Indian Journal of Nuclear Medicine
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   2013| October-December  | Volume 28 | Issue 4  
    Online since November 25, 2013

 
 
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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.
  5,599 137 -
ORIGINAL ARTICLES
Quality control of positron emission tomography radiopharmaceuticals: An institutional experience
Jaya Shukla, Rakhee Vatsa, Nitasha Garg, Priya Bhusari, Ankit Watts, Bhagwant R Mittal
October-December 2013, 28(4):200-206
DOI:10.4103/0972-3919.121963  PMID:24379528
Purpose of the Study: To study quality control parameters of routinely prepared positron emission tomography (PET) radiopharmaceuticals. Materials and Methods: Three PET radiopharmaceuticals fluorine-18 fluorodeoxyglucose (F-18 FDG), N-13 ammonia (N-13 NH 3 ), and Ga-68 DOTATATE (n = 25 each), prepared by standardized protocols were used. The radionuclide purity, radiochemical purity, residual solvents, pH, endotoxins, and sterility of these radiopharmaceuticals were determined. Results: The physical half-life of radionuclide in radiopharmaceuticals, determined by both graphical and formula method, demonstrated purity of radionuclides used. pH of all PET radiopharmaceuticals used was in the range of 5-6.5. No microbial growth was observed in radiopharmaceutical preparations. The residual solvents, chemical impurity, and pyrogens were within the permissible limits. Conclusions: All three PET radiopharmaceuticals were safe for intravenous administration.
  2,779 233 -
CASE REPORTS
Bone scintigraphy in Ollier's disease: A rare case report
Shoukat H Khan, Tanveer A Rather, Parvaiz A Koul, Rumana Makhdoomi, Abdul Rashid Bhat, Dharmender Malik, Ram Manohar
October-December 2013, 28(4):226-229
DOI:10.4103/0972-3919.121968  PMID:24379533
Ollier's disease is characterized by multiple skeletal enchondroma. There are published data regarding Ollier's disease being associated with vascular malformations and non-skeletal neoplasms. We report a case of Ollier's disease in a young male associated with osteochondroma, low grade glioma in the insular cortex of brain and Gilbert's syndrome. Technetium-99m methylene diphosphonate whole body bone scan is a sensitive investigation to ascertain the complete extent of skeletal involvement particularly the asymptomatic sites.
  1,893 97 -
LETTER TO EDITOR
Superscan caused by renal osteodystrophy: Observed on 18F FDG PET/CT scan
Nasrin Ghesani, Jin Jung, Shyam Patel, Tekchand Ramchand
October-December 2013, 28(4):251-252
DOI:10.4103/0972-3919.121981  PMID:24379542
  1,804 89 -
ORIGINAL ARTICLES
Adenosine stress myocardial perfusion scintigraphy in pediatric patients after arterial switch operation
Arun Reddy, Akshay K Bisoi, Suhas Singla, Chetan D Patel, Sambhunath Das
October-December 2013, 28(4):210-215
DOI:10.4103/0972-3919.121965  PMID:24379530
Context: Arterial switch operation (ASO) has become the established treatment for correction of transposition of great arteries (TGA). Despite the immediate correction of abnormal hemodynamics, acute and delayed complications related to the coronaries may cause morbidity and mortality. Aims: We evaluated the incidence of perfusion abnormalities and safety of adenosine by stress-rest myocardial perfusion single-photon emission computed tomography (SPECT) [myocardial perfusion scintigraphy (MPS)] using Tc-99m Sestamibi (MIBI) in asymptomatic children post-ASO. Settings and Design: Prospective study. Materials and Methods: We conducted a prospective, single-institutional study where stress-rest MPS was performed on 10 children of age between 1.25 and 6 years. Two of the patients had additional ventricular septal defect, one patient had left ventricular outflow tract obstruction, and another had Taussig-Bing anomaly. All the patients underwent corrective surgery as a single-stage procedure at the age of 176 ± 212 days (range 9-560 days). Adenosine was administered at a rate of 140 μg/kg/min intravenously as continuous infusion for duration of 6 min. Statistical Analysis Used: All the continuous variables were summarized as mean ± standard deviation, or range and median. Mann-Whitney test for unpaired data and Wilcoxon Rank test for paired samples were used. Results: The average increase in heart rate over the basal heart rate after adenosine stress was 59.7 ± 17.0%. No acute or remote complications were observed in any case. None of the patients demonstrated myocardial perfusion defects, either at rest or after adenosine stress. Conclusions: MPS post-adenosine induced vasodilatation is safe and feasible in patients of ASO for transposition of great arteries. One-stage repair, implantation of excised coronary buttons within neo-aortic sinus, and minimal or no mobilization of proximal coronaries may eliminate the occurrence of perfusion defects in patients of corrected TGA.
