Gastrointestinal Side Effects of the Radioiodine Therapy for the Patients with Differentiated Thyroid Carcinoma Two Days after Prescription.

Iodine-131 (I-131) therapy is one of the conventional approaches in the treatment of patients with differentiated thyroid carcinoma (DTC). The radioiodine agents also accumulate in the other organs that cause pain and damage to the patients. Radioiodine therapy is associated with various gastrointestinal (GI) toxicities. In this study, GI side effects of the radioiodine therapy were investigated. GI toxicities of the radioiodine therapy were studied in 137 patients with histologically proven DTC in Jun-Nov 2014. All the patients were treated by radioiodine agents in the research institute of Shariati Hospital, Tehran, Iran. The patients were examined 48 h after prescription (before discharge) and their GI side effects were registered. Correlation of the age, gender, administered dose, administered dose per body weight as the independent factors, and GI side effects were analyzed using the Pearson correlation test with Statistical Package for the Social Sciences (SPSS) version 20. Regression coefficients and linearity of the variable were investigated by MATLAB software. Line fitting was performed using MATLAB curve-fitting toolbox. From the subjects, 38 patients had GI complaints (30.4%). Significant factors influencing GI side effects were dose per body weight and administered doses. There was no significant correlation between age and gender as the independent parameters and GI complaints. The most prevalent GI side effect was nausea that occurs in 26.4% of the patients. From the results, it could be concluded that the GI side effects could be prevented by administering a safe radioiodine dose value less than 5,550 MBq.

The Effect of the Lumbar Vertebral Malpositioning on Bone Mineral Density Measurements of the Lumbar Spine by Dual-Energy X-Ray Absorptiometry.

A significant discrepancy between the results of previous human and phantoms studies is identified regarding the effects of vertebral positioning on bone mineral density (BMD) measurements. We aimed to evaluate the effects of lumbar vertebral positioning on BMD measurements by dual-energy X-ray absorptiometry in a human cadaveric spine phantom. A spine phantom was designed using L1-L4 vertebrae harvested from a 48-year-old male cadaver without coronal or sagittal deformity. The spine phantom was scanned by DEXXUM T bone densitometer in a constant scanning speed of 30 mm/s and resolution of 1.0 × 1.0 mm. BMD values were measured in a positive and negative lumbar lordosis and kyphosis tilt angles in the sagittal plane, from 0° to 35°, with 7° increments. Also BMD values were measured in axial and lateral rotations with 5° increments. Projectional dual-energy X-ray absorptiometry measurements are significantly affected by positioning of the lumbar spine, more severely affected by kyphotic curvature, but also by axial and lateral rotational scoliosis as well as lordotic curvature. Increasing the severity of lordosis and kyphosis curvatures leads to false reduction of BMD value up to 17.5% and 11.5%, respectively. Increasing the degree of lateral and axial rotational scolioses results in a false decrease in BMD measurements by up to 10.8% and 9.6%, respectively. To achieve the most accurate scanning results, error sources and abnormal positioning should be identified and minimized as much as possible. If not correctable, they should be taken into consideration while interpreting the results.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease)--imaging manifestations of renal involvement.

A 23-year-old lady presented with abdominal fullness and distension as well as large abdominal masses in physical exam. Upon ultrasonographic evaluation, two large space occupying lesions anterior to kidneys, with no clear distinction from renal tissue, as well as bilateral hydronephrosis were found. The findings were confirmed by MRI. Histopathological analysis of renal masses and lymph nodes showed proliferation of histiocytes mixed with occasional multinucleated giant cells, immunostaining of which was positive for S-100 and CD68. We present renal scintigraphy features of this rare case of renal sinus histiocytosis with massive intraabdominal lymphadenopathy (Rosai-Dorfman disease).

Withholding or continuing beta-blocker treatment before dipyridamole myocardial perfusion imaging for the diagnosis of coronary artery disease? A randomized clinical trial.

