Sudden sensorineural hearing loss from a Jugular Bulb Diverticulum

@#A 19-year-old woman presented with an 11-month history of sudden-onset left sided hearing loss accompanied by vertigo and headache. Audiometric testing revealed profound left- sided hearing loss. A contrast-enhanced MRI of the internal auditory canal performed 5 months after symptom onset was interpreted as showing a vascular loop, probably the anterior inferior cerebellar artery, abutting and indenting on the left vestibulocochlear nerve; and a prominent and high-riding left jugular bulb. In this study, the internal auditory canals were assessed to be of normal width, with walls that were smooth and sharply defined. A cerebral CT angiogram subsequently performed did not show any abnormal findings related to the previously identified vascular loop. On the basis of these radiologic findings, the patient was advised surgery by physicians at a tertiary- care institution, presumably to address the identified vascular loop. A second opinion was sought by the patient.

The value of 18F-PSMA PET/CT imaging in detecting bone metastasis of prostate cancer / 西安交通大学学报(医学版)

【Objective】 To compare the detection efficiency of 99mTc-MDP SPECT and PSMA PET/CT in detecting bone metastases in patients with prostate cancer. 【Methods】 We retrospectively collected data of 83 patients diagnosed with prostate cancer in The First Affiliated Hospital of Xi’an Jiaotong University from March 2019 to July 2020, concurrent with 99mTc-MDP SPECT and 18F-PSMA PET/CT whole body imaging in the same period. Two nuclear medicine physicians attending a double-blind interpretation compared whether the patients with bone metastases detected by two imaging methods under different PSA levels and different Gleason scores, and further analyzed the location and number of inconsistent bone metastases as well as the ability of PET/CT to detect metastatic lesions other than bone. 【Results】 Compared with 99mTc-MDP SPECT, 18F-PSMA PET/CT could detect more prostate cancer patients with bone metastases (P<0.001). When TPSA<10 ng/mL or >20 ng/mL, the detection rate of PET/CT for bone metastasis was higher than that of whole body bone scan (P<0.05). When Gleason score>8, PET/CT was more effective in detecting bone metastasis. The detection rate was higher than that of whole body bone scan (P<0.05). The lesions with positive PET/CT but not diagnosed by bone scan were mainly located in the chest bone, spine bone, and pelvic bone; the lesions with positive bone scan but missed by PET/CT were also more common in chest bone, with low nuclide uptake. The average SUVmax was 2.62±0.47 (1.60-3.30), and adjacent to the liver, spleen or salivary glands with higher metabolism. There were 21/51 (41.18%) cases of lymph node metastasis found outside of bone, 5/51 (9.80%) cases of lung metastasis, and 1/51 (1.96%) cases of liver metastasis. 【Conclusion】 18F-PSMA PET/CT imaging is significantly superior to 99mTc-MDP whole-body bone imaging in diagnosing bone metastasis of prostate cancer, and it can detect metastases other than bone.

Post-traumatic malleo-incudal complex dislocation

@#A 27-year-old man undergoes otolaryngologic evaluation for blunt head trauma suffered in a vehicular accident. With regards to the right ear, pertinent otologic findings include an ear canal laceration and a delayed-onset facial nerve paresis. Tuning fork testing reveals an abnormal Rinne test on the right (AC<BC). The radiologist’s interpretation of the computerized tomographic imaging study of the temporal bone indicated the presence of a longitudinal fracture of the right temporal bone with no disruption of the ossicular chain. (Figure 1) However, careful examination of the anatomy of the malleo-incudal complex in relation to the other structures in the epitympanum actually reveals findings indicative of a malleo-incudal complex dislocation. How can this discrepancy in the radiologic interpretation be accounted for? By what objective parameters can the presence of a malleoincudal complex dislocation be identified?