  1,665 91 -
Role of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of recurrence in patients with cervical cancer
Amit Bhoil, Bhagwant Rai Mittal, Anish Bhattacharya, Sampath Santhosh, Firuza Patel
October-December 2013, 28(4):216-220
DOI:10.4103/0972-3919.121966  PMID:24379531
Introduction: Treatment of cervical cancer is usually surgery in the early stages and radiotherapy or chemoradiotherapy in more advanced stages of the disease. Recurrence may occur in multiple sites following primary treatment. Although recurrent metastatic disease is not curable, surgical treatment may be of great help if locoregional recurrence is detected early. Fluorine-18 Fluorodeoxyglucose positron emission tomography - computed tomography (F-18 FDG PET/CT) forms an important part of investigations in the diagnosis of clinically suspicious recurrent cervical cancer. Objective: To assess the role of F-18 FDG PET/CT in diagnosing recurrence in patients with clinical suspicion of recurrent cervical cancer. Materials and Methods: We retrospectively evaluated 53 histopathologically proved patients of cervical cancer. All the patients had been treated with either surgery/radiation therapy with or without chemotherapy. The standard PET/CT acquisition protocol, with delayed post void static pelvic images, wherever required, was followed in all patients. Significant uptake of FDG in the lymph nodes was considered to be a recurrence suggestive of metastasis. Para-aortic lymph nodal involvement was considered to be distant metastasis. Any significant uptake in the lung nodule on FDG PET was evaluated either by histological confirmation, by taking fine needle aspiration cytology (FNAC), or by a follow-up chest CT done after three months. Results: Of the 53 patients with clinically equivocal recurrence, FDG PET/CT suggested recurrence in 41 patients (local recurrence in 14 patients and distant recurrence/metastasis with or without local recurrence in 27 patients). It had a sensitivity of 97.5%, a specificity of 63.6%, positive predictive value of 90.9%, and negative predictive value of 87.5%. Conclusion: PET/CT appears to have an important role in detecting recurrence following primary treatment of cervical cancer. The high positive and negative predictive values of PET/CT may be helpful in planning management of recurrent cervical cancer.
  1,588 118 1
IN MEMORIAM
Good Bye 'Sir'
Rakesh Kumar
October-December 2013, 28(4):193-194
DOI:10.4103/0972-3919.121961  
  1,412 149 -
CASE REPORTS
Ovarian carcinoma producing parathyroid hormone-related protein causing hypercalcemia and metastatic calcification detected on 18 F-FDG PET-CT
Krishan Kant Agarwal, Sellam Karunanithi, Sachin Jain, Rakesh Kumar
October-December 2013, 28(4):237-239
DOI:10.4103/0972-3919.121973  PMID:24379537
Hypercalcemia is associated with gynecologic malignant diseases, and cases involving various organs such as the uterus, ovaries, vulva, and vagina. This may be due to elevated levels of parathyroid hormone-related peptide (PTHrP). We describe here two cases of ovarian carcinoma simultaneously producing PTHrP that caused hypercalcemia and metastatic calcification detected on 18F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography-computed tomography (PET-CT).
  1,492 57 -
Identification of a unique cause of ring artifact seen in computed tomography trans-axial images
Ashish Kumar Jha, Nilendu C Purandare, Sneha Shah, Archi Agrawal, Ameya D Puranik, Venkatesh Rangarajan
October-December 2013, 28(4):232-233
DOI:10.4103/0972-3919.121970  PMID:24379535
Artifacts present in computed tomography (CT) image often degrade the image quality and ultimately, the diagnostic outcome. Ring artifact in trans-axial image is caused by either miscalibrated or defective detector element of detector row, which is often categorized as scanner based artifact. A ring artifact detected on trans-axial CT image of positron emission tomography/computed tomography (PET/CT), was caused by contamination of CT tube aperture by droplet of injectable contrast medium. This artifact was corrected by removal of contrast droplet from CT tube aperture. The ring artifact is a very common artifact, commonly cited in the literature. Our case puts forward an uncommon cause of this artifact and its method of correction, which also, has no mention in the existing literature.
