Indian Journal of Nuclear Medicine
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COMMENTARY
Regulatory requirements for designing PET-CT facility in India
Pankaj Tandon
April-June 2010, 25(2):39-43
DOI:10.4103/0972-3919.72684  PMID:21188061
  14,080 944 -
REVIEW ARTICLES
Radiation Safety in Nuclear Imaging and Radionuclide Therapy
Pankaj Tandon
October-December 2007, 22(4):122-122
  9,791 0 -
ORIGINAL ARTICLES
Role of Tc99m sulfur colloid scintigraphy in differentiating non-cirrhotic portal fibrosis from cirrhosis liver
Dhritiman Chakraborty, Hejjaji Venkataramarao Sunil, Bhagwant Rai Mittal, Anish Bhattacharya, Baljinder Singh, Yogesh Chawla
October-December 2010, 25(4):139-142
DOI:10.4103/0972-3919.78247  PMID:21713221
Background : Two most important causes of portal hypertension are cirrhosis of liver and non-cirrhotic portal fibrosis (NCPF). The purpose of this study was to assess the scintigraphic appearances of Tc99m sulfur colloid liver scan in differentiating liver cirrhosis from NCPF. Materials and Methods: Retrospective analysis records of 146 patients (91 male and 55 female) with diffuse hepatocellular disease was done for liver size, liver uptake, spleen size, spleen uptake, colloid shift to bone marrow and lungs. Results: Cirrhotic livers showed patchy and lower uptake than NCPF (59% vs. 20%, P-value 0.041). Spleen size was significantly increased in NCPF compared to cirrhosis (100% vs. 67%, P-value 0.0137). Significant colloid shift to bone marrow was noted in cirrhosis (84% vs. 7%, P-value<0.0001). Conclusion: Tc99m sulfur colloid liver scan is a non-invasive procedure having a useful adjunctive role in clinical differentiation of cirrhosis from NCPF.
  7,601 256 1
PICTORIAL ESSAY
Spectrum of single photon emission computed tomography/computed tomography findings in patients with parathyroid adenomas
Dhritiman Chakraborty, Bhagwant Rai Mittal, Chidambaram Natrajan Balasubramanian Harisankar, Anish Bhattacharya, Sanjay Bhadada
January-March 2011, 26(1):52-55
DOI:10.4103/0972-3919.84618  PMID:21969785
Primary hyperparathyroidism results from excessive parathyroid hormone secretion. Approximately 85% of all cases of primary hyperparathyroidism are caused by a single parathyroid adenoma; 10-15% of the cases are caused by parathyroid hyperplasia. Parathyroid carcinoma accounts for approximately 3-4% of cases of primary disease. Technetium-99m-sestamibi (MIBI), the current scintigraphic procedure of choice for preoperative parathyroid localization, can be performed in various ways. The "single-isotope, double-phase technique" is based on the fact that MIBI washes out more rapidly from the thyroid than from abnormal parathyroid tissue. However, not all parathyroid lesions retain MIBI and not all thyroid tissue washes out quickly, and subtraction imaging is helpful. Single photon emission computed tomography (SPECT) provides information for localizing parathyroid lesions, differentiating thyroid from parathyroid lesions, and detecting and localizing ectopic parathyroid lesions. Addition of CT with SPECT improves the sensitivity. This pictorial assay demonstrates various SPECT/CT patterns observed in parathyroid scintigraphy.