BACKGROUND: Although it has been shown that acute beta-blocker administration may reduce the presence or severity of myocardial perfusion defects with dipyridamole stress, little information is available about the potential effect of chronic beta-blocker treatment on the sensitivity of dipyridamole myocardial perfusion imaging (DMPI). METHODS: As a randomized clinical trial, one hundred twenty patients (103 male and 17 female) with angiographically confirmed CAD who were on long-term beta blocker therapy (≥3 months) enrolled in a randomized clinical trial study. The patients were allocated into two groups: Group A (n=60) in whom the beta-blocker agent was discontinued for 72h before DMPI and Group B (n=60) without discontinuation of beta-blockers prior to DMPI. RESULTS: No significant difference was noted between the groups concerning age, sex, type of the injected radiotracer and number of involved coronary vessels. The mean rank of total perfusion scores for whole myocardium (irrespective of reversibility or irreversibility) in group B was not significantly different from that of group A, (65.75 vs. 55.25, P=0.096). Regarding the only irreversible perfusion defects, the mean rank of perfusion score in group B was higher than that of group A for whole myocardium (72 vs. 49, P=0.0001); however, no difference was noted between two groups for only reversible perfusion defects (61.0 vs. 60.0, P=0.898). The overall sensitivity of DMPI for the diagnosis of CAD in group A (91.7%) was not statistically different from group B (90%). CONCLUSION: Beta-blocker withholding before DMPI did not generally affect the sensitivity of the test for the diagnostic purposes in our study. Thus, beta-blocker withdrawal for just the purpose of diagnostic imaging is not mandatory particularly when medication discontinuation may cause the patients to face increased risk of heart events.

Bone mineral density in adult patients with major thalassaemia: our experience and a brief review of the literature.

INTRODUCTION: Metabolic bone disease represents a major cause of morbidity in patients with thalassaemia major. The aim of our study was to assess the prevalence and underlying contributory factors of osteopenia/osteoporosis in a randomly selected population of adult patients with thalassaemia major. PATIENTS AND METHODS: The study population was selected using the random sampling method from the patients' database of our thalassaemia clinic. Only transfusion-dependent beta-thalassaemia patients aged over 17 and with no history of treatment with bisphosphonates were included. BMD of lumbar spine and right femoral neck were measured by means of the calibrated dual energy X-ray absorption method. Independent factors likely to be associated with low bone mass were determined and included in the analysis to ascertain possible associations. RESULTS: Our study included 40 patients (19 female and 21 male; mean age: 23.0 ± 4.1). The mean Z score of the right femoral neck was -1.2 (95% CI: -0.9 to -1.5) and for lumbar spine was -2.1 (95% CI: -1.7 to -2.5). The prevalences of osteopenia and osteoporosis involving the right femoral neck were 37.5%, and 12.5%, respectively. The respective prevalence rates for lumbar spine were 47.5% and 37.5%. Our study showed patient's weight, age, duration of the disease and history of hypogonadism or concurrent hypothyroidism are significant contributory factors or predictors of bone mineral loss. CONCLUSIONS: Regarding the high prevalence of osteopenia/osteoporosis in patients with thalassaemia major, all patients should be screened periodically for bone disease. The uncertainty and disagreements as to the possible role of different factors indicate the necessity for further studies in order to recognise the pathophysiologic fundamentals of this serious complication of thalassaemia major.

Bone scintigraphy elucidates different metabolic stages of melorheostosis.