  1,417 78 -
ORIGINAL ARTICLES
Indigenously developed close delivery system for oral iodine-131 therapy: Nominal cost but phenomenal protection
Nosheen Fatima, Maseeh uz Zaman, Imran A Shah, Imtiaz Ul Haq, Ali Javed
October-December 2013, 28(4):207-209
DOI:10.4103/0972-3919.121964  PMID:24379529
Background: Administration of radiopharmaceuticals through intravenous and oral routes is the major source of radiation exposure to nuclear medicine (NM) technologists. Adopting new strategies to minimize radiation exposure is an important step toward safe practice in nuclear pharmacy. Materials and Methods: We have indigenously developed a relatively close delivery system for oral administration of radioiodine-131 ( 131 I) to minimize radiation exposure to the technologists. Results: The efficacy of this indigenously developed close system was assessed upon 23 patients who were given 131 I therapies for benign (13 patients) and malignant thyroid disorders (10 patients). There was 64 ± 6% (P < 0.05) reduction in exposure rate using indigenously developed delivery system. Conclusion: The cost involved in developing this system was very nominal, but efficacy in terms of radiation safety and confidence of our technologists were phenomenal.
  1,207 92 -
CASE REPORTS
Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging
Alev Cinar, Murat Sadic, Koray Demirel, Meliha Korkmaz
October-December 2013, 28(4):246-248
DOI:10.4103/0972-3919.121977  PMID:24379540
In recent years 99m Technetium methoxy-isobutyl-isonitrile ( 99m Tc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99m Technetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of distribution of this radiotracer in order to recognize the abnormal uptake. Here in, we present a large diaphragmatic hernia, seemed as a mirror vision of myocardium that was determined incidentally during the MPI with 99m Tc MIBI.
  1,109 65 -
Synchronous papillary carcinoma thyroid with malignant struma ovarii: A management dilemma
Arvind Krishnamurthy, Vijayalakshmi Ramshankar, Venkatesh Vaidyalingam, Urmila Majhi
October-December 2013, 28(4):243-245
DOI:10.4103/0972-3919.121975  PMID:24379539
Struma ovarii (SO) is a rare form of ovarian tumor, which is defined by the presence of thyroid tissue comprising more than 50% of the overall tumor volume. The vast majority of the variants of SO are benign; however, malignant tumors have been reported in a small percentage of cases. An aggressive multimodality approach using ovarian cancer staging laparotomy, total thyroidectomy along with radioactive iodine-131 ablation, and thyroxin suppression therapy has been shown to safely treat malignant SO both its initial presentation as well as in the event of any subsequent recurrence with excellent efficacy and possibly better oncological outcomes. The rarity of the disease and the lack of evidence surrounding its management and prognosis continue to remain a challenge to the treating clinician. We present a unique case of malignant SO with an incidental synchronous association of follicular variant of papillary carcinoma of the cervical thyroid gland, this is possibly the second case reported in the English language literature.
  1,081 83 1
ORIGINAL ARTICLES
Correlation between the clinical pretest probability score and the lung ventilation and perfusion scan probability
Shanmugasundaram Bhoobalan, Riddhika Chakravartty, Gill Dolbear, Mazin Al-Janabi
October-December 2013, 28(4):221-225
DOI:10.4103/0972-3919.121967  PMID:24379532
Purpose: Aim of the study was to determine the accuracy of the clinical pretest probability (PTP) score and its association with lung ventilation and perfusion (VQ) scan. Materials and Methods: A retrospective analysis of 510 patients who had a lung VQ scan between 2008 and 2010 were included in the study. Out of 510 studies, the number of normal, low, and high probability VQ scans were 155 (30%), 289 (57%), and 55 (11%), respectively. Results: A total of 103 patients underwent computed tomography pulmonary angiography (CTPA) scan in which 21 (20%) had a positive scan, 81 (79%) had a negative scan and one (1%) had an equivocal result. The rate of PE in the normal, low-probability, and high-probability scan categories were: 2 (9.5%), 10 (47.5%), and 9 (43%) respectively. A very low correlation (Pearson correlation coefficient r = 0.20) between the clinical PTP score and lung VQ scan. The area under the curve (AUC) of the clinical PTP score was 52% when compared with the CTPA results. However, the accuracy of lung VQ scan was better (AUC = 74%) when compared with CTPA scan. Conclusion: The clinical PTP score is unreliable on its own; however, it may still aid in the interpretation of lung VQ scan. The accuracy of the lung VQ scan was better in the assessment of underlying pulmonary embolism (PE).
