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Key Clinical Message: If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Swift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy. Heterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding. [ABSTRACT FROM AUTHOR]

OBJECTIVE: A small percentage of acute pulmonary thromboembolisms (PTE) persist as chronic fibrin clots, potentially leading to chronic thromboembolic pulmonary hypertension (CTEPH). A scoring system for evaluating the burden of acute PTE based on computed tomography pulmonary angiogram (CTPA) findings was tested for its association with CTEPH within one year. MATERIAL AND METHODS: In this retrospective cohort of 475 patients with a definitive diagnosis of acute PTE, the Qanadli score (QS) was calculated on the initial CTPA. Through regular follow-up over 1 year, symptomatic patients underwent extensive evaluation. RESULTS: Of the 475 patients enrolled in the study [age 58.3 ± 16.6, 195 (41.1%) female, QS: 13.01 ± 7.37/40], 321 patients completed the study. A total of 22 (6.8%) patients were definitively diagnosed with CTEPH. In univariate analysis, the initial QS was significantly higher in patients with subsequent CTEPH than in patients without (17 ± 5.6 vs. 13 ± 7.6, P = .009). QS was directly associated with CTEPH (odds ratio: 1.08, 95% confidence interval: 1.0-1.16, P = .042). The evolution of CTEPH in men could be predicted with a sensitivity of 100% and a specificity of 54% when a cut-off point of 14.5 (43.5%) was set for QS. The area under the receiver operating characteristic curve in this setting was 0.74 with a P-value of .032. Qanadli score failed to predict CTEPH in women. CONCLUSION: Scoring the clot burden in the pulmonary arteries through the Qanadli method can predict the evolution of CTEPH only in men 1 year after acute PTE. Women comprise most of the CTEPH patients. Thus, strict follow-up adherence seems to be even more important in women. [ABSTRACT FROM AUTHOR]

Transurethral lithotripsy (TUL) procedure via ureteroscopy as an invasive method for nephrolithiasis treatment would lead to urinary tract injuries. In this reported case, the procedure caused severe damage to the left ureter that was detected by 99m Tc-diethylenetriaminepentaacetic acid (99m Tc-DTPA) scan. Generally, the TUL procedure through the ureter scope is used to manage urinary tract stones. In this case, the TUL was performed on a patient with a history of nephrolithiasis. Following that, she was accompanied with abdominal pain and discomfort, so 99m Tc-DTPA scintigraphy was performed to evaluate the urinary tract system. The scintigraphy showed a severe damage to the left ureter that finally resulted in autotransplantation. The control 99m Tc-DTPA scintigraphy performed 3 weeks after revealed no visible urinary leakage. In this case, the 99m Tc-DTPA scan prevented the patient from dangerous complications. So, 99m Tc-DTPA scan could be performed after TUL and ureteroscopy to detect probable risks. [ABSTRACT FROM AUTHOR]

Introduction: Myocardial perfusion SPECT by 99mTc-Sestamibi and 99mTc-Tetrofosmin radiopharmaceuticals usually presents a false significant increase in the radiotracer uptake in the inferior myocardium due to the uptake in organs such as liver, bowel, stomach and biliary system. The present study evaluated a suitable Slit angle for differentiating extra-cardiac activities by Slit Slat collimation. Methods: The Siemens E.CAM gamma camera equipped with a Low Energy High Resolution (LEHR) collimator was simulated with the Simulating Medical Imaging Nuclear Detectors (SIMIND)Monte Carlo program. Following the verification of the simulation, a Slit Slat collimator was simulated for SPECT imaging of a NURBS-based Cardiac Torso (NCAT) phantom with different Slit angels ranged from 0 to 30 degrees. The reconstructed images were qualitatively assessed with blinded observer method by three nuclear medicine specialists. Results: The improved differentiation of the bowel activity from the cardiac was obtained by a Slit-Slat collimator with the Slit angle of 7 degree. While for gastric activity differentiation an angle of 15 degree for the Slit was useful. Conclusion: The results showed that Slit Slat collimation with 7 and 15 Slit angle provide a suitable differentiation of the bowel and gastric activities from the cardia, respectively. [ABSTRACT FROM AUTHOR]

The collimator in single-photon emission computed tomography (SPECT) is a critical component of the imaging system and plays an impressive role in the imaging quality. In this study, the effect of the collimator material on the radioisotopic image and its functional parameters was studied. The simulating medical imaging nuclear detectors (SIMIND) Monte Carlo program was used to simulate a Siemens E.CAM SPECT (Siemens Medical Solutions, Erlangen, Germany) system equipped with a low-energy high-resolution (LEHR) collimator. The simulation and experimental data from the SPECT imaging modality using 99mTc were obtained on a point source and Jaszczak phantom. Seventeen high atomic number materials were considered as LEHR collimator materials. In order to determine the effect of the collimator material on the image and functional parameters, the energy resolution, spatial resolution, contrast, and collimator characteristics parameters such as septal penetration and scatter-to-primary ratio were investigated. Energy spectra profiles, full width at half maximums (FWHMs) (mm) of the point spread function (PSF) curves, system sensitivity, and contrast of cold spheres of the Jaszczak phantom for the simulated and experiment systems have acceptability superimposed. The results of FWHM and energy resolution for the 17 collimators showed that the collimator made of 98% lead and 2% antimony could provide the best FWHM and energy resolution, 7.68 mm and 9.87%, respectively. The LEHR collimator with 98% lead and 2% antimony offers the best resolution and contrast when compared to other high atomic number metals and alloys. [ABSTRACT FROM AUTHOR]