Melorheostosis is a rare benign non-hereditary sclerosing dysplasia involving the bone, often in a sclerotomal distribution. we report the case of a 27 years old lady with painful swelling of the left hand and forearm lasting for almost 15 years. The patient experienced aggravation of symptoms and limitation of motion during the past two months. Radiographic assessment revealed hyperostosis involving the left 3(rd) and 4(th) metacarpal bones and corresponding digits as well as the left ulna and distal humerus, with no soft tissue ossification. Angiographic and blood pool images of bone scintigraphy showed increased activity of mid-metacarpal region, corresponding to the sclerotom C-8. Delayed static views showed increased radiotracer uptake of the left 4(th) metacarpal bone and the corresponding digit as well as the left ulna and humerus, but no abnormal osteoblastic activity of the 3(rd) left metacarpal and digit. Histopathologic assessment confirmed the diagnosis of Melorheostosis. The case confirms that even in the same sclerotomal distribution, the multiple foci of involvement can present in different metabolic stages. In fact, the disease does not progress uniformly and different lesions can be seen in dissimilar stages of activity. Hence, metabolic imaging can be important to unmask which of the radiographically detected bony lesions are metabolically active and have the potential to be the source of current patient's symptoms and which of them are old, metabolically inactive and silent lesions, which are not clinically relevant to the patient's complaints.

Assessment of clinical impact in the application of Chang attenuation correction to lung ventilation/perfusion SPECT.

UNLABELLED: The presence of a highly nonuniform distribution of attenuating tissues in the thorax may lead to attenuation artifacts and inaccuracies in reconstructed lung ventilation/perfusion SPECT images. The Chang algorithm is an easily applicable and accessible method of attenuation correction. The advantages inherent in the technique prompted us to evaluate the effect of using Chang attenuation correction on the quality of lung SPECT images and the clinical impact on interpretation. METHODS: Lung scintigraphy started with planar and SPECT ventilation scans using (81m)Kr. A few minutes after the ventilation scintigraphy, planar and SPECT perfusion studies using (99m)Tc-macroaggregated albumin were performed. The Chang algorithm was applied for attenuation correction. Afterward, standard SPECT processing was performed on the images, leading to images in the horizontal, coronal, and sagittal planes. The same studies were also processed to the same planes without application of attenuation correction. Finally, all scintigraphic images were reviewed by 2 nuclear medicine academic clinicians, and a final diagnosis was reached by consensus, categorizing the studies into 3 groups-normal, low/intermediate, and high probability-for pulmonary embolism. RESULTS: The study included 45 patients (16 men and 29 women) with a mean age of 50.0 y. Between the 2 noncorrected and attenuation-corrected readings, 16 diagnoses remained the same. However, after attenuation correction, 13 patients were moved to lower categories (i.e., from high probability to normal or low/intermediate probability or from low/intermediate probability to normal) and 16 patients were moved to higher categories (i.e., from low/intermediate probability to high probability or from normal to low/intermediate or high probability). The difference between noncorrected and attenuation-corrected readings was statistically significant (P < 0.01). CONCLUSION: After attenuation correction, subjective image quality and sharpness improved, leading in some cases to increased confidence on the part of the readers. The Chang attenuation correction method may have the potential to be considered as an alternative approach toward attenuation correction in those situations in which the additional radiation burden of CT is not acceptable.

Hemosuccus pancreaticus in Glanzmann thrombasthenia: implication of scintigraphy in gastrointestinal bleeding (GIB) of unknown origin.

A 33-year-old man with Glanzmann thrombasthenia, enduring retractable melena, and with an active upper gastrointestinal bleeding (GIB) of unknown origin lasting intermittently for 6 months, was admitted. Abdominal ultrasound and computed tomography were not diagnostic. The patient underwent upper gastrointestinal endoscopy twice, both of which showed blood issuing forth from ampulla of vater and possible diagnoses of bleeding from papilla/hematobilia or hemosuccus pancreaticus were suspected. Digital subtraction angiography of celiac/superior mesenteric arteries was unremarkable. In GIB scintigraphy, a focus of activity appeared in the epigastric area early in the study (arrow), intensity of which increased gradually. Exploratory laparatomy confirmed the diagnosis of hemosuccus pancreaticus. Although the patient was doing well for few weeks after the surgery, he died 3 months later after an acute episode of severe GIB.