Fenestral otosclerosis: A subtle lesion easily missed

@#A 29-year-old Filipina of Chinese descent presented with progressive bilateral conductive hearing loss of several years’ duration. While working overseas, she consulted with an otolaryngologist and underwent computerized tomographic (CT) imaging of the temporal bone as part of her evaluation. She was informed that no abnormalities were identified in the imaging exam, and she was offered exploratory middle ear surgery with possible stapes surgery. She then sought a second opinion, with the intention of obtaining a more definitive diagnosis prior to any invasive medical intervention. A review of the CT imaging study, with particular emphasis on looking for radiologic evidence of otosclerosis, revealed the presence of a focal region of bone demineralization in the region of the fissula ante fenestram. (Figure 1) This finding is consistent with a diagnosis of fenestral otosclerosis.

The Study Of Hrct And Mri Temporal Bone Findings In Pediatric Patients With Congenital Sensorineural Hearing Loss

Introduction -The incidence of Congenital Sensorineural hearing loss (SNHL) is approximately 1: 1000 live births. SNHLis either due to disorders of the inner ear or cochleovestibular cranial nerve. Radiological evaluation is necessary to detect or rule out causes of SNHL. Also, the treatment of SNHLis predominantly determined by the etiology of hearing loss. Aim & objective-Radiological assessment of various congenital inner ear malformations in pediatric age group patients with sensorineural hearing loss in a tertiary care centre.Material & Methods-This is a prospective study conducted between 1 January 2018 and 1 June 2019 in Department of Radiodiagnosis, SAIMS, Indore & included all paediatric patients (93 children), who came for HRCTand MRI temporal bone imaging with the clinical diagnosis of congenital sensorineural hearing loss (SNHL) / for evaluating congenital sensorineural hearing loss (SNHL).Results-In our study out of 93 paediatric patients , no significant radiological abnormality were detected in 68 patients (73.11%), however, 25 patients (26.88%) had various congenital anomalies of the inner ear and vestibulocochlear nerve. Most commonly affected organ was cochlea. Among these 25 patients only cochlea was involved in 7(28%), both Cochlea and semicircular canal in 4(16%), and Cochlea and vestibular aqueduct in 1 patient(4%). Isolated vestibular aqueduct dilatation was found in 8 (32%) patients. Isolated semicircular canal involvement and cochleovestibular nerve abnormality were seen in 3 (12%) and 2 (8%) patients respectively.Conclusion-In this study, imaging has helped us to detect various inner ear malformations in children with congenital sensorineural hearing loss. It is helpful for preoperative planning and preparation for cochlear implant in a tertiary care centre

Radiation level in the surroundings of patients undergoing 99Tcm-MDP SPECT bone imaging and influence factors / 中华放射医学与防护杂志

Objective To study the radiation level in the surrounding of patients undergoing 99Tcm-MDP SPECT bone imaging and associated influencing factors and provide experimental data for the radiation safety of personnel around the patients.Methods A total of 367 patients undergoing whole-body bone imaging in Cancer Hospital,Chinese Academy of Medical Sciences were investigated to measure the ambient dose equivalent rate around the patients at different time and different distances from the patients,analyze the variations of ambient dose equivalent rate with time and distances,estimate the dose level at different distances around the patients,and evaluate the radiation dose to personnel around the patients.Results The ambient dose equivalent rate around the patient decreased exponentially with time;the effective half-life of 99Tcm in patients' body increased with time.The ambient dose equivalent rate varied by power function with increasing distance within 4 meters from the patient with the mean power value of -1.45.The radiation levels were 238.3 μSv at 0.5 m,99.7 μSv at 1 m,and 61.8 μSv at 1.5 m from the patient undergoing 99Tcm injection to its vanishing in patients' body.At different time points,the radiation doses at 0.5 m off the patient for 10 min were:9.9,3.0,1.9 μSv at 0,3 and 6 h,respectively.Conclusions The ambient dose equivalent rate around the patients undergoing 99Tcm-MDP SPECT bone imaging decrease rapidly with increasing time and distance.The patients can cause a certain degree of exposures to the surrounding personnel,but the exposure level is far lower than the relevant national standards.It is suggested that the patients should not receive other types of diagnosis and treatments spending lot of time and in close contact with medical staff while bone imaging being conducted on the same day.

