Indian Journal of Nuclear Medicine
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   2011| October-December  | Volume 26 | Issue 4  
    Online since February 1, 2013

 
 
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COMMENTARY
Tc-99m glucoheptonate is poor man's fluorodeoxyglucose
Ramchandra D Lele
October-December 2011, 26(4):165-170
DOI:10.4103/0972-3919.106678  PMID:23559709
While fluoro-deoxy-glucose (FDG) has emerged as an important radiotracer for imaging tumors, myocardial viability and infection, the role of other glucose analogues should also be explored. Tc-99m Glucoheptonate (GHA) has been used for imaging brain tumors and lung tumors. The uptake mechanism may be linked to GLUT-1 (Glucose transporter) and GLUT-4 expression similar to FDG. GHA is easily available and cheap. With the availability of single photon emission computed tomography/computed tomography (SPECT/CT), GHA imaging should be re-explored as a tumor agent and also for imaging myocardial viability.
  1,749 115 -
ORIGINAL ARTICLES
Role of 18 F-fluorodeoxyglucose Positron Emission Tomography scan in differentiating enhancing brain tumors
Kajal Das, Bhagwant R Mittal, Rakesh K Vasistha, Paramjit Singh, Suresh N Mathuriya
October-December 2011, 26(4):171-176
DOI:10.4103/0972-3919.106698  PMID:23559710
Aim: To determine whether F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) can be used to differentiate among common enhancing brain tumors such as gliomas, metastatic brain tumors, and lymphoma. Materials and Methods: We evaluated 20 patients with an enhancing brain tumor on magnetic resonance imaging (MRI). FDG PET scan was done in all patients pre operatively. For PET image analysis, regions of interest were placed over the tumor (T), contralateral cortex (C), and white matter (WM). Average and maximum pixel values were determined at each site. On the basis of these measurements, average and maximum standard uptake values (SUV avg and SUV max ) were calculated, and comparisons among lesions were then made. Results: SUV avg and SUV max are significantly higher for central nervous system (CNS) lymphoma than for other tumors ( P < 0.01). High-grade gliomas showed significantly higher SUV avg and SUV max than the low grade gliomas ( P < 0.05) and metastatic tumor showed higher SUV avg and SUV max than all gliomas, both low and high grade ( P < 0.05). When the lowest values of CNS lymphoma parameter were used as cutoff levels to distinguish CNS lymphomas from other tumors (i.e. 100% sensitivity), SUV max was the most accurate parameter. Using a SUV max of 15.0 as a cutoff for diagnosing CNS lymphoma, only one case of metastasis (SUV max , 16.3) was found to be false positive in this study. Conclusion: FDG PET appears to provide additional information for differentiating common enhancing malignant brain tumors, namely lymphoma versus high grade glioma and metastatic tumor, particularly when differential diagnoses are difficult to narrow using MRI alone.
  1,687 107 1
CASE REPORTS
New axillary lymph nodal F-18 fluoro-deoxy glucose uptake in an interim positron emission tomography scan - not always a sign of disease progression
Kuruva Manohar, Kanhaiyalal Agrawal, Anish Bhattacharya, Bhagwant Rai Mittal
October-December 2011, 26(4):192-193
DOI:10.4103/0972-3919.106703  PMID:23559715
Fluoro-deoxy glucose (FDG) is a non-specific tracer and may accumulate in non-malignant conditions causing potential pitfalls leading to false-positive interpretations of interim positron emission tomography scan. We report a case of a potential pitfall of false-positive axillary lymph nodal F-18 FDG uptake caused by injection extravasation.