  1,050 75 -
CASE REPORTS
A rare case of primary malignant melanoma of clivus with extensive skeletal metastasis demonstrated on 18F-FDG PET/CT
Sonia Mahajan Dinesh, Batchu Suneetha, Ashok Sen
October-December 2013, 28(4):234-236
DOI:10.4103/0972-3919.121971  PMID:24379536
Malignant melanoma of the clivus is a rare entity, for which there is little evidence-based literature for guiding clinicians to understand the importance of disease staging via noninvasive imaging strategy. This report highlights the case of a 55-year-old lady with histopathologically confirmed melanocytic melanoma of the clivus-postoperative status, with multiple skeletal metastasis, demonstrated on 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT scan). The experience gained with this patient demonstrates the feasibility and usefulness of this noninvasive application in accurate staging and hence, correct decision making regarding further treatment.
  995 74 -
Extraosseous uptake of technetium-99m methylene diphosphonate by an acute territorial cerebral infarct in a classical biodistribution pattern
Anbalagan Kannivelu, Ajit Kumar Padhy, Sivasubramanian Srinivasan, Syed Zama Ali
October-December 2013, 28(4):240-242
DOI:10.4103/0972-3919.121974  PMID:24379538
Technetium-99m methylene diphosphonate scintigraphy is usually performed to assess bone lesions, especially skeletal metastases in patients with a history of malignancy. However, it is important to recognize some specific conditions with a unique pattern of tracer uptake, especially in extraosseous locations as they are not related to primary neoplasm or metastases. Diagnosing such unusual presentation is essential as it significantly influences the clinical management. This case report describes an unusual presentation detected in a bone scan of an elderly female patient, who was a treated case of breast cancer and was referred for a bone scan to rule out bone metastases. Incidentally, a large acute territorial cerebral infarct was diagnosed, which was later confirmed by magnetic resonance imaging on diffusion-weighted images. Diagnosis of the typical presentation and timely management saved the patient life.
  998 58 -
LETTER TO EDITOR
Multiple 'skip' lesions in oropharynx and contralateral synchronous primary in hypopharynx detected on FDG PET/CT in case of oral cavity cancer
Ameya D Puranik, Nilendu C Purandare, Sneha Shah, Archi Agrawal, Venkatesh Rangarajan
October-December 2013, 28(4):252-254
DOI:10.4103/0972-3919.121985  PMID:24379543
  955 58 -
INTERESTING IMAGE
'Double cortex' sign on FDG-PET/CT in diffuse band heterotopia
Madhavi Tripathi, Manjari Tripathi, Ganesh Kumar, Arun Malhotra, Chandra Sekhar Bal
October-December 2013, 28(4):249-250
DOI:10.4103/0972-3919.121979  PMID:24379541
F-18 Fluorodeoxyglucose (FDG) Positron emission tomography/Computed Tomography (PET/CT) has come to play an increasingly important role for the pre-surgical evaluation of drug resistant epilepsy and complements Magnetic Resonance Imaging (MRI) in the evaluation of grey matter heterotopias. This case illustrates the characteristic pattern of metabolic abnormality in diffuse band heterotopia (DBH) which is otherwise called double cortex syndrome. The presence of metabolic activity in the heterotopic inner cortical band and in the overlying true cortex gives rise to the 'double cortex' sign on FDG-PET, concurrent CT provides a good anato-metabolic coregistration.
  932 73 -
LETTER TO EDITOR
Hybrid SPECT/CT as a diagnostic modality in suspected urinoma with ambiguous planar Tc99m EC renal scintigraphy
Rayamajhi Sampanna Jung, Kanhaiyalal Agarwal, Ashwani Sood, Anish Bhattacharya, Bhagwant Rai Mittal
October-December 2013, 28(4):254-255
DOI:10.4103/0972-3919.121986  PMID:24379544
  828 55 -
Brain perfusion single photon emission computed tomography with 99m Tc-hexamethylpropyleneamineoxime in hereditary obsessive compulsive disorder
Amburanjan Santra, Ramesh Kumar Thukral
October-December 2013, 28(4):256-257
DOI:10.4103/0972-3919.121989  PMID:24379545
  782 62 -
CASE REPORTS
Technetium-99m methylene diphosphonate uptake in the brachialis muscle hematoma in a patient with prostate cancer and coagulation disorder mimicking bone metastasis evaluated by single-photon emission tomography-computed tomography/computed tomography
Koramadai Karuppusamy Kamaleshwaran, Vyshakh Mohanan, Devdas Madhavan, Ajit Sugunan Shinto
October-December 2013, 28(4):230-231
DOI:10.4103/0972-3919.121969  PMID:24379534
We report a case of 79-year-old male with prostate cancer and coagulation disorder presented with left shoulder pain. He underwent bone scintigraphy to rule out metastasis, which showed intense foci of tracer activity in the left axilla. Hybrid single-photon emission tomography-computed tomography (SPECT/CT) of the shoulder region localized tracer uptake to the left brachialis muscle hematoma.
  772 63 -
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