Indian Journal of Nuclear Medicine
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   2016| April-June  | Volume 31 | Issue 2  
    Online since March 9, 2016

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A comparison study of 11 C-methionine and 18 F-fluorodeoxyglucose positron emission tomography-computed tomography scans in evaluation of patients with recurrent brain tumors
Rajnish Sharma, Maria D'Souza, Abhinav Jaimini, Puja Panwar Hazari, Sanjeev Saw, Santosh Pandey, Dinesh Singh, Yachna Solanki, Nitin Kumar, Anil K Mishra, Anupam Mondal
April-June 2016, 31(2):93-102
Introduction: 11 C-methonine ([11 C]-MET) positron emission tomography-computed tomography (PET-CT) is a well-established technique for evaluation of tumor for diagnosis and treatment planning in neurooncology. [ 11 C]-MET reflects amino acid transport and has been shown to be more sensitive than magnetic resonance imaging (MRI) in stereotactic biopsy planning. This study compared fluorodeoxyglucose (FDG) PET-CT and MET PET-CT in the detection of various brain tumors. Materials and Methods: Sixty-four subjects of brain tumor treated by surgery, chemotherapy, and/or radiotherapy were subjected to [ 18 F]-FDG, [ 11 C]-MET, and MRI scan. The lesion was analyzed semiquantitatively using tumor to normal contralateral ratio. The diagnosis was confirmed by surgery, stereotactic biopsy, clinical follow-up, MRI, or CT scans. Results: Tumor recurrence was found in 5 out of 22 patients on [F-18] FDG scan while [ 11 C]-MET was able to detect recurrence in 18 out of 22 patients in low-grade gliomas. Two of these patients were false positive for the presence of recurrence of tumor and later found to be harboring necrosis. Among oligodendroglioma, medulloblastoma and high-grade glioma out of 42 patients 39 were found to be concordant MET and FDG scans. On semiquantitative analysis, mean T/NT ratio was found to be 2.96 ± 0.94 for lesions positive for recurrence of tumors and 1.18 ± 0.74 for lesions negative for recurrence of tumor on [ 11 C]-MET scan. While the ratio for FDG scan on semiquantitative analysis was found to be 2.05 ± 1.04 for lesions positive for recurrence of tumors and 0.52 ± 0.15 for lesions negative for recurrence of tumors. Conclusion: The study highlight that [ 11 C]-MET is superior to [ 18 F]-FDG PET scans to detect recurrence in low-grade glioma. A cut-off value of target to nontarget value of 1.47 is a useful parameter to distinguish benign from malignant lesion on an [ 11 C]-MET Scan. Both [ 18 F]-FDG and [ 11 C]-MET scans were found to be useful in high-grade astrocytoma, oligodendroglioma, and medulloblastoma.
  2,895 233 -
Pharmacovigilance in radiopharmaceuticals
Rishi Kumar, Vivekanandan Kalaiselvan, Rakesh Kumar, Ravendra Verma, Gyanendra Nath Singh
April-June 2016, 31(2):89-92
Indian Pharmacopoeia Commission is Committed for maintaining the standards of drugs including Radiopharmaceuticals (RPs) by publishing Indian Pharmacopoeia. These RPs are being used in India for diagnostic or therapeutic purpose. RPs though contain relatively small quantities of active ingredient and administered in small volumes could cause some adverse reactions to the patients. The objective of presenting this article is to introduce the system of adverse drug reaction reporting to the nuclear medicine fraternity who are dealing with RPs.
