Pattern of distribution of metastatic lesions within skeleton in patients with breast carcinoma of Faisalabad and its vicinity

Evaluation of pattern of distribution of skeletal metastases in patients with breast carcinoma. by using [99m]Tc MDP Skeletal Scintigraphy. Retrospective Analysis. Study was conducted at Punjab Institute of Nuclear Medicine [PINUM], Faisalabad Pakistan from January 2006 to June 2009. A retrospective study was performed on 465 consecutive patients having CA Breast irrespective of preoperative/postoperative status, presenting for bone scan at Punjab Institute of Nuclear Medicine. Whole body bone scan was performed, along with additional spot views, where needed. The images were interpreted for metastatic deposits by three independent observers. Where needed, plain X-ray was performed to correlate in favor of benign pathology. Out of 465 patients [453 female and 12 Male], 286 [62%] patients were having either normal bone scan or some benign pathology as correlated with plain x-ray of the suspected area. 179 [38%] patients were positive for metastases within skeleton. Among these, 61.4% patients were having multiple, 14% with two, while 24.6% were diagnosed as having solitary lesions within the skeleton. In patients having multiple skeletal lesions, highest number was noted in spine [84.5%- most common in thoracolumbar], followed by ribs [55.5%], pelvis [37.3%---most frequent in iliac bone], skull [32%], scapula [27.3%], sternum [26.4%], femur [19.1%], humerus [14.5%], clavicle [3.6%] and tibia [0.9%]. In humerus and femur, most lesions were located in their upper ends, followed by shafts. Right side of skeleton was more frequently involved than the left. In patients having lesions in ribs and pelvis, most of the lesions were bilateral. Patients with two lesions showed maximum number of lesions in rib cage [44%], followed by spine [32%-all being in thoracolumbar region], scapula [24%], pelvis and scapula [24% in each], sternum [16%], skull [8%], humerous and femur [4% in each]. In patients having solitary focal lesion, highest number was noted in spine [45.5%-most common in thoracolumbar spine], followed by ribs [22.7%], sternum and pelvis [13.6% each], and skull [6.8%]. No lesion was noted in appendicular skeleton. Multiple skeletal metastases are much more common than solitary or two lesions in cases of known breast carcinoma. Axial skeleton including skull is most commonly involved. Spine [especially thoracolumbar] is the most frequent site of involvement followed by rib cage, pelvis and then skull. In peripheral bones, most frequent site is the upper end of femur followed by humerus

Gated spect myocardial perfusion scintigraphy for identifying septal perfusion artifacts in left bundle branch block

To determine the role of gated Single Photon Emission Computed Tomography [SPECT] for accurate assessment of myocardial perfusion scintigraphy [MPS] of patients with left bundle branch block [LBBB]. Analytical study. Punjab Institute of Nuclear Medicine [PINUM], Faisalabad, Pakistan, from June 2002 to April 2003. MPS data of patients with LBBB was analyzed. Resting gated SPECT MPS was performed after an injection of 740 MBq 99mTc-MIBI in 10 normal and 25 subjects with LBBB [with low probability of coronary artery disease]. Visual and quantitative analyses were done on non-gated [NG], end diastolic [ED], end systolic [ES] images. Calculations included septal to lateral wall ratio [SLR], myocardial thickening [MT=% increase in counts during systole] at end systolic phase and myocardial thickening at peak level [% peak MT]. Septal hypoperfusion was noted in 19 [76%] patients on NG images and in only 1 [4%] patient on gated SPECT ED images. On NG images of LBBB group, SLR was lower than in controls [0.68 +/- 0.07 vs. 0.87 +/- 0.05, p<0.001]. SLR of LBBB patients approached to that of control group in gated SPECT ED data [0.86 +/- 0.06 vs 0.88 +/- 0.06, p=ns]. Myocardial thickening at ES for septum was markedly lower in LBBB group than in controls [21.83% ' 10.86 vs. 66.32% ' 20.15, p<0.001]. In patients with LBBB, reduced septal thickening results in artifactual septal perfusion defects. Gating the perfusion scintigraphy and reporting perfusion status on end diastolic frames in LBBB patients can eliminate these artifacts