  6,687 135 1
ORIGINAL ARTICLES
Lutetium DOTATATE whole body scans: A novel approach for evaluation of neuroendocrine tumors
Natasha Singh, BA Krishna, Madhusudan Vyas, Meera Venkatesh, Sharmila Banerjee, Tapas Das, KV Vimal Nair, Sudipta
July-September 2011, 26(3):135-138
DOI:10.4103/0972-3919.103994  PMID:23326064
Aim: We undertook a study to evaluate whether Lutetium (Lu) DOTATATE whole body scan is well comparable to Gallium positron emission tomography (PET) / Indium Octreotide, and hence with dosimetric advantage can replace it in the pre-therapy setting. Materials and Methods: We undertook a prospective study of a total of 39 patients with metastatic neuroendocrine tumor (age 11-70 years), who underwent Lu-DOTATATE scans within the period August 2009-November 2010. This included 28 males and 11 females. Dose of Lu-DOTATATE injected for diagnostic scanning purpose was 10 mCi i.v. Whole body planar images and single-photon emission computed tomography (SPECT)-CT images were obtained at 4, 24 and 48 hours. The Lu-DOTATATE whole body and SPECT-CT images were compared to contrast CT scans in all patients, and Indium Octreotide and Gallium DOTATATE PET images in nine patients, with reference to detection sensitivity of number of lesions. The pre-therapy scans were also used for dosimetric calculations. Fourteen of these 39 patients further went ahead with Lu-DOTATATE therapy. Results: All 39 patients demonstrated Lu-DOTATATE uptake in the disease sites seen on the contrast CT images. The uptake intensity was well comparable to Indium Octreotide and Gallium DOTATATE PET scans of all nine patients, with equally well-defined lesions. The post-therapy Lu-DOTATATE scans of the 14 patients who underwent therapy demonstrated higher intensity uptake pattern in the same disease sites, suggesting favorable therapeutic effect. The scans were useful in determining dosimetric details for therapeutic purpose and adequate exposure rates to suggest good ablative effect. Conclusion: Our preliminary data suggest that Lu-DOTATATE whole body scanning procedure is cost effective and equally sensitive as Gallium DOTATOC/NOC PET scan in pre-therapy setting of neuroendocrine tumors. The additional advantage of dosimetry calculations on this scanning procedure makes it more ideal to tailor therapies with more accuracy.
  6,290 262 1
REVIEW ARTICLE
Radiological and radionuclide imaging of degenerative disease of the facet joints
Natalie Shur, Alexis Corrigan, Kanhaiyalal Agrawal, Amidevi Desai, Gopinath Gnanasegaran
July-September 2015, 30(3):191-198
DOI:10.4103/0972-3919.158526  PMID:26170560
The facet joint has been increasingly implicated as a potential source of lower back pain. Diagnosis can be challenging as there is not a direct correlation between facet joint disease and clinical or radiological features. The purpose of this article is to review the diagnosis, treatment, and current imaging modality options in the context of degenerative facet joint disease. We describe each modality in turn with a pictorial review using current evidence. Newer hybrid imaging techniques such as single photon emission computed tomography/computed tomography (SPECT/CT) provide additional information relative to the historic gold standard magnetic resonance imaging. The diagnostic benefits of SPECT/CT include precise localization and characterization of spinal lesions and improved diagnosis for lower back pain. It may have a role in selecting patients for local therapeutic injections, as well as guiding their location with increased precision.
  6,267 251 -
PET/CT imaging of neuroendocrine tumors with 68Gallium-labeled somatostatin analogues: An overview and single institutional experience from India
Punit Sharma, Harmandeep Singh, Chandrasekhar Bal, Rakesh Kumar
January-March 2014, 29(1):2-12
DOI:10.4103/0972-3919.125760  PMID:24591775
Neuroendocrine tumors (NETs) are rare neoplasms characterized by overexpression of somatostatin receptors (SSTRs). Functional imaging plays a crucial role in management of NETs. Recently, positron emission tomography/computed tomography (PET/CT) with 68Gallium (68Ga)-labeled somatostatin analogues has shown excellent results for imaging of NETs and better results than conventional SSTR scintigraphy. In this review we have discussed the utility of 68 Ga-labeled somatostatin analogue PET/CT in NETs for various established and potential indications. In addition we have also shared our own experience from a tertiary care center in India.
