ,business ,Diffuse large B-cell lymphoma ,medicine.drug - Abstract
18F fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) is a standard imaging tool in staging as well as response evaluation for lymphoma. Here, we present a young male with extensive extranodal lymphoma with cardiac involvement which presented as diffuse myocardial lesion mimicking hypertrophic obstructive cardiomyopathy. 18F-FDG PET/CT helped in the staging by revealing multiple systemic involvements. Interim PET after three cycles of chemotherapy showed a complete metabolic response to therapy in all the extranodal sites including the cardiac involvement, thus retrospectively confirming the lymphomatous involvement. Previous literature also conforms to the superior role of 18F-FDG PET/CT in the clinical management of extensive extranodal lymphoma.
- Published
- 2018
134. Active herpes zoster infection involving lumbosacral dermatome, an unusual site of manifestation and incidental finding in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography scan
- Author
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Gaurav Prakash, Bhagwant Rai Mittal, Deepa Singh, Anish Bhattacharya, and Rajender Kumar
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,lcsh:R895-920 ,Case Report ,030218 nuclear medicine & medical imaging ,Vulva ,03 medical and health sciences ,0302 clinical medicine ,lymph nodes ,Dermatomal ,Cutaneous lesions ,medicine ,Right Thigh ,Fluorodeoxyglucose ,medicine.diagnostic_test ,business.industry ,herpes zoster virus ,medicine.disease ,Lymphoma ,medicine.anatomical_structure ,Dermatome ,Positron emission tomography ,fluorine-18 fluorodeoxyglucose positron emission tomography ,030220 oncology & carcinogenesis ,Radiology ,business ,Lumbosacral joint ,lumbosacral dermatome ,medicine.drug - Abstract
Herpes zoster virus reactivation in the lumbosacral dermatomal distribution is an unusual site of manifestation and atypical in presentation than its usual sites in thoracolumbar (D3–L2) and facial (V1) dermatomes. Here, we are reporting a patient of marginal zone lymphoma who on fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography scan performed for chemotherapy response evaluation showed hypermetabolic cutaneous and subcutaneous lesions in the right vulva and posteromedial aspect of the right thigh along with ipsilateral pelvic lymph nodes involvement as an incidental finding. Subsequently, FDG active lesions were considered to be as herpes zoster virus reactivation rather than the recurrence of lymphoma and treated with antiviral drug.
- Published
- 2018
135. Reversible perfusion defect in hypertrophied papillary muscle on myocardial perfusion imaging: The ‘filled doughnut sign’
- Author
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Ajay Bahl, Madan Parmar, Shelvin Kumar Vadi, Uma Debi, Ashwani Sood, Bhagwant Rai Mittal, Mohamed Yaser, and Prashant Panda
- Subjects
Male ,medicine.medical_specialty ,Adenosine ,Heart Ventricles ,Myocardial Ischemia ,Myocardial perfusion imaging ,Internal medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,Gamma Cameras ,Radiology, Nuclear Medicine and imaging ,Papillary muscle ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Hypertrophy ,Middle Aged ,Papillary Muscles ,Magnetic Resonance Imaging ,Perfusion ,medicine.anatomical_structure ,Echocardiography ,Hypertension ,Exercise Test ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Sign (mathematics) - Published
- 2019
136. Isolated Involvement of Prostate Gland by Immunoglobulin G4–Related Disease Diagnosed With the Help of FDG PET/CT
- Author
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Rajender Kumar, Rakesh Kochhar, Harmandeep Singh, Bhagwant Rai Mittal, Anish Bhattacharya, and Kousik Vankadari
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Prostate ,General Medicine ,Disease ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Fluorodeoxyglucose F18 ,Immunoglobulin G ,Positron Emission Tomography Computed Tomography ,030220 oncology & carcinogenesis ,Immunoglobulin g4 ,medicine ,Humans ,Abdomen ,Radiology, Nuclear Medicine and imaging ,Fdg pet ct ,Immunoglobulin G4-Related Disease ,Radiology ,Prostate gland ,business - Abstract
Immunoglobulin G4 (IgG4)-related disease is known to mimic multiple malignancies and always poses a diagnostic challenge. We report a case of a 20-year-old young man, who presented with unexplained recurrent episodes of fever and pain abdomen. F-FDG PET/CT revealed intense focal FDG avidity in the prostate. On further workup, he had an elevated serum IgG4 level, and a clinical diagnosis of immunoglobulin G4-related disease was kept. A follow-up FDG PET/CT after glucocorticoid therapy revealed resolution of FDG avidity in the prostate with fall in serum IgG4 levels, hence confirming a diagnosis of atypical immunoglobulin G4-related disease involving isolated prostate gland.
