Evaluation of Diagnostic Value of SPECT/CT Imaging in Post-radioiodine Therapy in Thyroid Cancer.

Objectives: This study aimed to investigate the value of single photon emission computed tomography/computed tomography (SPECT/CT) imaging in well-differentiated thyroid cancer (DTC) after radioiodine (I-131) ablation/therapy for clinical staging and risk stratification. It also aimed to determine whether SPECT/CT would change the management plan or predict the clinical outcomes of DTC patients. Methods: A total of 78 DTC patients underwent first post radioiodine therapy "Whole body iodine-131 scintigraphy (WBS) along with SPECT/CT" at the Department of Radiology and Molecular imaging, Sultan Qaboos University Hospital, Muscat, Oman, between January 2014 and August 2017. Differences between WBS and SPECT/CT, change in clinical staging, risk stratification and management were recorded. The clinical outcome at 6-12 months was recorded. A generalised McNemar test was used to assess disagreement between WBS and SPECT/CT. Results: According to the American Thyroid Association (ATA) risk stratification, the sample showed low (35.8%), intermediate (53.8%) and high-risk groups (10.2%) on WBS, which changed to 44.8%, 38.4% and 16.6%, respectively, on SPECT/CT imaging. Overall change in risk stratification was noted in 16.7% and TNM stage in 11.5% of patients after SPECT/CT imaging. SPECT/CT changed the therapeutic plan and clinical outcome in 19.2% of patients. Conclusion: SPECT/CT allows better detection and characterisation of metastatic lymph nodes and distant metastasis in DTC patients compared to WBS imaging alone. It alters TNM staging, ATA risk classification and management in a significant number of patients. It is recommended that SPECT/CT should be done routinely along with WBS in well-differentiated thyroid carcinoma.

Lesson of the month 1: Subacute thyroiditis: a rare cause of fever of unknown origin.

Fever of unknown origin (FUO) is sometimes a diagnostic dilemma for clinicians. Endocrine causes reported in the literature include subacute thyroiditis, thyrotoxicosis, adrenal insufficiency and pheochromocytoma. Among these, subacute thyroiditis is often overlooked as it can occasionally lack typical symptoms. This case illustrates the fact that subacute thyroiditis should be considered as a possible cause of fever even if signs and symptoms of hyperthyroidism and thyroid tenderness are absent.

Paget's Disease in an Omani: Long-term Improvement Following a Single Injection of Zoledronic Acid.

Paget's disease of bone is a patchy skeletal disorder characterized by an increase in bone resorption and formation in the affected areas. It affects up to 3% of individuals of Anglo-Saxon origin over the age of 40 years but is rare in Arabs. Although most patients are asymptomatic, a variety of symptoms and complications may develop directly from bone involvement or secondarily to compression by bone expansion and increased blood flow. The disease can be treated by using medications that inhibit bone resorption, such as calcitonin and the bisphosphonates. Here we describe the case of an Omani patient with the disease, involving the skull, spine, pelvis, and tibia. He presented to the endocrine clinic in Sultan Qaboos University Hospital with a six-year history of headache, bone pain, progressive skull enlargement, and left-sided deafness. His alkaline phosphatase (ALP) level was 1500 U/L. His disease responded gradually to six months of subcutaneous and nasal calcitonin followed by a single 5 mg intravenous injection of zoledronic acid. This resulted in a further progressive reduction of his bone pain, skull size, and improvement in his hearing, as well as normalization of his serum ALP levels after one-year. This effect has been sustained for 3 years.

Radioactive iodine-131 therapy in the management of ectopic thyroid tissue.

The occurrence of ectopic lingual thyroid tissue was first reported over 100 years ago. We report an unusual presentation of ectopic thyroid tissue occurring in the submental area. A 27-year-old female presented to the Sultan Qaboos University Hospital in Muscat, Oman, in October 2011 with an 8 × 6 cm mass which caused difficulty in talking and a feeling of heaviness in the jaw. She was clinically and biochemically euthyroid upon presentation. The clinical diagnosis was confirmed by a technetium(-99m) thyroid scan, magnetic resonance imaging and fine needle aspiration. A single dose of 976 megabecquerels of radioactive iodine-131 resulted in hypothyroidism after three months and the complete disappearance of the swelling and associated symptoms. At a two-year follow-up, the patient was healthy and continuing lifelong replacement therapy with thyroxine.