Characteristics of 99m Tc-MDP bone imaging in patients with bone tumors and tumor-like lesions of extremities and their differential diagnosis significances / 吉林大学学报(医学版)

Objective: To explore the radionuclide distribution characteristics of99m Tc-MDP bone imaging of bone tumors or tumor-like lesions in extremities, to clarify the application value of radionuclide distribution characteristics of99mTc-MDP bone imaging of bone tumor and tumor-like lesions with different pathological types in the differential diagnosis, and to provide the clues for clinical diagnosis. Methods: A total of 76 patients with abnormal radionuclide distribution characterics of exetremities showed in99mTc-MDP bone imaging were selected. The results of99mTc-MDP bone imaging were compared with the results of the final clinica diagnosis. The differences in the age, lesion location, radienuclide distribution characteristics of the patients with different pathological types were analyzed. Semi quantitative method (T/N) was used to detect the degree of radioactivity and the differences in T/N between benign and malignant lesions groups. Results: (1) Among 76 patients with bone tumors and tumor-like lesions, the pathological benign findings were in 24 cases and the malignant findings were in 52 cases. (2)The age of the patients with giant cell tumor of bone around knee joint was (42. 1 ± 17. 4) years old, and the age of the patients with fibrous dysplasia in proximal femur was (48. 0 ± 17. 1) years old. In malignant lesions, the age of the patients with metastatic carcinoma located in femoral shaft was (64.0 ± 14.2) years old; the age of the patients with osteosarcoma around epiphysis end was (30. 3± 15. 3) years old; the age of the patient with Ewing' s sarcoma located in femur was (49. 2 ± 4. 7) years old; the age of patients with fibrosarcoma in long bone was (39. 5 ± 17. 2) years old; the age of patients with chondrosarcoma occurred in long bone was (63. 0± 14. 8) years old. (3)The radionuclide distribution characteristics of giant cell tumor, osteosarcoma, Ewing's sarcoma, chondrosarcoma and fibrosarcoma were "wedge" or "lumpy"; the radiological defect of giant cell tumor was greater than Ewing' s sarcoma and fibrosarcoma, while osteosarcoma and chondrosarcoma rarely had center defects; the radionuclide distribution characteristics of fibrous dysplasia and metastasis were " strip-type", and the metastases involving bilateral cortical bone had the radioactive defect in the central region, but fibrous dysplasia distributed uniformly along with the unilateral cortical bone. (4) The average value of T/N in malignant lesions (3. 38±1. 95) was higher than that in benign lesions (1. 43±0. 51) (t=-11.35, P<0. 01). Conclusion: The pathological types of lesions can be preliminarily speculated according to the characteristics of99mTc-MDP bone imaging of bone tumors and tumor-like lesions of extremities, which can provide a reliable reference for clinical diagnosis and differential diagnosis.

Application of radionuclide bone imaging in diagnosis and localization of osteoporotic vertebral compressive fracture / 实用医学杂志

Objective To investigate the value of radionuclide bone imaging in the diagnosis and localization of osteoporotic vertebral compressive fracture.Methods Percutaneous vertebroplasty was applied to 40 patients suffering from osteoporotic vertebral compressive fracture.Responsible vertebral bodys located according to the radionuclide bone imaging was involved as bone scan group,and responsible vertebral bodys located according to the physical examination,X-ray,CT and MRI as standard group.Then the Kappa test was carried out.Result In bone scan group,56 vertebrae were located by radionuclide bone imaging,and in standard group,58 vertebrae were located by X-ray,54 vertebrae by CT and 52 vertebrae by MRI.The Kappa value was 0.76,indicating essentially excellent agreement and statistical significance.Conclusion Radionuclide bone imaging was another good choice for the diagnosis of osteoporotic vertebral compressive fracture.Especially for cases with contraindication of MRI,it offers a reliable choice.

A preliminary study on the bone-targeting potential of a new type of bisphosphonate in rabbits / 中国药学杂志

OBJECTIVE: To study the bone-targeting potential and dynamic changing process in vivo of a new type of anti-osteoporosis bisphosphonate drug under research (SC). METHODS: The distribution in rabbits and bone-targeting of SC was observed by isotope tracer technique. 99Tcm-SC was injected into the rabbits, then the SPECT images were collected and analyzed in 12 h. RESULTS: The labeling rate of 99Tcm-SC could be maintained above 90% within 12 h, which proved the good stability of 99Tcm-SC in vitro. The rabbit bone imaging showed that the targeting of SC to bone was equivalent to MDP, a bone imaging agent. CONCLUSION: This study provides valuable data for the non-clinical and clinical studies of SC. SC has a good potential for being developed into a new generation of anti-osteoporosis drug.

