Dandy-Walker Malformation with Refractory Epilepsy: Role of Radionuclide Scintigraphy in Assessing Ventriculo-Peritoneal Shunt Patency

@#Dandy-Walker malformation (DWM) is an uncommon congenital anomaly characterised by enlarged posterior fossa involving the cerebellum and fourth ventricle. Most of DWM patients with hydrocephalus require ventriculo-peritoneal shunt (VPS) especially in those with symptoms such as headache and seizures. In cases with worsening hydrocephalus although on VPS, computed tomography and magnetic resonance imaging can be performed to assess ventricular sizes, and an obstructed shunt may be confirmed with iodinated contrast media injection into shunt reservoir under fluoroscopy guidance. VPS scintigraphy is one of infrequently performed nuclear imaging studies that has the capability to assess shunt patency and detect site of blockage with minimal radiation exposure. We describe here a 32-year-old lady with underlying DWM and hydrocephalus on VPS complicated by refractory epilepsy. Radionuclide scintigraphy has proven to be a safe, simple and useful tool in evaluating shunt function and localising the site of VPS obstruction in this patient.

Is thyroid stunning clinically relevant? A retrospective analysis of 208 patients / O atordoamento da tireoide é clinicamente relevante? Análise retrospectiva de 208 pacientes

Objective : Current guidelines have advised against the performance of 131I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome.Subjects and methods : This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD).Results : Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476).Conclusion : The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

Objetivo : As diretrizes atuais alertam contra a execução da cintigrafia de corpo inteiro com iodo-131 (dxWBS) para minimizar a ocorrência de atordoamento e garantir a eficiência do tratamento com radioiodo (RIT). O objetivo deste estudo foi avaliar o impacto do atordoamento sobre a eficácia do RIT e desfechos da doença.Sujeitos e métodos : Esta análise retrospectiva incluiu 208 pacientes com câncer diferenciado de tireoide submetidos ao mesmo protocolo e acompanhados por 12-159 semanas (média de 30 ± 69 meses). Os pacientes receberam RIT com doses variando de 3.700 a 11.100 MBq (100 mCi a 300 mCi). As imagens da cintigrafia após a RIT foram feitas 10 dias depois da RIT em todos os pacientes. Além disso, as imagens foram também obtidas após 24-48h em 22 pacientes. O desfecho foi classificado como nenhuma evidência de doença (NED), doença estável (SD) e doença progressiva (PD).Resultados : O atordoamento da tireoide ocorreu em 40 pacientes (19,2%), incluindo 26 pacientes com NED e 14 pacientes com SD. A análise multivariada não mostrou associação entre o desfecho da doença e a ocorrência de atordoamento (p = 0,3476).Conclusão : A eficácia da RIT e o desfecho da doença não parecem estar relacionados com o atordoamento da tireoide. Arq Bras Endocrinol Metab. 2014;58(3):292-300.

Ectopic Thyroid Tissue Co-Existing with a Eutopic Thyroid.

Ectopic thyroid tissue, a developmental defect of thyroid gland, is met with rarity in day to day clinical practice. The diagnosis of ectopic thyroid demands a meticulous clinical examination and use of different imaging modalities. We are here reporting a case which presented as an anterior neck swelling, moving with deglutition, and also on and off dysphagia. After necessary investigations she underwent surgery and then the diagnosis of ectopic thyroid was made which was later confirmed with biopsy report which was suggestive of lymphocytic thyroiditis.

The Usefulness of Scintigraphy for the Detection ofGastroesophageal Reflux and Pulmonary Aspiration / 대한소아소화기영양학회지

PURPOSE: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. METHODS: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a (99m)Tc-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. RESULTS: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). CONCLUSION: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.

Evaluation of degree of hepatocirrhosis with liver cell magong by SPECT / 中国基层医药

Objective To evaluate the damaging degree of hepatic cell in the patients with hepatocirrhosis. Methods 25 cases of hepatocirrhosis and 13 eases of normal controls were performed the dynamic imaging with 99mTc-EHIDA.By the three compartmental model configurations,the time-activity curers of the liver cell,and the function indexes liver cell extraction and excretion were calculated.Results The peak time and mean residence time in the hepatocirrhosis group were higher than those in the normal controls(P＜0.01).Compared to normal controls, the peak value,index of uptake,take slope,and excretion slope of the hepatocirrhosis were all lower(P＜0.01).Con- clusion Liver cell imaging is a better method for reflecting the change of liver cell function,and may be used to analyse the degree of hepatocirrhosis.

Studies of assessment of myocardial viability by Tc - ~(99m) sestamibi myocardial scintigraphy and application coronary revasculatrization / 中国实用内科杂志

Objective The purpose of the studies was to explore the elective ways to enhance the ability of routine rest To - 99m - sestamibi (MIBI) myocardial scintigraphy to assess myocardial viability during the percutaneous transluminal coronary angioplasty (PTCA ) in assessing viable myocwhium. Methods Three methods, (1) rest- nitroglycerine augment, (2) rest-gated, (3) rest-delayed 99mc - MIBI myocardial scintigraphies, were performed in 20,30 and 10 patients with coronary artery disease treated with coronary revascularization. Results The results showed that in evaluating viable myocardium, the positive predictive values for methods(1 )-(3) were 95. 9%,68. 5% and 84.1%,mepectively, the negative predictive values were 68. 2%, 90. 1% and 90.0%, respecihvely, the predictive accuracy rates were 82. 5%, 77. 3% and 87.2%. Conclusions The results indicate that identification of viable myocardium with 98mTc - MIBI can be effectively enhanced with methods (1) - (3); the 99mTc - MIBI myocardial scintigraphy can provide objective data for evaluating treatment effects by coronary revascularization.