- Published
- 2019
137. 68Ga-DOTA-Exendin PET-MRI Fusion Imaging in a Case of Insulinoma
- Author
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Mandeep Kang, Rithambhra Nada, Rama Walia, Arunanshu Behera, Rajender Kumar Basher, Bhagwant Rai Mittal, Anish Bhattacharya, Jaya Shukla, and Apurva Sood
- Subjects
Adult ,endocrine system ,medicine.medical_specialty ,medicine.disease_cause ,Multimodal Imaging ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Culprit lesion ,Organometallic Compounds ,medicine ,Humans ,DOTA ,Radiology, Nuclear Medicine and imaging ,Pet tracer ,Receptor ,Hyperinsulinemic hypoglycemia ,Insulinoma ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Dihydroxyphenylalanine ,Pancreatic Neoplasms ,chemistry ,Positron emission tomography ,Positron-Emission Tomography ,030220 oncology & carcinogenesis ,Female ,Radiology ,Radiopharmaceuticals ,Peptides ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Persistent hyperinsulinemic hypoglycemia in adults is most commonly caused by insulinomas, which pose a diagnostic challenge to physicians, surgeons, and radiologists and require multimodality imaging for precise localization and staging. PET tracers such as F-FDOPA and glucagon-like peptide 1 receptor analogs have been used for imaging insulinomas. Glucagon-like peptide 1 receptor analogs have recently shown promising results in preoperative localization of these tumors, as all insulinomas express glucagon-like peptide 1 receptors. Ga-DOTA-Exendin PET and MRI done in the present case helped in precise localization and management of the culprit lesion, whereas contrast-enhanced CT and F-FDOPA PET failed to do so.
- Published
- 2019
138. 68Ga-DOTANOC PET/CT in an Atypical Extraskeletal Paravertebral Hemangioma Mimicking as Neurogenic Tumor in a Known Case of Breast Cancer
- Author
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Harmandeep Singh, Shelvin Kumar Vadi, Rajender Kumar, Bhagwant Rai Mittal, Gurpreet Singh, and Ashwin Singh Parihar
- Subjects
Pathology ,medicine.medical_specialty ,Neoplasms, Nerve Tissue ,Breast Neoplasms ,Neuroendocrine tumors ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Hemangioma ,Pheochromocytoma ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Paraganglioma ,Positron Emission Tomography Computed Tomography ,Organometallic Compounds ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,business.industry ,Somatostatin receptor ,General Medicine ,Middle Aged ,medicine.disease ,Oncogenic osteomalacia ,030220 oncology & carcinogenesis ,Female ,Radiopharmaceuticals ,business - Abstract
Ga-DOTANOC PET/CT is well documented in evaluation of well-differentiated neuroendocrine tumors and in other lesions with somatostatin receptor expression such as pheochromocytoma, paraganglioma, neuroblastoma, meningioma, and mesenchymal tumors causing oncogenic osteomalacia. Causes of interpretative pitfalls include prominent pancreatic uncinate process activity, inflammation, osteoblastic activity (degenerative bone disease/fracture/vertebral hemangioma), splenunculi/splenosis, and others. We present a case of extraskeletal paravertebral lesion detected in a known case of breast cancer with increased Ga-DOTANOC uptake later proved to be hemangioma. This is a novel finding and should be kept as a rare benign differential in evaluation of lesions with somatostatin receptor expression.