Value of radionuclide bone imaging and MRI in locating responsible vertebrae after osteoporotic vertebral compressive fractures / 中华创伤杂志

Objective To compare the effect of radionuclide bone imaging and MRI in locating responsible vertebrae after osteoporotic vertebral compressive fractures (OVCF).Methods A retrospective analysis was made on 25 patients with OVCF treated by percutaneous kyphoplasty (PKP)from May 2015 to December 2015.There were 4 males and 21 females,at age range of 63-87 years [(73.3 ±6.16)years].The fractured vertebrae included 2 T4,3 T5,2 T6,2 T7,5 T8,3 T9,3 T10,7 T11,9 T12,11 L1,10 L2,2 L3,5 L4 and 1 L5.Cervical imaging examinations (X-ray,bone mineral density,MRI,radionuclide bone imaging) were performed on admission.Oswestry disability index (ODI) and visual analogue scale (VAS) were estimated before operation and 1 d after operation.Results of MRI and radionuclide bone imaging were compared.Results A total of 64 vertebrae were included in our study.Thirty-six vertebrae were recognized as fresh OVCFs by MRI,and 40 by radionuclide bone imaging.Kappa-test indicated the results of the examination methods were statistically significant (P ＜0.05).Specificity (96.6％) and accuracy (98.4％) of MRI were higher than radionuclide bone imaging bone scan (82.8％,92.2％).Conclusions Radionuclide bone imaging has a high consistency with MRI in locating responsible vertebrae after OVCF,but MRI is associated with higher specificity and accuracy.In exceptional cases,radionuclide bone imaging can partly replace MRI as a way to locate OVCF.

The diagnosis value of whole body bone imaging with coincidence SPECT/CT fusion imaging for solitary“hotspots” / 重庆医学

Objective To evaluate the differentiating diagnosis value of coincidence SPECT/CT fusion imaging used in the soli-tary“hotspots”in the whole body bone imaging.Methods Fifty patients with malignancy were selected to have examination.the sensitivity,specificity and accuracy of these imaging methods were calculated by contrasting the pathology examination,CT and MRI examination,more than 6 months follow-up results between the cases.Results The sensitivity,specificity and accuracy of SPECT imaging were 94%,23%,and 63%,respectively,and that of CT were 47%,87%,66%;the sensitivity,specificity and accu-racy of SPECT/CT were 95%,80%,88%,respectively.The specificity and accuracy of SPECT/CT was significantly higher than SPECT(P<0.05)and its sensitivity and accuracy was higher than that of CT(P<0.05).Conclusion Coincidence SPECT/CT hy-brid imaging could raise the sensitivity,specificity and accuracy of diagnosis of solitary“hotspot”in whole bone imaging,which is of high clinical application value.

Synthesis, quality control and dosimetry of the radiopharmaceutical 18F-sodium fluoride produced at the Center for Development of Nuclear Technology - CDTN / Síntese, controle de qualidade e dosimetria do radiofármaco 18 -F de fluoreto de sódio produzido no Centro de Desenvolvimento da Tecnologia Nuclear - CDTN

18F-Sodium fluoride (Na18F) is a radiopharmaceutical used for diagnosis in nuclear medicine by positron emission tomography (PET) imaging. Bone scintigraphy is normally performed using 99mTc-MDP. However, 18F PET scans promise high quality imaging with increased resolution and improved sensitivity and specificity. In order to make available a tool for more specific studies of tumors and non-oncological diseases of bone tissue, the UPPR/CDTN team undertook the production and quality control of Na18F injectable solution with the physical-chemical, microbiological and biological characteristics recommended in the U.S. Pharmacopeia. Na18F radiochemical purity was 96.7 ± 1.3 percent, with Rf= 0.026 ± 0.006. The product presented a pH of 5.3 ± 0.6, half life of 109.0 ± 0.8 minutes, endotoxin limit < 5.0 EU.mL-1 and no microbial contaminants. The biodistribution of Na18F was similar to that described in the literature, with a clearance of 0.19 mL.min-1 and distribution volume of 18.76 mL. The highest bone concentration (5.0 ± 0.5 percentID.g-1) was observed 20 minutes after injection. Na18F produced at the UPPR presented all the quality assurance requirements of the U.S. Pharmacopeia and can be safely used for clinical bone imaging.