  1,818 191 -
A technique for automatically extracting useful field of view and central field of view images
Anil Kumar Pandey, Param Dev Sharma, Deepak Aheer, Jay Prakash Kumar, Sanjay Kumar Sharma, Chetan Patel, Rakesh Kumar, Chandra Sekhar Bal
April-June 2016, 31(2):108-113
Introduction: It is essential to ensure the uniform response of the single photon emission computed tomography gamma camera system before using it for the clinical studies by exposing it to uniform flood source. Vendor specific acquisition and processing protocol provide for studying flood source images along with the quantitative uniformity parameters such as integral and differential uniformity. However, a significant difficulty is that the time required to acquire a flood source image varies from 10 to 35 min depending both on the activity of Cobalt-57 flood source and the pre specified counts in the vendors protocol (usually 4000K-10,000K counts). In case the acquired total counts are less than the total prespecified counts, and then the vendor's uniformity processing protocol does not precede with the computation of the quantitative uniformity parameters. In this study, we have developed and verified a technique for reading the flood source image, remove unwanted information, and automatically extract and save the useful field of view and central field of view images for the calculation of the uniformity parameters. Materials and Methods: This was implemented using MATLAB R2013b running on Ubuntu Operating system and was verified by subjecting it to the simulated and real flood sources images. Results: The accuracy of the technique was found to be encouraging, especially in view of practical difficulties with vendor-specific protocols. Conclusion: It may be used as a preprocessing step while calculating uniformity parameters of the gamma camera in lesser time with fewer constraints.
  1,424 198 -
FDG PET/CT findings in a clinically diagnosed case of childhood autism
Ashmi S Manglunia, Ameya D Puranik
April-June 2016, 31(2):138-140
Autism is a neurodevelopmental disorder with multifactorial etiology and varied presentation, in which early diagnosis is crucial to the implementation of early treatment. A 6-year-old child clinically diagnosed with autism, and a normal magnetic resonance imaging underwent dedicated 18F-fluorodeoxyglucose brain positron emission tomography (PET) as an ancillary investigation. PET image showed diffuse bilateral temporal hypometabolism. Although PET imaging is currently not indicated in the evaluation of autism, characteristic imaging patterns on PET can provide corroborative information and increase the diagnostic confidence for the same.
  1,389 179 -
Metastatic superscan in prostate carcinoma on gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography scan
Krishan Kant Agarwal, Madhavi Tripathi, Rajeev Kumar, Chandrasekhar Ba
April-June 2016, 31(2):150-151
We describe the imaging features of a metastatic superscan on gallium-68 Glu-NH-CO-NH-Lys-(Ahx)-[Ga-68(HBED-CC)], abbreviated as gallium-68-prostate-specific membrane antigen ( 68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging. 68 Ga-PSMA is novel radiotracer undergoing evaluation for PET/CT imaging of prostate carcinoma. This patient had a superscan of metastases on conventional bone scintigraphy and was referred for 68 Ga-PSMA PET/CT to evaluate the feasibility of 177 Lu-PSMA therapy.
  1,342 147 -
Indirect evidence of intravesical ureterocele on 99m Tc-diethylene triamine pentaacetic acid scan
Deepa Kumar, Ravinder Singh Sethi, Ritu Misra, Md Izhar Ali
April-June 2016, 31(2):147-149
Ureterocele is a common ureteric anomaly detected in pediatric population. Ureterocele diagnosis and evaluation need a variety of radiological methods. We report a case of 5-year-old female child sent for 99m Tc-diethylene triamine pentaacetic acid scan for evaluation of glomerular filtration rate and excretory function of kidneys in view of right-sided hydroureteronephrosis and pyonephrosis with percutaneous tube in situ. Incidental photopenia was noted in the urinary bladder. On ultrasonography of abdomen cause of this photopenia was found to be an intravesical ureterocele.