  1,648 75 2
Bilateral axillary and internal mammary drainage in breast cancer without prior surgery during sentinel node mapping
Justo Serrano Vicente, M Luz Domínguez Grande, Carmen Durán Barquero, Jrafael Infante Torre, Lucía García Bernardo, J Ignacio Rayo Madrid, M Isabel Correa Antúnez
October-December 2011, 26(4):205-207
DOI:10.4103/0972-3919.106716  PMID:23559720
Lymphatic drainage outside the ipsilateral axilla in breast cancer is discovered in as many as 25% of all sentinel lymph node procedures and it is evidenced by lymphoscintigraphy. Contralateral axillary drainage is a rare clinical situation, mostly if there is not prior breast surgery, but this situation is extremely exceptional if we also found internal mammary chain drainage. We have not found such a case published in literature. This atypical finding is source of doubts because it could have clinical implications in the management of patients. We present a woman just diagnosed of breast carcinoma with hot nodes in bilateral axillary and ipsilateral internal mammary chain lymph nodes, shown by preoperative lymphoscintigraphy. We review published cases with contralateral axillary drainage, which enhance the role of scintigraphic procedure in such cases and show induced controversies in selecting the most adequate management.
  1,628 73 1
Bilateral axillary lymph node uptake of radiotracer during lower extremity and scrotal lymphoscintigraphy in a case of primary scrotal lymphoedema
Anuj Jain, Abhinav Jaimini
October-December 2011, 26(4):199-201
DOI:10.4103/0972-3919.106710  PMID:23559718
Lymphoscintigraphy is a useful technique for the evaluation of lymphatic function in the presence of limb swelling. The authors report a case where genital swelling in a 20-year-old man was investigated by lymphoscintigraphy. We performed lower limb lymphoscintigraphy and scrotal lymphoscintigraphy in the patient on two different days. Lower limb revealed dermal backflow pattern in lower limbs, inguinoscrotal reflux of the lymph and unexpected avid radiotracer uptake in the axillae bilaterally. Scrotal lymphoscintigraphy revealed slow movement of the lymph from the scrotal skin and again unexpected avid radiotracer uptake in the axillae bilaterally. Findings were concluded as congenital hypoplasia of lymphatics in lower limbs, congenital lymphectasia/compensatory megalymphatics in scrotum and aberrant lymphatic pathway, possibly due to malfunctioning/nonfunctioning thoracic duct.
  1,601 80 -
ORIGINAL ARTICLES
Incremental benefit of SPECT + CT bone scans over conventional planar and SPECT bone scans in vertebroplasty
Kush Kumar, Raghuveer K Halkar, Scott C Bartley, David M Schuster
October-December 2011, 26(4):181-184
DOI:10.4103/0972-3919.106700  PMID:23559712
Study design: Planar bone scans with SPECT and SPECT + CT were performed in those patients who underwent peri-operative evaluation for vertebroplasty. The scans were evaluated separately to identify the "culprit" vertebra (e) by two readers and their results were analyzed. Objective: Use of planar and SPECT bone scan for identifying the "culprit" vertebra (e) for vertebroplasty is well established. SPECT + CT is a relatively recent imaging tool providing co-registered fused images. Theoretical advantages of SPECT + CT over conventional SPECT imaging needs to be evaluated and documented. Summary of Background Data: Percutaneous stabilization of collapsed vertebra by bone cement has now become a standard procedure. However, it is essential to localize the correct vertebra. Imaging modalities like CT scan provides structural or anatomical information where as bone scan (planar + SPECT images) provides more functional or physiological information. Combination of these two imaging modalities is expected to provide much more than information obtained by any one imaging modality separately. To the best our knowledge, there is no reference available in the literature adopting this approach. Materials and Methods: Two expert readers, blinded to patient history, evaluated the scans. They independently analyzed planar + SPECT only images followed by SPECT/CT fused images with the aim to identify the acutely fractured vertebra for vertebroplasty. Results: Interpretations changed, on average, 50% of the time as a result of the additional information provided by SPECT + CT. SPECT + CT more precisely localizes tracer abnormalities in the vertebra compared to SPECT imaging alone Conclusion: The greatest value of co-registered SPECT + CT bone scan lies in the accurate localization of affected vertebrae in complicated cases of multiple collapsed vertebrae of different ages as well as in the post-vertebroplasty setting