Cognitive profiles in patients with multi-infarct dementia: an omani study.

BACKGROUND: Studies on neurocognitive impairment among patients presenting with multi-infarct dementia (MID) have received little attention from non-Western societies, and the Arab world is no exception. To our knowledge, this is the first study to characterize neurocognitive, affective and vegetative functioning in patients with MID in Oman. METHODS: In this study, we recruited 20 Omani patients presenting with MID and age- and gender-matched controls at the outpatient clinic of the Department of Behavioral Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman. In addition to the collection of clinical and demographic information, various cognitive batteries were administered to the consenting participants, including those indexing nonverbal reasoning abilities, working memory (attention, concentration and recall) and executive functioning. Questionnaires that elicit the affective range and the quality of sleep were also administered. RESULTS: Compared with the matched healthy subjects, the patients diagnosed with MID significantly differed in the presently operationalized indices of visuospatial function, semantic memory and affective and vegetative functioning. In contrast, episodic memory and some attentional capacities were not significantly different compared with the control subjects. CONCLUSIONS: The present study was explorative and clinically designed to describe neurocognitive functioning in patients with MID seeking consultation at a tertiary care center in Oman. Our data are necessary for planning and setting up community services and health care programs for demented patients in a society where dementia is a growing silent epidemic.

Investigation of the cerebral blood flow of an Omani man with supposed 'spirit possession' associated with an altered mental state : a case report.

INTRODUCTION: The view that spirits may possess humans is found in 90% of the world population, including Arab/Islamic societies. Despite the association between possessive states and various neurological and psychiatric disorders, the available literature has yet to correlate possessive states with functional brain imaging modalities such as single-photon-emission computed tomography. CASE PRESENTATION: This paper describes the clinical case of a 22-year-old male Omani patient who presented to us with an altered state of consciousness that his caregiver attributed to possession. We examined whether the patient's mental state correlated with neuro-imaging data. The patient's distress was invariably associated with specific perfusion in the left temporal lobe and structural abnormality in the left basal ganglia. CONCLUSION: We discuss the case in the context of possession as a culturally sanctioned idiom of distress, and highlight the importance of studying cross-cultural presentations of altered states of consciousness within biomedical models.

Orbital infarction in sickle cell disease.

PURPOSE: To determine the role of hematological and genetic factors in the development of orbital infarction in sickle cell disease. DESIGN: Retrospective, noncomparative case series. METHODS: Fourteen sickle cell disease patients were diagnosed with orbital infarction during a vaso-occlusive crisis. Clinical and radiological findings were reviewed retrospectively. Sickle cell disease patients without orbital infarction were recruited as controls after matching for disease severity. Sickle haplotypes were determined for all patients. Differences between groups were evaluated statistically. RESULTS: Patients with orbital infarction in sickle cell disease presented with acute periorbital pain and swelling with or without proptosis, ophthalmoplegia, and visual impairment during a vaso-occlusive crisis. Radiological findings included orbital soft tissue swelling (100%), hematoma (orbital, 36%; intracranial, 21%), and abnormal bone marrow intensities. Severity of orbital involvement was unrelated to that of the systemic disease (Pearson correlation coefficient, -0.1567). Affected patients predominantly had the Benin haplotype (P < .00782). CONCLUSIONS: Orbital infarction is a potential threat to vision in sickle cell disease patients. Magnetic resonance imaging is more specific than computed tomography or nuclear scintigraphy in the evaluation of orbital changes. The degree of severity of the orbital manifestations appears unrelated to the severity of sickle cell disease. Patients with the Benin haplotype are more likely to develop orbital infarction during vaso-occlusive crises.