- Published
- 2019
139. Evaluation of recurrent parathyroid carcinoma: A new imaging tool in uncommon entity
- Author
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Bhagwant Rai Mittal, N. T. K. Thanseer, Sanjay Kumar Bhadada, Divya Dahiya, Priyanka Singh, Ashwani Sood, and Ashwin Singh Parihar
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,endocrine system diseases ,lcsh:R895-920 ,Computed tomography ,Case Report ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Imaging Tool ,medicine ,positron emission tomography and computed tomography ,Recurrent parathyroid carcinoma ,Parathyroid adenoma ,medicine.diagnostic_test ,business.industry ,Distant recurrence ,Rare entity ,medicine.disease ,18F-fluorocholine ,Parathyroid carcinoma ,Positron emission tomography ,030220 oncology & carcinogenesis ,Radiology ,18F-fluorodeoxyglucose ,business ,recurrent parathyroid carcinoma - Abstract
Parathyroid carcinoma (PTC) is a rare endocrine tumor and uncommon cause for primary hyperparathyroidism.18F-fluorocholine (FCH) positron emission tomography and computed tomography (PET/CT) has shown promising results in the detection of parathyroid adenoma, though its role in PTC is undefined due to the paucity of incidence. The authors in this case report discuss the possible complimentary role of FCH PET/CT with 18F-fluorodeoxyglucose PET/CT in the evaluation of the management of suspected recurrence, since this rare entity has high loco-regional and distant recurrence of the disease.
- Published
- 2019
140. Comparative Effectiveness of Ultrasonography, 99mTc-Sestamibi, and 18F-Fluorocholine PET/CT in Detecting Parathyroid Adenomas in Patients With Primary Hyperparathyroidism
- Author
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Arun Kumar Reddy Gorla, Priyanka Singh, Bhagwant Rai Mittal, Renjith R. Kalathoorakathu, Arunanshu Behera, Ntk Thanseer, Divya Dahiya, Ashwani Sood, Uma Nahar Saikia, Sudhaker D Rao, and Sanjay Kumar Bhadada
- Subjects
Adenoma ,Adult ,Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Choline ,030218 nuclear medicine & medical imaging ,Lesion ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Prospective Studies ,Prospective cohort study ,Aged ,Ultrasonography ,PET-CT ,Hyperparathyroidism ,Parathyroid neoplasm ,business.industry ,General Medicine ,Middle Aged ,Hyperparathyroidism, Primary ,medicine.disease ,Parathyroid Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Parathyroid gland ,Radiology ,medicine.symptom ,business ,Primary hyperparathyroidism - Abstract
PURPOSE Accurate preoperative localization of parathyroid lesion(s) is crucial for successful surgical management of primary hyperparathyroidism (PHPT). This study was conducted to compare the effectiveness of ultrasonography (USG) of the neck, Tc-sestamibi (MIBI) imaging with or without SPECT/CT, and F-fluorocholine (FCH) PET/CT imaging in the preoperative localization of parathyroid lesions in patients with PHPT. METHODS Fifty-four consecutive patients with PHPT were included in this prospective study who underwent preoperative localization of the parathyroid lesion(s) using 3 diagnostic modalities followed by surgery. The sensitivity, positive predictive value, and accuracy of the 3 imaging procedures to accurately detect abnormal parathyroid glands were determined using histopathology as criterion standard with postoperative biochemical response confirmation. RESULTS F-fluorocholine PET/CT detected 52 of 54 patients and 52 of 56 lesions with histopathologically proven parathyroid adenomas on patient-based and lesion-based analysis, respectively. Preoperative USG, MIBI, and FCH PET/CT localized abnormal parathyroid gland(s) in 39 (72.2%), 43 (79.6%), and 54 (100%) patients, respectively. The sensitivity and positive predictive value were 69.3% and 87.1% for USG, 80.7% and 97.6% for MIBI, and 100% and 96.3% for FCH PET/CT. The accuracy was 62.9%, 79.6%, and 96.3% for USG, MIBI, and FCH PET/CT, respectively, in patient-wise analysis. In 6 patients with ectopic lesions, FCH PET/CT demonstrated higher sensitivity and accuracy than MIBI and USG (100% vs 66.6% and 16.7%, respectively). CONCLUSIONS Among the 3 imaging techniques tested simultaneously, FCH PET/CT was superior for accurate preoperative localization of parathyroid adenomas, especially for ectopic or small parathyroid lesions.