  6,168 345 4
PICTORIAL ESSAY
Tc-99m macro aggregated albumin scintigraphy - indications other than pulmonary embolism: A pictorial essay
Sunny J Gandhi, Sanjay Babu, Padma Subramanyam, Palaniswamy Shanmuga Sundaram
July-September 2013, 28(3):152-162
DOI:10.4103/0972-3919.119546  PMID:24250023
Introduction: Tc-99m macro aggregated albumin (MAA) is synonymous for lung perfusion scintigraphy and is part of the study in the evaluation of pulmonary thromboembolism. We wanted to highlight the utilities of Tc-99m MAA other than pulmonary embolism as a pictorial assay. Materials and Methods: Patients referred for Tc-99m MAA scintigraphy under various indications were included in this pictorial essay. Commercially available TechneScan LyoMAA cold kit from Mallinckrodt Medical B.V., Holland was used. Acquisition protocols for different indications are described in this article. Different clinical indications (e.g., pulmonary artery stenosis, hepatopulmonary syndrome, FEV1 calculation in lung surgery planning, selective internal radiation therapy planning, venography for deep venous thrombosis, left to right cardiac shunts, etc.) where Tc-99m MAA scintigraphy was asked for; how it helped in different clinical scenarios and how it can be used clinically is explained with unique and interesting case examples and images. We also reviewed the literature to look for certain remote indications of MAA imaging for the sake of completion like - (shunt scintigraphy, peritoneopleural communication, etc.) Conclusion: Tc-99m MAA is a very useful radiopharmaceutical, which can be used for many other indications apart from the commonly used indication of lung perfusion scan in pulmonary embolism. It can provide useful clinical information in other indications, which we try to highlight in this article.
  6,145 308 -
ORIGINAL ARTICLES
A study to improve the image quality in low-dose computed tomography (SPECT) using filtration
SC Kheruka, UC Naithani, AK Maurya, NK Painuly, LM Aggarwal, S Gambhir
January-March 2011, 26(1):14-21
DOI:10.4103/0972-3919.84595  PMID:21969774
Background: The output of the X-ray tube used in computed tomography (CT) provides a spectrum of photon energies. Low-energy photons are preferentially absorbed in tissue; the beam spectrum shifts toward the higher energy end as it passes through more tissue, thereby changing its effective attenuation coefficient and producing a variety of artifacts (beam-hardening effects) in images. Filtering of the beam may be used to remove low-energy photon component. The accuracy of attenuation coefficient calculation by bilinear model depends highly upon accuracy of Hounsfield units. Therefore, we have made an attempt to minimize the beam-hardening effects using additional copper filter in the X-ray beam. The quantitative evaluation were made to see the effect of additional filters on resulting CT images. Materials and Methods: This study was performed on dual-head SPECT (HAWKEYE 4, GE Healthcare) with low-dose CT which acquires images at peak voltages of 120/140 kV and a tube current of 2.5 mA. For the evaluation of image quality, we used CT QA Phantom (PHILIPS) having six different density pins of Water, Polyethylene, Nylon (Aculon), Lexan, Acrylic (Perspex) and Teflon. The axial images were acquired using copper filters of various thicknesses ranging from 1 to 5 mm in steps of 1 mm. The copper filter was designed in such a manner that it fits exactly on the collimator cover of CT X-ray tube. Appropriate fixation of the copper filter was ensured before starting the image acquisition. As our intention was only to see the effect of beam hardening on the attenuation map, no SPECT study was performed. First set of images was acquired without putting any filter into the beam. Then, successively, filters of different thicknesses were placed into the beam and calibration of the CT scanner was performed before acquiring the images. The X-ray tube parameters were kept the same as that of unfiltered X-ray beam. All the acquired image sets were displayed using Xeleris 2 (GE Healthcare) on