Diagnosis of coronary artery disease by stress Echocardiography and perfusion scintigraphy

This meta-analysis was performed to compare the diagnostic efficacy of stress echocardiography [SE] and Stress perfusion studies [SPS] in detecting coronary artery disease [CAD]. A meta-analysis of peer reviewed articles, published in English language, reporting head-to-head comparison of vasodilator stress echocardiography [VSE] and SPS for the diagnosis of CAD, was performed. Data of 13 studies comprising of 860 patients from 13 different institutions were analyzed. Algorithms were developed to generate raw data from published papers to calculate statistical parameters with confidence intervals and then compare them at specified significance levels. The overall diagnostic accuracy of the two tests was almost similar, 0.77 for VSE vs 0.8 for SPS [p=ns]. SPS gave higher sensitivity, 0.88 vs 0.70 in cumulative data [p<0.0001] while VSE gave higher specificity, 0.90 vs 0.67 [p<0.0001]. Accuracy of VSE with state-of-the-art protocols became even better than SPS [p<0.05]. In hypertensive patients specificity of SPS was markedly deteriorated. Contrary to this, VSE gave higher specificity [0.90 vs 0.40] in this subgroup of patients as well. VSE might become an effective alternative of SPS where scintigraphy techniques are not available or affordable

99mTc MAG3 and 99mTc DTPA; comparison to evaluate renal functions in renal transplant patients

Renal scintigraphy evaluates the renal function non-invasively. The present study was conducted to compare 99mTc MAG3 and 99mTc DTPA in renal transplant patients for the evaluation of renal functions. Materials and 99mTc MAG3 and 99mTc DTPA studies were performed on 33 renal transplant patients and 10 normal subjects, with 1 day interval in between the two studies. Renal transplant patients were categorized as normal, acute tubular necrosis, rejection, urine outflow obstruction and urinary tract infection groups on the basis of routine clinical investigations and preliminary results of scintigraphic studies. Both radiopharmaceuticals, 99mTc MAG3 and 99mTc DTPA were having equal diagnostic efficacy, however image quality with 99mTc MAG3 was superior to that of 99mTc DTPA. Renograms clearly differentiated various renal groups. Correlation between glomerular filtration rate [GFR] and effective renal plasma flow [ERPF] was good [r=0.89 at P<0.00001]. In terms of perfusion index [PI] our results with both agents were similar [r=0.96 at p<0.00001], clearly differentiating all cases of rejection from acute tubular necrosis. PI was raised in rejection cases, while normal in all other groups. In cases of acute tubular necrosis and rejection, 99mTc MAG3 based parenchymal retention index [R-20/3] was markedly raised, compared to that of 99mTc DTPA [p<0.00001]. 99mTc- MAG3 and 99mTc DTPA have equal diagnostic efficacy in renal transplant patients. However visual delineations of the kidneys is better with 99mTc MAG3, especially in cases with compromised renal functions

Detection of severity of coronary stenosis by technetium-99M-MIBI imaging at rest, a quantitative spect study

Our main aim of the study was to evaluate the potential role of resting technetium-99m-MIBI imaging as a detector of degree of severity of coronary stenosis in patients having an episode of acute myocardial infarction six to twelve weeks before. There were 18 patients underwent resting technetium-99m MIBI perfusion imaging. Scintigraphic results obtained in the form of perfusion indices and angiographic results in the form of percentage stenosis. Perfusion index < 0.65 was considered as tested positive and percentage stenosis > 80 percent without the existence of collateral circulation was taken as diseased positive. The sensitivity, specificity, positive predictive value, and a negative predictive value of the overall test is ninety, eighty five, seventy eight, and ninety four percent respectively. In the myocardial segments supplied by severely stenosed coronary arteries, there was significantly higher MIBI uptake in the segments with good collateral circulation as compared with those subtended by a vessel totally occluded with poor collateral circulation [p<0.01]. It is concluded that quantitative analysis of myocardial tomography with technetium99m MIBI at rest can differentiate between myocardial segments supplied by critically stenosed and non-critically stenosed coronary arteries. It also evaluates the existence of collateral circulation