- Published
- 2017
141. Invasive Duct Carcinoma of the Breast With Dominant Signet-Ring Cell Differentiation: A Microsatellite Stable Tumor With Aggressive Behavior
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Amanjit Bal, Pavneet Singh Kohli, Ashim Das, Debajyoti Chatterjee, Bhagwant Rai Mittal, and Gurpreet Singh
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Adult ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,Pathology ,Histology ,Breast Neoplasms ,MLH1 ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Signet ring cell carcinoma ,Carcinoma ,PMS2 ,Humans ,Medicine ,Aged ,business.industry ,Signet ring cell ,Carcinoma, Ductal, Breast ,Microsatellite instability ,Middle Aged ,Prognosis ,medicine.disease ,Immunohistochemistry ,digestive system diseases ,DNA-Binding Proteins ,Medical Laboratory Technology ,MutS Homolog 2 Protein ,030104 developmental biology ,MSH2 ,030220 oncology & carcinogenesis ,Female ,business ,Carcinoma, Signet Ring Cell ,Microsatellite Repeats - Abstract
Aims Invasive duct carcinoma, no special type (IDC, NST), of the breast with signet-ring cell differentiation is uncommon. This study was undertaken to describe the clinicopathologic characteristics of IDC, NST, with dominant signet-ring cell differentiation, and look for microsatellite instability in these tumors. Methods Cases of IDC, NST, with dominant signet-ring cell differentiation, diagnosed over the past 2 years, were retrieved. Detailed clinical and pathologic analyses were performed. Immunohistochemistry was performed for estrogen receptor, progesterone receptors, Her-2 neu, Ki-67, E-cadherin, CK7, and CK20. Microsatellite instability was examined using immunohistochemistry for the 4 mismatch repair proteins: MLH1, MSH2, MSH6, and PMS2. Results Of the total 1646 cases of IDC, NST, only 5 cases showed dominant signet-ring cells (ranging from 70% to 100%) and strong E-cadherin positivity and were diagnosed as IDC, NST, with dominant signet-ring cell differentiation. The age ranged from 32 to 65 years. Two cases were of histologic grade 3 and the remaining cases were grade 2 tumors. Four patients had T2 tumor and 1 had T3 tumor. All cases had axillary lymph node metastasis and distant metastasis was present in 1 case. All cases were microsatellite stable. Conclusions Signet-ring cell differentiation in IDC, NST, is rare and associated with a high histologic grade. Lymph node metastasis and distant metastasis are common, indicating an aggressive clinical behavior. Thus, they should be recognized separately as they may warrant aggressive management. However, these are microsatellite-stable tumors in contrast to signet-ring cell tumors of other organs.
- Published
- 2017
142. Flip-flop right ventricle myocardial perfusion on stress-rest 99mTc-MIBI myocardial perfusion scintigraphy: An indirect evidence for severe left ventricular coronary arterial disease?