a high-resolution monitor. Moreover, Jaszak's SPECT Phantom after removing the spheres was used to see the different contrast intensities by inserting the different contrast materials of iodine and bismuth in water as background media. Images were analyzed for visibility, spatial resolution and contrast. Results: Successive improvement in the image quality was noticed when we increased the filter thickness from 1 to 3 mm. The images acquired with 3-mm filter appeared almost with no artifacts and were visibly sharper. Lower energy photons from X-ray beam cause a number of artifacts, especially at bone-tissue interfaces. Additional filtrations removed lower energy photons and improved the image quality. Degradation in the image quality was noticed when we increased the filter thickness further to 4 and 5 mm. This degradation in image quality happened due to reduced photon flux of the resulting X-ray beam, causing high statistical noise. The spatial resolution for image matrix of 512 × 512 was found to be 1.29, 1.07, 0.64 and 0.54 mm for without filter, with 1, 2 and 3 mm filters, respectively. The image quality was further analyzed for signal-to-noise ratio (SNR). It was found to be 1.72, 1.78, 1.98 and 1.99 for open, with 1, 2 and 3 mm filters respectively. This shows that 3-mm filter results in an improvement of 15.7% in SNR. Conclusion: On the basis of this study, we could conclude that use of 3-mm copper filter in the X-ray beam is optimal for removing the artifacts without causing any significant reduction in the photon flux of the resulting X-ray beam. We also propose that as artifacts have been removed from the images, the value of Hounsfield units will be more accurate and hence the value of attenuation coefficients lead to better contrast and visualization of SPECT images.
  5,958 181 2
Spectrum of neurocognitive dysfunction in Indian population on FDG PET/CT imaging
Rajnish Sharma, Madhavi Tripathi, Maria M D'Souza, Abhinav Jaimini, Raunak Varshney, Puja Panwar, Aruna Kaushik, Sanjeev Saw, Romana Seher, Santosh Pandey, Dinesh Singh, Yachna Solanki, Anil K Mishra, Anupam Mondal, RP Tripathi
April-June 2011, 26(2):67-77
DOI:10.4103/0972-3919.90255  PMID:22174510
Background : A variety of neurodegenerative disorders produce significant abnormal brain function which can be detected using fluorodeoxyglucose positron emission tomography (FDG PET) scan even when structural changes are not detected on CT or MRI Scan. A study was undertaken at our institute to evaluate the FDG PET/CT findings in Indian population suffering from mild cognitive impairment (MCI), Alzheimer's disease (AD), fronto-temporal dementia (FTD), dementia with lewy body disease (DLBD) and other miscellaneous causes of dementia. Materials and Methods : 117 0 subjects having neurocognitive deficits and 36 normals were included in our study. All patients underwent a detailed history and clinical examination. This was followed by a mini mental state examination. Subsequently an FDG brain PET scan and an MRI were done. Results :In the patient population included in our study group 36 were normal, 39 had MCI, 40 had AD, 14 had FTD, and 13 had DLBD and 11 dementia due to other miscellaneous causes. MCI patients showed primarily reduced tracer uptake in the mesio-temporal cortex. AD patients showed reduced tracer concentration in temporo-parietal lobes, while patients with advanced diseases showed frontal lobe disease additionally. In subjects of FTD, reduced radiotracer uptake in the fronto-temporal lobes was noted. In addition, FTD patients also showed basal ganglia defects. In contrast the DLBD patients showed globally reduced FDG uptake including severely affecting the occipital cortices. Conclusion :In the current study the F18-FDG PET scans have been shown to be highly useful in the diagnosis of various neurocognitive disorders of the brain. AD was found to be the most common dementia in the Indian population followed by MCI. Diffuse Lewy body disease, FTD and other miscellaneous categories of dementia had a near similar incidence.