  1,353 118 -
Evaluation of single-photon emission computed tomography images obtained with and without copper filter by segmentation
Subhash Chand Kheruka, Lalit Mohan Aggarwal, Neeraj Sharma, Umesh Chand Naithani, Anil Kumar Maurya, Sanjay Gambhir
April-June 2016, 31(2):114-118
Background: Measurement of accurate attenuation of photon flux in tissue is important to obtain reconstructed images using single-photon emission computed tomography (SPECT). Computed tomography (CT) scanner provides attenuation correction data for SPECT as well as anatomic information for diagnostic purposes. Segmentation is a process of dividing an image into regions having similar properties such as gray level, color, texture, brightness, and contrast. Image segmentation is an important tool for evaluation of medical images. X-ray beam used in CT scan is poly-energetic; therefore, we have used a copper filter to remove the low energy X-rays for obtaining correct attenuation factor. Images obtained with and without filters were quantitatively evaluated by segmentation method to avoid human error. Materials and Methods: Axial images of AAPM CT phantom were acquired with 3 mm copper filter (low intensity) and without copper filter (high intensity) using low-dose CT (140 kvp and 2.5 mA) of SPECT/CT system (Hawkeye, GE Healthcare). For segmentation Simulated Annealing Based Fuzzy c-means, algorithm is applied. Quantitative measurement of quality is done based on universal image quality index. Further, for the validation of attenuation correction map of filtered CT images, Jaszczak SPECT phantom was filled with 500 MBq of 99m Tc and SPECT study was acquired. Low dose CT images were acquired for attenuation correction to be used for reconstruction of SPECT images. Another set of CT images were acquired after applying additional 3 mm copper filter. Two sets of axial SPECT images were reconstructed using attenuation map from both the CT images obtained without and with a filter. Results and Conclusions: When we applied Simulated Annealing Based Fuzzy c-means segmentation on both the CT images, the CT images with filter shows remarkable improvement and all the six section of the spheres in the Jaszczak SPECT phantom were clearly visualized.
  1,217 142 -
Femoroacetabular impingement mimicking avascular osteonecrosis on bone scintigraphy
Juan Pablo Suarez, María Luz Domínguez, Zulema Nogareda, María Asunción Gómez, Jose Muñoz
April-June 2016, 31(2):156-157
Femoroacetabular impingement (FAI) is a structural abnormality of proximal femur and/or acetabulum. It has been recently described, and there are limited reports in nuclear medicine literature because bone scintigraphy is not listed in its diagnostic protocol, but it should be included on differential diagnosis when evaluating patients, with hip-related symptoms because it may be misinterpreted as degenerative changes or avascular necrosis, and its early treatment avoid progression to osteoarthritis. We describe the case of a male who suffered from hip pain. Bone planar scintigraphic appearance mimicked avascular necrosis, but single photon emission computed tomography (CT) imaging and CT examination confirmed the diagnosis of FAI.
  1,202 114 -
Thyrotropinoma with Graves' disease detected by the fusion of indium-111 octreotide scintigraphy and pituitary magnetic resonance imaging
Kursat Okuyucu, Engin Alagoz, Nuri Arslan, Abdullah Taslipinar, Mehmet Salih Deveci, Erol Bolu
April-June 2016, 31(2):141-143
Thyroid-stimulating hormone-secreting pituitary adenoma (TSHoma) is a rare benign endocrinological tumor which produces TSH in the pituitary gland. Herein, we presented a female patient having TSHoma with Graves' disease during and just after pregnancy that we found by indium-111 octreotide scintigraphy while investigating the patient for hyperthyroidism symptoms.
  1,143 115 -
Inferior vena cava thrombosis with hot quadrate lobe sign demonstrated by Tc-99m macroaggregated albumin radionuclide venogram and single-photon emission computed tomography/computed tomography
Daris Theerakulpisut
April-June 2016, 31(2):144-146
In this article, a case of a young woman who presented with extensive deep venous thrombosis of the inferior vena cava and lower extremities with pulmonary embolism is described. Findings of various imaging modalities highlighting an interesting finding of a "hot quadrate lobe" sign demonstrated by planar radionuclide venography and single photon emission computed tomography/computed tomography are illustrated.
  1,117 96 -
Clinical Utility of 18 F-FDG PET/CT in brachial plexopathy secondary to metastatic breast cancer
Piyush Chandra, Nilendu Purandare, Archi Agrawal, Sneha Shah, Venkatesh Rangarajan
April-June 2016, 31(2):123-127
Role of fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in breast cancer is rapidly evolving. Brachial plexopathy is a rare clinical entity in follow-up of operated breast cancer patients, who presents with disease recurrence in the axilla. Conventionally, magnetic resonance imaging is the imaging modality of choice for diagnostic evaluation in these cases and only few case reports/short studies have explored the utility of PET/CT in this clinical indication. We present here a short case series to demonstrate the utility of PET/CT as an important adjunctive imaging modality to magnetic resonance to supplement diagnosis of brachial plexopathy, differentiate radiation-induced brachial plexopathy from neoplastic plexopathy, accurately restage the disease and to monitor response to chemotherapy.