- Author
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Ashwani Sood, Bhagwant Rai Mittal, Madan Parmar, Vaishnavi Dasagrandhi, Komalpreet Kaur, Saurabh Mehrotra, and Shelvin Kumar Vadi
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medicine.medical_specialty ,medicine.diagnostic_test ,Arterial disease ,business.industry ,Indirect evidence ,Myocardial perfusion imaging ,Coronary circulation ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Technetium Tc 99m Sestamibi ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Rest (music) - Published
- 2018
143. Stress-induced ischemia in the right ventricular myocardium on 99mTc-MIBI myocardial perfusion scintigraphy in a rare case of double-chambered right ventricle
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Bhagwant Rai Mittal, Madan Parmar, Palanivel Rajan, Shelvin Kumar Vadi, Komalpreet Kaur, Ashwani Sood, and Manoj Kumar Rohit
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Stress induced ,Ischemia ,medicine.disease ,Right ventricular myocardium ,Myocardial perfusion imaging ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Rare case ,Myocardial perfusion scintigraphy ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Technetium Tc 99m Sestamibi ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
144. COVID-19 related multisystem inflammatory syndrome in children (MIS-C): Role of 18F-FDG PET/CT to assess myocardial involvement
- Author
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Venkata Subramanian Krishnaraju, Anwin Joseph Kavanal, Prateek Deo, Arivan Ramachandran, Bhagwant Rai Mittal, Rajender Kumar, Varun Dhir, and Swayamjeet Satapathy
- Subjects
Pathology ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,Text mining ,medicine ,Radiology, Nuclear Medicine and imaging ,Fdg pet ct ,Cardiology and Cardiovascular Medicine ,business ,Images That Teach - Published
- 2021
145. Docetaxel-Induced Interstitial Pneumonitis Detected on 68Ga-PSMA PET/CT
- Author
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Bhagwant Rai Mittal, Harmandeep Singh, Rajender Kumar, Chandan Krushna Das, and Sunil Kumar
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Male ,Oncology ,Biochemical recurrence ,medicine.medical_specialty ,Gallium Radioisotopes ,Docetaxel ,urologic and male genital diseases ,030218 nuclear medicine & medical imaging ,Interstitial pneumonitis ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Text mining ,Positron Emission Tomography Computed Tomography ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Drug reaction ,neoplasms ,Edetic Acid ,Gallium Isotopes ,Aged ,PET-CT ,business.industry ,68ga psma ,Prostatic Neoplasms ,General Medicine ,medicine.disease ,030220 oncology & carcinogenesis ,Lung Diseases, Interstitial ,business ,Oligopeptides ,therapeutics ,medicine.drug - Abstract
68Ga-PSMA PET/CT is a commonly performed procedure in the staging of intermediate- and high-risk prostate cancer after biochemical recurrence. Uptake of 68Ga-PSMA in benign conditions is also reported in the literature. Docetaxel is the mainstay of treatment in high-volume hormone-sensitive prostate cancer and castration-resistant prostate cancer. The major treatment-emergent adverse drug reactions attributed to docetaxel include myelosuppression, alopecia, and asthenia. Interstitial pneumonitis is seen in less than 2% of docetaxel-treated patients. We present a case of metastatic castration-resistant prostate cancer, wherein docetaxel-induced interstitial pneumonitis was detected on 68Ga-PSMA PET/CT, after docetaxel treatment.
- Published
- 2020
146. Infection imaging using [18F]FDG-labelled white blood cell positron emission tomography–computed tomography
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Rajender Kumar, Bhagwant Rai Mittal, Anish Bhattacharya, Sarika Sharma, Venkata Subramanian Krishnaraju, and Harmandeep Singh
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Gallium citrate ,Pictorial Review ,Infections ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,White blood cell ,Leukocytes ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Infection imaging ,Positron Emission Tomography-Computed Tomography ,Chemistry ,business.industry ,Positron emitters ,General Medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Inflammatory cascade ,Radiopharmaceuticals ,Nuclear medicine ,business - Abstract
Localizing the sites of infection in the body is possible in nuclear medicine using a variety of radiopharmaceuticals that target different components of the infective and inflammatory cascade. Gamma(γ)-emitting agents such as [67Ga]gallium citrate were among the first tracers used, followed by development of positron-emitting tracers like 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG). Though these tracers are quite sensitive, they have limited specificity for infection due to their concentration in sites of non-infective inflammation. White blood cells (WBC) labelled with γ or positron emitters have higher accuracy for differentiating the infective processes from the non-infective conditions that may show positivity with tracers such as 18F-FDG. We present a pictorial review of potential clinical applications of PET/CT using 18F-FDG labelled WBC.
