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A 68-year-old male, known case of abdominal aortic dissection and recent aortic stent insertion, presented with gross hematuria. The urologists suspected aoro-ureteric fistula and performed open surgery (ureterolysis). Tc-99m labeled red blood cell (99mTc-RBC) scintigraphy was ordered to confirm the diagnosis and localize the possible aorto-ureteric fisula, Considering sustained gross hematuria and ongoing anemia, and the fact that the patient had some degrees of renal insufficiency consequently not a candidate for contrast Computed Tomography (CT) angiography, a 99mTc-RBC blood pool study was requested instead. The dynamic planar images showed a zone of abnormal radiotracer accumulation in the left side of the aorta, which remained till the end of study. SPECT images revealed a left aorto-ureteric fistula approximately 8cm above the aortic bifurcation. [ABSTRACT FROM AUTHOR]

Purpose: (2RS,4S)-2-[F]Fluoro-4-phosphonomethyl-pentanedioic acid (BAY1075553) shows increased uptake in prostate cancer cells. We compared the diagnostic potential of positron emission tomography (PET)-X-ray computed tomography (CT) imaging using BAY1075553 versus [F]f luorocholine (FCH) PET-CT. Procedures: Twelve prostate cancer patients (nine staging, three re-staging) were included. The mean prostate-specific antigen in the primary staging and re-staging groups was 21.5 ± 12 and 73.6 ± 33 ng/ml, respectively. Gleason score ranged from 5-9. In nine patients imaged for pre-operative staging, the median Gleason score was 8 (range, 7-9). PET acquisition started with dynamic PET images in the pelvic region followed by static whole-body acquisition. The patients were monitored for 5-8 days afterward for adverse events. Results: There were no relevant changes in laboratory values or physical examination. Urinary bladder wall received the largest dose equivalent 0.12 mSv/MBq. The whole-body mean effective dose was 0.015 mSv/MBq. There was a significant correlation between detected prostatic lesions by the two imaging modalities (Kappa = 0.356, P < 0.001) and no significant difference in sensitivity ( P = 0.16) and specificity ( P = 0.41). The sensitivity and specificity of PET imaging using BAY1075553 for lymph node (LN) staging was 42.9 % and 100 %, while it was 81.2 % and 50 % using FCH. The two modalities were closely correlated regarding detection of LNs and bone metastases, although BAY1075553 failed to detect a bone marrow metastasis. Degenerative bone lesions often displayed intense uptake of BAY1075553. Conclusions: BAY1075553 PET-CT produced no adverse effects, was well tolerated, and detected primary and metastatic prostate cancer. FCH PET-CT results were superior, however, with respect to detecting LN and bone marrow metastases. [ABSTRACT FROM AUTHOR]

Evidence-based medicine (EBM) is defined as using the best available evidence for managing patients in daily healthcare practice. Although this approach has been applied successfully in many medical fields, it has not been addressed fully in the radiological discipline in general and nuclear medicine in particular. In this review, the concept of EBM has been introduced briefly and four steps of EBM practice have been explained. Asking answerable questions and finding the best evidence that constitutes the first two parts of EBM practice are explained in brief. The next two steps (appraising the available evidence and applying the best evidence) are explained in more detail. Since the bulk of nuclear medicine studies are of a diagnostic nature and most of the daily practice of a nuclear medicine specialist is involved in diagnosis, we have focused on the diagnosis studies. Systematic reviews are also explained to some extent. Appraisals of other kinds of study, such as interventional or prognosis studies, are not included in this review. [ABSTRACT FROM AUTHOR]

We present a female patient with atypical chest pain who was referred to our department for ischemia evaluation. 99mTc-MIBI myocardial perfusion scan with dipyridamole stress was performed. Sub-diaphragmatic activity in the hepatic tissue and then in the bowel loops caused severe overlap on the inferior wall even on consecutive delayed images. Dipyridamole stress was repeated for the patient with 201TI. The study was interpretable this time without any interfering sub-diaphragmatic activity. [ABSTRACT FROM AUTHOR]