  5,732 245 2
Three phase bone scan interpretation based upon vascular endothelial response
Kush Kumar
April-June 2015, 30(2):104-110
DOI:10.4103/0972-3919.152949  PMID:25829726
Objectives: A new method of interpretation of Three Phase Bone Scan (TPBS) scan based upon the normal physiological vascular endothelial related response. Materials and Methods: Fifty cases of TPBS were evaluated. Thirteen were normal. In remaining 37 positive studies, 20 showed localized hyperemic response. All localized hyperemic responses except one with vascular endothelial dysfunction were without infection (95.0%). Infection could be ruled out in absence of generalized massive flow and pool response. All 17 cases with generalized massive hyperemic response had infection, consistent with infection or CRPS/RSD. Micro-bacterial or histological confirmation of infection was obtained in 11 cases. All 11 cases with confirmed infection showed generalized massive hyperemic response (100.0%). Two were CRPS/RSD and 2 cases were of cellulitis (100.0%). Among remaining 2, one refused surgery and other was lost to follow-up. Additionally, 20 published cases in the literature of osteomyelitis were also analyzed. Nineteen cases of bone and joint infection, (osteomyelitis/arthritis/cellulitis) except one with endothelial dysfunction showed generalized massive increased flow and pool response (95.0%). All published cases of osteomyelitis in the literature showed generalized massive hyperemic response (100.0%). Results: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern. Infection could be ruled out in absence of generalized massive flow and pool response. All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response. Conclusion: By incorporating the concept of vascular endothelial related response causing massive vasodilatation in infection, the interpretation of the TPBS can be more précised as it is based upon the normal physiology. Larger studies are recommended.
  5,617 170 -
PICTORIAL ESSAYS
Skeletal scintigraphy manifestations of hematologic disorders
Shrikant V Solav, Ritu Bhandari, Pallavi Solav
January-March 2012, 27(1):59-62
DOI:10.4103/0972-3919.108880  PMID:23599605
Skeletal manifestations are common in hematologic disorders. Benign entities such as Sickle cell disease develop microvascular embolization causing skeletal crisis. Leukemia, acute myeloblastic or lymphoblastic may develop bone marrow infarcts. Compromised immunity makes them susceptible to secondary infection leading to osteomyelitis or septic arthritis. Exposure to steroids may lead to osteonecrosis in these cases. Presented here is an atlas of various scintigraphic skeletal manifestations encountered over the past 10 years, in hematologic disorders.
  5,534 139 1
REVIEW ARTICLES
Avoidable challenges of a nuclear medicine facility in a developing nation
Kayode Solomon Adedapo, Yetunde Ajoke Onimode, John Enyi Ejeh, Adewale Oluwaseun Adepoju
October-December 2013, 28(4):195-199
DOI:10.4103/0972-3919.121962  PMID:24379527
The role of nuclear medicine in disease management in a developing nation is as impactful as it is in other regions of the world. However, in the developing world, the practice of nuclear medicine is faced with a myriad of challenges, which can be easily avoided. In this review, we examine the many avoidable challenges to the practice of nuclear medicine in a developing nation. The review is largely based on personal experiences of the authors who are the pioneers and current practitioners of nuclear medicine in a typical developing nation. If the challenges examined in this review are avoided, the practice of nuclear medicine in such a nation will be more effective and practitioners will be more efficient in service delivery. Hence, the huge benefits of nuclear medicine will be made available to patients in such a developing nation.
  5,528 125 -
PICTORIAL ESSAY
Fluoro-deoxy-glucose positron emission tomography/computed tomography in lymphoma: A pictorial essay
Kuruva Manohar, Bhagwant Rai Mittal, Anish Bhattacharya, Pankaj Malhotra, Subhash Varma
April-June 2013, 28(2):85-92
DOI:10.4103/0972-3919.118256  PMID:24163512
F-18 fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has emerged as a powerful imaging modality in the field of oncology. F-18 FDG PET/CT is now an established tool in the management of lymphoma. This has been shown to be useful in staging, detection of bone marrow involvement (BMI), early response assessment and end of therapy response assessment in lymphoma. Interpretation of F-18 FDG PET/CT in lymphoma is carried out by various qualitative response assessment criteria. London criteria are used for interpretation of interim PET/CT and International Harmonization Project (IHP) criteria are used to interpret PET/CT done after the end of chemotherapy. Quantitative analysis is also found to be useful in assessment of response early after two cycles of chemotherapy in patients with diffuse large B cell lymphoma (DLBCL). This pictorial essay provides few images describing the FDG avidity of lymphoma, patterns of bone marrow uptake and their relevance in predicting BMI, role of staging PET/CT, quantitative analysis in response assessment, example images of response according to London criteria and IHP criteria. Few pitfalls in imaging of lymphoma with PET/CT are also discussed in the images legend.