- Published
- 2021
147. Fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography masquerading as a case of sporadic malignant peripheral nerve sheath tumor of lower extremity presenting as massive lower limb edema
- Author
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Deepa Singh, Bhagwant Rai Mittal, Subhash Varma, Ashim Das, and Rajender Kumar
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,Neurofibromatosis type I ,medicine.medical_specialty ,Pathology ,medicine.diagnostic_test ,business.industry ,lcsh:R895-920 ,Fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography ,medicine.medical_treatment ,Case Report ,Malignant peripheral nerve sheath tumor ,Magnetic resonance imaging ,medicine.disease ,Malignant transformation ,neurofibromatosis Type I ,Lymphedema ,Amputation ,Positron emission tomography ,Medicine ,malignant peripheral nerve sheath tumors ,Radiology ,Neurofibromatosis ,business - Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare neuroectodermal tumors resulting from the malignant transformation of benign plexiform neurofibromas. The sporadic form of these tumors is rare than familial variants (seen in neurofibromatosis Type 1) and making the diagnosis difficult. We are presenting a case of 40–-year-old female with the complaint of progressive swelling of lower limb with initial suspicion of lymphedema and underwent lymphoscintigraphy, magnetic resonance imaging, and finally fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scans were done to rule out mitotic etiology and extent of the disease. The patient underwent below-knee amputation, and histopathological examination confirmed the diagnosis of sporadic MPNST.
- Published
- 2017
148. Role of inflammatory and hemostatic biomarkers in Alzheimer’s and vascular dementia – A pilot study from a tertiary center in Northern India
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Manish Modi, Venugopalan Y Vishnu, S. Prabhakar, Bhagwant Rai Mittal, Vivek Garg, Manoj Kumar Goyal, Manju Mohanty, and Vivek Lal
- Subjects
Pathology ,medicine.medical_specialty ,India ,Pilot Projects ,030204 cardiovascular system & hematology ,Fibrinogen ,Sensitivity and Specificity ,Gastroenterology ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Alzheimer Disease ,Internal medicine ,mental disorders ,D-dimer ,medicine ,Humans ,Dementia ,Neuropsychological assessment ,Vascular dementia ,Interleukin 6 ,General Psychology ,biology ,medicine.diagnostic_test ,Interleukin-6 ,business.industry ,Dementia, Vascular ,C-reactive protein ,Brain ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Psychiatry and Mental health ,C-Reactive Protein ,Positron-Emission Tomography ,Disease Progression ,biology.protein ,Biomarker (medicine) ,business ,Biomarkers ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Introduction A reliable plasma biomarker in differentiating between Alzheimer’s disease (AD) and Vascular dementia (VaD) is the need of the hour, in most memory clinics. Even though there is no disease modifying treatment, it is important to know the type of dementia for both symptomatic treatment and prognostication. Methods Neuropsychological assessment, MRI brain, FDG-PET brain and CSF biomarkers of AD (Aβ42 and total tau) were used for establishing the diagnosis of Mild Cognitive Impairment (MCI), AD or VaD. Results 68 diagnosed patients of AD/MCI/VaD were included. FDG PET brain, plasma fibrinogen, d dimer, IL6 and CRP were done in all 68 patients while 48 patients underwent CSF biomarker analysis. Sixteen patients had MCI, of which 11 were MCI-AD and 5 were MCI-VaSC. There were 41 patients with AD (Mild AD-9, Mod AD-23, Severe AD-9) and 11 patients with VaD. Alzheimer group (MCI-AD and AD) and Vascular group (MCI VaSC & VaD) consisted of 52 and 16 patients respectively. Alzheimer and Vascular groups did not exhibit significant difference in IL6 and CRP levels. Plasma fibrinogen levels were significantly higher in VaD and vascular group as compared to Alzheimer group. But MCI-VaSC was not significantly different from MCI-AD. Plasma d dimer levels were significantly higher in all vascular subgroups compared to Alzheimer subgroups except between MCI-VaSC and MCI-AD. Conclusion Hemostatic biomarkers were higher in Vascular group compared to Alzheimer group whereas there was no difference in inflammatory biomarkers. But the sensitivity and specificity of fibrinogen and d -dimer were not high enough for routine clinical use. Further studies in a larger sample are required to confirm these results.