  1,529 114 -
Fluorodeoxyglucose positron emission tomography-computed tomography in evaluation of pelvic and para-aortic nodal involvement in early stage and operable cervical cancer: Comparison with surgicopathological findings
Vandana Bansal, Kaizad Damania, Anshu Rajnish Sharma
October-December 2011, 26(4):177-180
DOI:10.4103/0972-3919.106699  PMID:23559711
Introduction: Nodal metastases in cervical cancer have prognostic implications. Imaging is used as an adjunct to clinical staging for evaluation of nodal metastases. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has an advantage of superior resolution of its CT component and detecting nodal disease based on increased glycolytic activity rather than node size. But there are limited studies describing its limitations in early stage cervical cancers. Objective: We have done meta-analysis with an objective to evaluate the efficacy of FDG PET/CT and its current clinical role in early stage and operable cervical cancer. Materials and Methods: Studies in which FDG PET/CT was performed before surgery in patients with early stage cervical cancers were included for analysis. PET findings were confirmed with histopathological diagnosis rather than clinical follow-up. FDG PET/CT showed lower sensitivity and clinically unacceptable negative predictive value in detecting nodal metastases in early stage cervical cancer and therefore, can not replace surgicopathological staging. False negative results in presence of microscopic disease and sub-centimeter diseased nodes are still the area of concern for metabolic imaging. However, these studies are single institutional and performed in a small group of patients. There is enough available evidence of clinical utility of FDG PET/CT in locally advanced cervical cancer. But these results can not be extrapolated for early stage disease. Conclusion: The current data suggest that FDG PET/CT is suboptimal in nodal staging in early stage cervical cancer.
  1,505 98 2
CASE REPORTS
Poor Tc-99m dimercaptosuccinic acid uptake, re-evaluation with Tc-99m MAG3 scintigraphy in Lowe syndrome
Gokhan Koca, Hasan Ikbal Atilgan, Koray Demirel, Akif Diri, Meliha Korkmaz
October-December 2011, 26(4):185-187
DOI:10.4103/0972-3919.106701  PMID:23559713
Tc-99m dimercaptosuccinic acid (DMSA) is filtered through the glomeruli and reabsorbed by the proximal tubules as low molecular weight proteins. In Lowe syndrome this mechanism is impaired and so poor DMSA uptake is seen. Poor DMSA uptake was shown in very few studies, but none mentioned normal Tc-99m MAG3 uptake. In this case, the patient had poor DMSA uptake, normal MAG3 uptake and a neurogenic bladder in anterior to the left kidney that attenuates left kidney.
  1,509 63 -
Oncogenic osteomalacia diagnosed by blood pool scintigraphy
Shanmuga Sundaram Palaniswamy, Padma Subramanyam, Harish Kumar
October-December 2011, 26(4):188-191
DOI:10.4103/0972-3919.106702  PMID:23559714
Oncogenic osteomalacia is a rare metabolic bone disease characterized by phosphaturia and hypophosphatemia. Certain tumors secrete a phosphaturic factor, which results in this metabolic abnormality; this factor called as phosphatonin, is in fact a fibroblast growth factor 23 (FGF-23) involved closely in phosphate homeostasis and skeletogenesis. Complete excision of these tumors facilitates reversal of the problem. We have reported here the case of a patient who was crippled with this disease and on thorough investigation revealed an oncogenic osteomalacia with tumor focus in the right tibia. The tumor was identified as a mesenchymal tumor, i.e., hemangiopericytoma. Tumor excision alleviated patient symptoms with rapid symptomatic and biochemical improvement.
  1,357 89 -
Febrile renal transplant recipient with discordant findings of 99m Tc-Leukoscan (Sulesomab) and 67 Ga-citrate scan in pyelonephritis
Sunita Tarsarya Sonavane, Atul Marwah, Rajnath Jaiswar
October-December 2011, 26(4):202-204
DOI:10.4103/0972-3919.106712  PMID:23559719
Nuclear medicine techniques like 99m Tc-Leukoscan and 67 Ga-citrate scan have been used in localizing infectious pathologies in renal transplant patients. We present an interesting case of febrile renal transplant with discordant findings of tracer uptake in the transplant kidney on 99m Tc-Leukoscan and 67 Ga-citrate scan.