  5,404 175 -
Metastatic mimics on bone scan: “All that glitters is not metastatic”
Archi Agrawal, Nilendu Purandare, Sneha Shah, Venkatesh Rangarajan
July-September 2016, 31(3):185-190
DOI:10.4103/0972-3919.183605  PMID:27385887
In this pictorial review, cases where benign diseases caused a diagnostic dilemma on bone scan are illustrated. This review highlights the value of correlative imaging- single-photon emission computed tomography/computed tomography (CT), CT, and magnetic resonance imaging in solving the diagnostic problem by exact localization and characterization of the lesions. All these eventually lead to increased diagnostic confidence, better and more accurate reporting and avoidance of delay in initiation of treatment due to equivocal results. The imaging features of these benign pathologies – which are “mimics of metastatic disease,” are elaborated so that the reader can incorporate them while reporting so as to avoid mis-interpretations.
  5,217 276 -
CASE REPORTS
Ribbing disease: Uncommon cause of a common symptom
Nishikant Avinash Damle, Manish Patnecha, Praveen Kumar, Ankur Gadodia, Kiran Subbarao, Chandrasekhar Bal
January-March 2011, 26(1):36-39
DOI:10.4103/0972-3919.84612  PMID:21969779
Ribbing disease is a rare form of sclerosing dysplasia characterized by benign endosteal and periosteal bone growth confined to the diaphyses of the long bones, usually the tibiae and femora. It occurs after puberty and is more commonly seen in women. The most common presenting symptom is pain that is usually self-limited; however, progression is known. The etiology and optimal treatment for the disease are as yet undefined. We present here the case of a 31-year-old woman with clinical, radiological and bone scan manifestations of Ribbing disease corroborated by bone biopsy. Radiographs demonstrated cortical thickening of the diaphyses of both tibiae. 99mTc-methylene diphosphonate bone scan revealed intense irregular uptake in diaphyseal region of both tibiae. Magnetic resonance imaging showed cortical thickening with bone marrow edema in bilateral tibial diaphysis with minimal adjacent soft tissue edema. Bone biopsy revealed predominantly dense lamellar bone with irregular sized and spaced haversian systems. Serum and urine markers of bone metabolism were within normal limits. The patient was treated with analgesics, and had partial relief from pain. Medullary rimming is the next treatment option in case pain progresses. This report emphasizes the role of bone scan in the diagnosis of this rare condition.
  5,319 141 -
ABSTRACTS
Radiopharmacy

July-September 2010, 25(3):78-87
  4,959 297 -
CASE REPORTS
Scintigraphic and radiological correlative and confirmative features obviating invasive biopsy in caffey's disease
M Ranadheer, Santhi Bhushan Murari, N Sujith, Jayanthi , Pushpalatha Sudhakar, VVS Prabhakar Rao
January-March 2010, 25(1):20-22
DOI:10.4103/0972-3919.63595  PMID:20844665
Caffey's disease is not a common clinical occurrence; it often poses problems in diagnosis due to its close resemblance to osteomyelitis. Initial plain radiographic diagnosis is sometimes fraught with the limitation of not being able to differentiate it from chronic osteomyelitis. Skeletal scintigraphy is sensitive in localizing the disease activity to the radiological features of the affected regions and the characteristic location of the lesions helps make the diagnosis without resorting to biopsy and further workup.
  5,125 119 -
COMMENTARY
Inclusion of brain in FDG PET/CT scanning techniques in cancer patients: Does it obviate the need for dedicated brain imaging?