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- 2017
149. Fluorodeoxyglucose-positron emission tomography/computed tomography performs better than contrast-enhanced computed tomography for metastasis evaluation in the initial staging of pancreatic adenocarcinoma
- Author
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Deepak K. Bhasin, Bhagwant Rai Mittal, Ashim Das, Surinder Singh Rana, Ritambhra Nada, Sampath Santhosh, and Rajesh Gupta
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreatic malignancy ,Statistical difference ,Contrast Media ,Nodal staging ,Computed tomography ,Adenocarcinoma ,Sensitivity and Specificity ,Metastasis ,Fluorodeoxyglucose positron emission tomography ,03 medical and health sciences ,0302 clinical medicine ,McNemar's test ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Neoplasm Staging ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,General Medicine ,Middle Aged ,Image Enhancement ,medicine.disease ,Pancreatic Neoplasms ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,Radiopharmaceuticals ,Tomography, X-Ray Computed ,business - Abstract
To evaluate the additional role of FDG-PET/CT to the conventional multiphasic CECT in the initial staging of pancreatic adenocarcinoma. 54 patients diagnosed with pathologically proven pancreatic malignancy underwent FDG-PET/CECT. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal and metastatic staging were calculated. The statistical difference was calculated by McNemar’s test. Of 54 patients, 15 had distal metastasis. The sensitivity, specificity, PPV, NPV, and accuracy of PET/CT and CECT for nodal staging were 33 vs 89%, 84 vs 100%, 67 vs 100%, 60 vs 90%, and 59 vs 95%, respectively, p
- Published
- 2017
150. Infiltrative Optic Neuropathies: Opening Doors to Sinister Pathologies
- Author
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Kirti Gupta, Vivek Lal, Darakshan Naheed, Manoj Kumar Goyal, Ramandeep Singh, Aastha Takkar, Bhagwant Rai Mittal, Mohit Dogra, and Nalini Gupta
- Subjects
Pathology ,medicine.medical_specialty ,genetic structures ,business.industry ,Case Reports ,medicine.disease ,eye diseases ,03 medical and health sciences ,Ophthalmology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Edema ,Optic nerve ,Medicine ,sense organs ,Neurology (clinical) ,Pinealoblastoma ,medicine.symptom ,business ,Infiltration (medical) ,030217 neurology & neurosurgery ,Infiltrative optic neuropathy - Abstract
Optic disc edema may be caused by a number of conditions. A commonly ignored but important aspect is the presence of “infiltration” of disc; that may closely mimic disc edema. Disc edema, optic nerve dysfunction and a normal appearing disc in any combination may occur in infiltrative optic neuropathies. Identifying disc infiltration can aid in diagnosis of many sinister pathologies even in the absence of other specific clinical features. We describe two patients presenting with optic nerve dysfunction and infiltrated disc appearance, which on investigations were found to have underlying malignancies thereby underscoring the importance of detecting infiltrative optic neurpathies.
- Published
- 2017
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