O Fluoreto de sódio 18F (Na18F) é um radiofármaco empregado para diagnóstico através da Tomografia por Emissão de Pósitrons (PET). Cintilografias ósseas são normalmente obtidas utilizando-se 99mTc-MDP. Entretanto, o interesse pelo Na18F é crescente, principalmente devido à obtanção de imagens de elevada resolução. Com o objetivo de tornar disponível uma ferramenta mais específica para estudos de tumores e doenças não-oncológicas do tecido ósseo, o grupo da UPPR/CDTN implementou a produção e o controle de qualidade da solução injetável de Na18F com as características físico-química, microbiológica e biológica preconizadas pela farmacopéia. Sua pureza radioquímica foi de 96,7 ± 1,3 por cento, com Rf= 0,026 ± 0,006. O produto apresentou pH igual a 5,3 ± 0,6, tempo de meia-vida de 109,0 ± 0,8 minutos, limite de endotoxinas < 5,0 EU.mL-1 e ausência de microrganismos. O perfil de biodistribuição em camundongos foi semelhante ao disponível na literatura, com depuração igual a 0,19 mL.min-1 e volume de distribuição igual a 18,76 mL. A concentração máxima (5,0 ± 0,5 por cento DI.g-1) foi observada no osso 20 minutos após a injeção. O Na18F produzido na UPPR do CDTN apresentou os parâmetros de qualidade definidos na farmacopéia americana e pode ser usado com segurança para uso clínico em cintilografia óssea.

The influence of integrated-CT artifacts on the attenuation correction results of SPECT/CT bone imaging / 中国医学影像技术

Objective To evaluate the influence of integrated-CT artifacts on attenuation-corrected (AC) images of SPECT bone imaging. Methods Imaging documents of 78 patients who underwent SPECT/CT bone imaging were retrospectively analyzed, and the artifacts on CT images and CT attenuation maps were visually studied. Compared with the non-attenuation corrected (NC) images, the coefficient of variation (CV) and percentage difference (PD) of radioactive count of regional bone influenced by CT artifacts were calculated and statistically analyzed to estimate the influence of CT artifacts on AC images of SPECT bone imaging. Results The integrated-CT artifacts were found in 38 patients of 78, and appeared the same image findings as those on CT attenuation maps respectively, including truncation artifact, thoraco-abdominal gas artifact, photon starvation artifact, etc. On all the AC images with integrated-CT artifacts, regional bones were influenced not only on uniformity (CVAC 17.62%±4.13%, CVNC 11.19%±3.81%;t=2.13, P<0.05), but also by the distribution (PDAC 16.98%±3.31%, PDNC 9.84%±1.62%;t=2.46, P<0.05) of radioactive count. Conclusion Artifacts on integrated-CT images can induce false AC information on CT attenuation maps, therefore, a comparative analysis with NC images is recommended if necessary.

Clinical value of radionuclinde bone imaging in spinal tuberculosis / 中国矫形外科杂志

[Objective]To evaluate the value of ECT in diagnosing and treatment the spinal tuberculosis.[Method]ECT by injecting 99Tcm-MDP to human body was used to know the developing of focus in spinal tuberculosis and whether other bone and joints tuberculosis were complicating simultaneously.[Result]The developing of 175 patients were positive,including multi-vertebral bodies tuberculosis 146 cases,which were composed of 2 vertebral bodies 78 case,3 vertebral bodies 26 cases,4 vertebral bodies and more 42 cases.Complicating tuberculosis of bones and joints 22 cases,articulatio sacroiliaca 29 cases.[Conclusion]ECT plays an important role in diaognosing the spinal tuberculosis and the tuberculose focus of body can be found and has the guidance for doctors to formulate the therapeutic regimem of spinal tuberculosis.