  1,074 129 -
Unusual presentation of metastatic carcinoma cervix with clinically silent primary identified by  18 F-flouro deoxy glucose positron emission tomography/computed tomography
Raja Senthil, Ranjan Kumar Mohapatra, Shripriya Srinivas, Mouleeswaran Koramadai Sampath, Sumati Sundaraiya
April-June 2016, 31(2):134-137
Carcinoma cervix is the most common gynecological malignancy among Indian women. The common symptoms at presentation include abnormal vaginal bleeding, unusual discharge from the vagina, or pain during coitus and postmenopausal bleeding. Rarely, few patients may present with distant metastases without local symptoms. We present two patients with an unusual presentation of metastatic disease without any gynecological symptoms, where 18 F-flouro deoxy glucose positron emission tomography/computed tomography helped in identifying the primary malignancy in the uterine cervix.
  1,086 91 -
Time reducing exposure containing 18 fluorine flourodeoxyglucose master vial dispensing in hot lab: Omega technique
Vatturi Venkata Satya Prabhakar Rao, Ranadheer Manthri, Pottumuthu Hemalatha, Vuyyuru Navin Kumar, Mohammad Azhar
April-June 2016, 31(2):158-160
Hot lab dispensing of large doses of 18 fluorine fluorodeoxyglucose in master vials supplied from the cyclotrons requires high degrees of skill to handle high doses. Presently practiced conventional method of fractionating from the inverted tiltable vial pig mounted on a metal frame has its own limitations such as increasing isotope handling times and exposure to the technologist. Innovative technique devised markedly improves the fractionating efficiency along with speed, precision, and reduced dose exposure.
  996 152 -
Contrast-enhanced fluorodeoxyglucose positron emission tomography/computed tomography in solid pseudopapillary neoplasm of the pancreas
Sampath Santhosh, Ramesh Kumar Lakshmanan, Bhavay Sonik, Rajagopalan Padmavathy, Rajamani Emmanuel Gunaseelan
April-June 2016, 31(2):131-133
Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic tumor with low malignant potential. It occurs characteristically more often in young women. Radiological and pathological studies have revealed that the tumor is quite different from other pancreatic tumors. Limited information is available in the literature reporting their accumulation of fluorine-18 fluorodeoxyglucose (18F-FDG) in positron emission tomography/computed tomography (PET/CT). Here, we report a case of pancreatic SPN imaged with contrast-enhanced FDG PET/CT. A percutaneous fine needle aspiration from the metabolically active lesion revealed SPN, and it was confirmed with histopathological results. Recurrence or metastasis was not found after 7 months of follow-up.
  970 106 -
An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers
Motahareh Motazedian, F Tabeie, P Vatankhah, B Shafiei, M Amoui, M Atefi, M Ansari, I Neshandar Asli
April-June 2016, 31(2):119-122
Purpose: Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics. Materials and Methods: The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010. Results: The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with 131 I and 99m Tc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago. Conclusion: Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future.
  921 114 -
Active subcutaneous calcinosis demonstrated by fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of limited cutaneous systemic sclerosis
Manuela Vadrucci, Massimo Castellani, Riccardo Benti
April-June 2016, 31(2):154-155
Systemic sclerosis (SSc) is a rheumatic autoimmune disease of unknown origin causing fibrosis of the skin and the internal organs. The limited cutaneous variant is the most common subtype of SSc, and it is predominantly characterized by skin and soft-tissues involvement. A 72-year-old woman, who had been diagnosed with the limited cutaneous form of SSc 16 years before, underwent fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) examination due to unexplained weight loss and recent onset of fatigue and joint pain. PET/CT images showed widespread soft-tissue calcinosis characterized by elevated glucose uptake.