  1,352 55 -
Solid variant of papillary carcinoma thyroid in a child with no history of radiation exposure
Nishikant Damle, Soundararajan Ramya, Chandrasekhar Bal, Prashant Durgapal
October-December 2011, 26(4):196-198
DOI:10.4103/0972-3919.106707  PMID:23559717
Solid variant is a rare and poorly characterized variant of papillary thyroid carcinoma (PTC) and comprises approximately 3% of PTCs. It is more common in children and has high propensity for extrathyroidal metastasis. It is seen in higher proportion in post-radiation PTCs and has been seen in more than one-third of post Chernobyl radiation induced PTCs in some studies. It usually presents with differential diagnosis of poorly differentiated carcinoma versus anaplastic versus medullary thyroid carcinoma versus metastasis from extrathyroidal malignancy on fine needle aspiration cytology. This report describes a case of solid variant of PTC in a child who had no history of radiation exposure and shows the importance to be given to histopathology when the pre-operative diagnosis is not clear.
  1,330 77 2
Triple ectopic thyroid: A rare entity
Sujit Nilegaonkar, Chetna Naik, Sameer Sonar, Deepti Hirawe
October-December 2011, 26(4):194-195
DOI:10.4103/0972-3919.106705  PMID:23559716
Ectopic thyroid tissue is an uncommon congenital aberration. It is extremely rare to have three ectopic foci at three different sites. The thyroid scan has been used successfully to diagnose ectopic thyroid tissue. We report a case of ectopic thyroid tissue at base of tongue, another at the level of hyoid and third one as aberrant tissue at suprahyoid location in a 16 year old female who presented with swelling in front of neck. This patient was clinically diagnosed as thyroglossal cyst and was being planned for surgery. Preoperative thyroid scan helped in establishing diagnosis of ectopic thyroid which was the only functioning thyroid tissue. Thus, it prevented unnecessary surgery. Therefore it is suggested that thyroid scan and USG/CT scan must be done as routine work up in neck swellings pre operatively to avoid unnecessary surgeries.
  1,266 81 -
False positive localisation of C-11 methionine in a colloid nodule
Sonia Mahajan, Madhavi Tripathi, Abhinav Jaimini, Anant Dinesh
October-December 2011, 26(4):208-210
DOI:10.4103/0972-3919.106719  PMID:23559721
A 45-year-old female diagnosed with carcinoma of the left breast on histopathological examination underwent both 18 F-flourodeoxyglucose (FDG) and 11C-methionine (MET) positron emission tomography/computed tomography (PET/CT) as part of a protocol comparing the utility of these tracers for predicting a response to neoadjuvant chemotherapy in breast carcinoma. Abnormal FDG and MET accumulation was noted in the left breast primary, left axillary lymph nodes, and also in a well-defined nodule present in the left lobe of the thyroid gland. Keeping in mind the possibility of thyroid neoplasm/metastasis, the patient was referred for fine needle aspiration cytology (FNAC) from the thyroid nodule that revealed features of a simple colloid nodule. Focal thyroid lesions incidentally found on 18 F-FDG PET/CT have a high risk of thyroid malignancy. Non-specific accumulation of FDG in thyroid adenomas is also known. This case highlights a potential cause for false positive on C-11 MET PET/CT in colloid adenomas, which should be kept in mind while using this tracer for oncological indications.
  700 52 -
LETTERS TO EDITOR
Importance of diffuse versus focal F-18 fluoro-deoxy-glucose uptake in oesophagus
Sampath Santhosh, Bhagwant Rai Mittal, Anish Bhattacharya, Ashim Das, Rakesh Kochhar
October-December 2011, 26(4):211-211
DOI:10.4103/0972-3919.106721  PMID:23559722
  678 51 -
Response to "Does thyroxine suppression therapy help to rationalize surgery in benign euthyroid nodules"
Panchangam Ramakanth Bhargav
October-December 2011, 26(4):212-212
DOI:10.4103/0972-3919.106722  PMID:23559723
  541 49 -
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