Nilendu C Purandare
April-June 2011, 26(2):64-66
DOI:10.4103/0972-3919.90253  PMID:22174509
  4,889 216 -
ORIGINAL ARTICLES
Rare developmental abnormalities of thyroid gland, especially multiple ectopia: A review and our experience
Anuj Jain, Sujata Pathak
October-December 2010, 25(4):143-146
PMID:21713222
Background : Developmental structural abnormalities of the thyroid gland are relatively rare. There are scanty reports of hemiagensis, dual and triple ectopia of the thyroid in the literature Materials and Methods: We did a retrospective analysis of 236 patients referred to us for Tc-99m Pertechnetate thyroid scan over period of four months (May 2010 to Sept 2010). Twenty of these 236 patients aged less than 20 years found to have developmental abnormality of the thyroid gland on thyroid scan. Diagnosis was correlated with anatomical imaging (USG/CT scan), fine needle aspiration cytology (FNAC) and histopathology. Results : Out of the 20 patients, 8 were diagnosed with thyroglossal cyst, 4 with ectopic thyroid gland, 4 with dual ectopia, two had agenesis of thyroid gland, one case each with hemiagenesis and triple ectopia. Conclusion: The study has emphasized the indispensable role of Tc-99m Pertechnetate thyroid scan in the evaluation of midline neck swellings of childhood and diagnosing developmental anomalies of thyroid gland.
  4,913 173 2
CASE REPORTS
TC 99m MDP bone scan in evaluation of painful scoliosis
Sujit Nilegaonkar, Sameer Sonar, Ashish Ranade, Madhav Khadilkar
April-June 2010, 25(2):67-69
DOI:10.4103/0972-3919.72691  PMID:21188068
A 18-year-old male presented with low back ache. The patient was investigated and was diagnosed to have painful scoliosis. X-ray and other examinations could not reveal any diagnosis. The patient was referred to undergo bone scan on clinical suspicion of osteoid osteoma and to rule out stress fracture if any. Planar bone scan was performed, which showed a lesion in L3 vertebra and was further evaluated with SPECT (Single photon emission computed tomography) study to characterize the lesion. On SPECT examination, the classical features of osteoid osteoma, the double density sign (11), was noted in the pars interarticularis region. These findings were confirmed by a CT scan, which showed a sclerotic lesion in pars interarticularis of L3 vertebra. The patient was posted for operation and was relieved of symptoms in the postoperative follow-up.
  4,804 93 -
ORIGINAL ARTICLES
Radiation exposure to nuclear medicine personnel handling positron emitters from Ge-68/Ga-68 generator
Durgesh Kumar Dwivedi, Snehlata , Alok Kumar Dwivedi, Satya Pal Lochab, Rakesh Kumar, Niraj Naswa, Punit Sharma, Arun Malhotra, Guru Pad Bandopadhayaya, Chandrashekhar Bal, Gauri Shankar Pant
April-June 2011, 26(2):86-90
DOI:10.4103/0972-3919.90258  PMID:22174513
Objective : To measure the radiation exposure to nuclear medicine personnel during synthesis and injection to the patients of Ga-68 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-1-Nal 3 -octreotide (NOC)- (DOTA-NOC) using ring thermoluminescence dosimeters (TLDs). Materials and Methods : Synthesis of Ga-68 DOTA-NOC was done on a semi-automated system. Finger doses were measured during synthesis and injection of Ga-68 DOTA-NOC. The occupational workers wore TLDs at the base of ring finger of both hands. The finger doses of two radio chemists were measured during synthesis of Ga-68 DOTA-NOC while that of a physician during its injection to the patients. Results : Duration of the study was eight months and a total of 20 samples were prepared. During synthesis, the mean dose to base of left ring finger was 3.02 ± 1.01 mSv and to base of right ring finger was 1.96 ± 0.86 mSv. Mean dose to base of left ring finger was 1.26 ± 0.35 mSv while that to base of right ring finger was 1.03 ± 0.13 mSv during injection. The mean dose was observed to be higher during synthesis than injection. However, the difference was not significant (P = 0.27 and P = 0.18, respectively). Overall mean finger dose of left hand was 2.43 ± 1.21 mSv, whereas for the right hand the same was 1.65± 0.82 mSv. Conclusion : Finger doses to radio chemists during semi-automated synthesis of Ga-68 DOTA-NOC and that to the physician involved in injection of Ga-68 DOTA-NOC were found to be within permissible limits. Ring dosimeters must be worn for the safety of the nuclear medicine personnel involved in synthesis and injection of Ga-68 DOTA-NOC.