  938 96 -
Calcified peritoneal metastasis identified on 18F-fluoride positron emission tomography/computed tomography: Importance of extraosseous uptake of F-18 fluoride
Priyanka Verma, Piyush Chandra, Archi Agrawal, Nilendu Purandare, Sneha Shah, Venkatesh Rangarajan
April-June 2016, 31(2):152-153
F-18 NaF positron emission tomography/computed tomography (PET/CT) is used for the evaluation of malignant and nonmalignant osseous disease. Extraosseous uptake of 18 fluoride-NaF has been observed in the arterial vasculature, gastrointestinal tract, and genitourinary tract. We describe a case of a woman with carcinoma of unknown primary in whom F-18 NaF PET/CT showed tracer uptake in the calcified peritoneal metastasis. Extraosseous findings on F-18 NaF PET/CT, though rare, may be visualized and may result in important management changes.
  889 101 -
Disseminated histoplasmosis demonstrated on F18-fluorodeoxyglucose positron emission tomography/computed tomography in a renal transplant recipient
Manas Kumar Sahoo, Madhavi Tripathi, Rakesh Deepak, Ravi Kant Gupta, Nishikant Damle, Chandrasekhar Bal
April-June 2016, 31(2):162-164
  845 117 -
Role of fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography in management of pulmonary mucoepidermoid carcinomas and review of literature
Arvind Krishnamurthy, Vijayalakshmi Ramshankar, Urmila Majhi
April-June 2016, 31(2):128-130
Pulmonary mucoepidermoid carcinoma (PMEC) is a rare tumor of bronchial gland origin with a striking resemblance to MEC of the salivary glands. The World Health Organization classifies PMECs as "salivary gland type" tumors along with pulmonary adenoid cystic carcinomas and epimyoepithelial lung carcinomas. Their description in literature is largely limited to a few case series/case reports. Further, the experience of imaging in these tumors with fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET-CT) is also limited and evolving largely due to rarity of PMEC. We recently managed an interesting case of a PMEC and reviewed the literature surrounding this rare tumor with an emphasis on the role of 18 F-FDG PET-CT in its management. An 18 F-FDG PET-CT appears to be a useful imaging modality for predicting the tumor grade of patients with PMECs; further, there is emerging data to suggest the role of 18 F-FDG PET-CT for predicting the long-term prognosis of patients with PMEC.
  813 108 -
111 In-pentetreotide uptake in accessory spleen: A potential pitfall in somatostatin receptor scintigraphy
Yavuz Sami Salihoglu, Tarik Elri, Rabiye Uslu Erdemir, Omer Yazgan
April-June 2016, 31(2):161-162
  744 78 -
Effect of trifluoperazine on Tc-99m sestamibi uptake in patients with advanced nonsmall cell lung cancer
Ümmühan Abdülrezzak, Zeynep Erdogan, Güler Silov, Aysegül Özdal, Özgül Turhal
April-June 2016, 31(2):103-107
Objective: The aim of this study was to investigate whether there is an effect of trifluoperazine on Tc-99m  methoxyisobutylisonitrile (MIBI) uptake in patients with advanced nonsmall cell lung cancer (NCLC). Materials and Methods: A total of 23 patients with biopsy-proven advanced NCLC who had no previous history of chemo-radiotherapy, underwent baseline dual phase planar, single photon emission computed tomography and whole body Tc-99m MIBI scintigraphy performed at 20 and 120 min. After oral administration of trifluoperazine (5 mg, 2 times a day, for 5 days), dual phase Tc-99m MIBI scintigraphy was repeated. For each patient, and for both studies, regions of interest were drawn over the tumor area (T) and over the normal lung area (L) on the contralateral side in transverse slices where tumor was visualized clearly. Then, early and delayed T/L ratios and washout rate (WR) were calculated. Results: Tc-99m MIBI was accumulated in the cancer tissue in all of the patients. Delayed ratio after the oral administration of trifluoperazine (DR2) was significantly higher (P = 0.039) than delayed ratio before trifluoperazine (DR1). We found no significant differences of early ratio before trifluoperazine (ER1) and early ratio after trifluoperazine (ER2), and washout rate before (WR1) and washout rate after trifluoperazine (WR2). Conclusion: In patients with advanced NCLC, trifluoperazine treatment in addition to chemotherapy might be useful. However, our results need to be confirmed in larger series of patients.
  726 32 -