Gamma camera malfunction is a major source of imaging artifacts in the every day nuclear medicine practice. These artifacts can be avoided by routine quality control of the equipment as well as routine review of the images after each acquisition. We report perfusion defect in the myocardial perfusion scan of a patient due to spontaneous malfunction of a photomultiplier tube (PMT). This PMT malfunction was detected by reviewing the raw acquired projections and was due to a loose connection in the PMT circuit. After correcting the malfunction, the scan was repeated and the defect disappeared. This case shows the importance of raw data reviewing after each image acquisition to avoid any gamma camera related artifact. [ABSTRACT FROM AUTHOR]

Synthetic somatostatin analogs have been posed as a potential source of error in somatostatin receptor imaging through interference with tumor detection; however, experimental models and clinical studies have shown a complex mechanism of the effect of octreotide on tumors. The aim of this study was to assess whether 68 Ga-DOTATATE uptake before treatment with long-acting somatostatin analogs differs from that after treatment. Methods: Thirty patients (15 men; age [mean ± SD], 64.6 ± 13.4 y) who had intermediately differentiated to well-differentiated neuroendocrine tumors and who underwent 68 Ga-DOTATATE PET/CT scanning before and after receiving long-acting repeatable octreotide (Sandostatin LAR) were included in the study. The SUV max and SUV mean of healthy target organs, residual primary tumor, and up to 5 lesions with the highest SUV max in each organ were compared before and after octreotide treatment. Results: The mean time interval between the 2 68 Ga-DOTATATE studies was 9.6 ± 7.2 mo, and the mean time gap between the last Sandostatin LAR injection and the second 68 Ga-DOTATATE study was 25.1 ± 14.8 d. The pretreatment mean SUV max and SUV mean were both significantly higher in the thyroid, liver, and spleen ( P < 0.05) than the values measured after the administration of Sandostatin LAR. No significant differences were found among the uptake indices for residual primary tumor or any metastatic lesions in the liver, bone, lung, or lymph nodes before and after Sandostatin LAR administration ( P > 0.05). Conclusion: Long-acting octreotide treatment diminished 68 Ga-DOTATATE uptake in the liver, spleen, and thyroid but did not compromise tracer uptake in residual primary tumor and metastatic lesions. These findings have a direct impact on the interpretation of 68 Ga-DOTATATE PET/CT scans., (© 2018 by the Society of Nuclear Medicine and Molecular Imaging.)

Aim: The aim of this study is to evaluate the role of functional imaging for forensic purposes., Methods: We reviewed a few outpatient cases that were sent to our department for examination after traumatic events and one case with neuropsychic disturbances., Results: Functional imaging showed signs of traumatic lesions in the skeletal system, of brain metabolism and of renal failure., Conclusion: Functional disturbances following traumatic events are in some cases more important than morphological abnormalities. Targeted scintigraphic examinations could be applied for visualisation of traumatic lesions or evaluation of functional disturbances caused by traumatic events. These examinations can be used as evidence in the courtroom.

Serum thyroglobulin (Tg) measurement has a pivotal role in the management of differentiated thyroid carcinoma (DTC). Serum Tg increment after thyroid hormone discontinuation seems to be a better predictor of tumor recurrence, however, minimal Tg increment may not be a specific marker. This study tries to evaluate the importance of different levels of Tg increment after thyroid hormone discontinuation. Fifty-five patients (46 females and 9 males with mean age of 41.40 yrs) with DTC, treated with total or subtotal thyroidectomy and radioiodine-131 ((131)I) were studied. Ninety-one per cent of the patients had papillary carcinoma. Serum Tg and thyroid stimulating hormone (TSH) were measured using high sensitive IRMA assays during thyroxine (T4) suppression and after discontinuation of T4 treatment. The mean time interval between Tg on T4 and off T4 was 110.29+/-53.43 days and less than 180 days in all patients. Serum Tg level was increased >or= 1 ng/ml in 25 patients after discontinuation of T4. Of these patients, 17 had metastatic disease or a detectable thyroid remnant. Of 16 patients with unchanged Tg (-1or= 7 ng/ml had residual disease or metastases. If DeltaTg was unchanged or decreased, the negative predictive value was 83.3%. The sensitivity of WB(131)IS was 63.6% for the detection of thyroid remnant or metastases. Our study indicates that DeltaTg is a more reliable indicator of remnant disease than on T4-Tg or off T4-Tg levels.