  4,366 375 2
PICTORIAL ESSAY
Spectrum of brain abnormalities detected on whole body F-18 FDG PET/CT in patients undergoing evaluation for non-CNS malignancies
Madhavi Tripathi, Abhinav Jaimini, Maria M D'Souza, Rajnish Sharma, Jyotika Jain, Gunjan Garg, Dinesh Singh, Nitin Kumar, Anil K Mishra, Rajesh K Grover, Anupam Mondal
April-June 2011, 26(2):123-129
DOI:10.4103/0972-3919.90271  PMID:22174526
We present the pattern of metabolic brain abnormalities detected in patients undergoing whole body (WB) F-18 flurodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) examination for non-central nervous system (CNS) malignancies. Knowledge of the PET/CT appearance of various intracranial metabolic abnormalities enables correct interpretation of PET scans in oncological patients where differentiation of metastasis from benign intracranial pathologies is important and improves specificity of the PET study. A complete clinical history and correlation with CT and MRI greatly helps in arriving at a correct imaging diagnosis.
  4,561 131 -
COMMENTARY
PET-MRI: Challenges and new directions
Aditya Daftary
January-March 2010, 25(1):3-5
DOI:10.4103/0972-3919.63590  PMID:20844660
  4,201 446 5
CASE REPORTS
New intraspinal cause of physiological FDG uptake
S Padma, P Shanmuga Sundaram, GS Shagos, S Vijay Harish
October-December 2010, 25(4):173-175
DOI:10.4103/0972-3919.78257  PMID:21712915
We present a paediatric case of Papillary Ca thyroid under evaluation for elevated Thyroglobulin (Tg) level with negative 131 I wholebody scintigraphy. Differentiated thyroid cancer (DTC) arises from follicular epithelium and retains basic biological features like expression of sodium iodide symporter (NIS), which is the cellular basis of radio iodine ( 131 I) concentration during thyroid ablation. Once dedifferentiation of thyroid cells occurs, cells fail to concentrate 131 I, posing both diagnostic and therapeutic problems in DTC and one may have to resort to other imaging techniques for disease localization. As DTC progression is slow, patients have a relatively good prognosis. However children with thyroid malignancies need aggressive management, as initial presentation itself maybe with nodal metastases. It is well known that FDG PET CT apart from its oncological applications, is also used in the evaluation of vascular inflammation especially Takayasu's arteritis. It is also reported in literature, that 18 F-FDG uptake can be seen relatively frequently in the arterial tree of cancer patients. Dunphy et al reported the association of vascular FDG uptake in inflammation as well as in normal arteries. This study typically describes FDG uptake in a patchwork of normal vessel, focal inflammation and or calcification of vessels. The other plausible reasons for significant vascular 18 F-FDG uptake are drugs such as potent non steroidal anti-inflammatory agents, dexamethasone, prednisone and tacrolimus. Our patient showed false positive 18 F Fluorodeoxyglucose (FDG) uptake in spinal cord at D11/12 and D12/L1 vertebral levels in FDG PET CT imaging performed as part of raised Thyroglobulin workup. This intra spinal FDG uptake is attributed to physiological uptake and inadequate FDG clearance from artery of Adamkiewicz, which can be added as a new physiological cause of FDG uptake unreported in literature as yet.
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