The role of myocardial perfusion imaging in the evaluation of patients undergoing percutaneous transluminal coronary angioplasty.

INTRODUCTION: We studied the value of myocardial perfusion imaging (MPI) for the evaluation of improvement in myocardial perfusion in patients with successful percutaneous transluminal coronary angioplasty (PTCA). METHODS: Sixty patients (10 women, 50 men) aged 54.18 +/- 11.71 years were analyzed. MPI was performed before PTCA, 6-10 days (16 cases), 1-3 months (21 cases), and then 3-6 months (23 cases) after the procedure. In all patients repeated coronary angiography was done at least once after PTCA. Statistical analysis of the numbers of segments with various degrees of perfusion (normal, ischemia, fixed segment), before and after PTCA, was performed for three groups (6-10 days, 1-3 months and 3-6 months after PTCA) separately, using paired T and also ANOVA tests. A p-value <0.05 was considered to be statistically significant. RESULTS: Improvement, defined as a decrease in the number of ischemic or fixed segments, was observed in 13 of 16 patients at 6-10 days after PTCA, in 18 of 21 cases 1-3 months after PTCA, and in 20 of 23 patients 3-6 months after PTCA. The sensitivity and specificity of MPI calculated before PTCA and at the 3 subsequent time points, using angiography as the gold standard, were 80/81, 100/35, 90/100, and 76/100 percent, respectively. CONCLUSION: Our results confirm the necessity for an assessment of perfusion both before and shortly after angioplasty, since it provides the best documentation of the changes in myocardial perfusion.

The long term effect of levothyroxine on bone mineral density in patients with well differentiated thyroid carcinoma after treatment.

To date a few studies have focused on the possible effects of subclinical hyperthyroidism on bone metabolism, showing conflicting results. This study was designed to evaluate this possibility. Sixty-six patients, 22 pre-menopausal women, 33 post-menopausal women and 11 men, who had received iodine-131 ((131)I) ablation postoperatively for well differentiated thyroid carcinoma (WDTC) and were treated for a long term with levothyroxine (T(4)), entered the study and were compared with sixty-six healthy controls individually matched to the patients for age, gender and menopausal status. The bone mineral density (BMD) of lumbar and hip regions of the patients was measured, while on the T(4) suppressive treatment, with average duration of 14.93+/-2.17 months after initiation of the T(4) suppressive treatment and was compared with the BMD of healthy controls. All patients were in the subclinical hyperthyroid state, while all controls were serologically and clinically euthyroid. Our results show that there was no significant difference in BMD measured at the lumbar spine of patients and controls in any subgroup (P>0.05). Analysis of the data of BMD from the hips in men, premenopausal women and controls, also revealed no difference. It was noted that the mean BMD of the femur in the postmenopausal women were at the statistical limit of significance as compared to the control group (P=0.05). In conclusion, our findings indicate that the replacement dose of T(4) in WDTC patients after (131)I ablation, does not have a significant effect on BMD in men, in pre and post-menopausal women and hence on the risk of osteoporosis. In post-menopausal women, the mean femoral BMD was at the limit of statistical significance.

Biliary atresia in infants with prolonged cholestatic jaundice: diagnostic accuracy of hepatobiliary scintigraphy.

BACKGROUND: Cholestatic jaundice during infancy is one of the most problematic challenges for pediatricians. Biliary atresia (BA) and neonatal hepatitis syndrome (NHS) are major causes of cholestatic jaundices. Our aim was to compare the diagnostic accuracy of hepatobiliary scintigraphy with liver biopsy and ultrasonography in excluding BA. METHODS: Seventy consecutive patients, all suffering from prolonged cholestatic jaundice (>1 month), were included. Laparotomy with surgical cholangiography was considered as the gold standard; however, in nine patients, based on the patient's recovery from jaundice and the normalization of laboratory values during the clinical follow-up period (=6-12 months), the diagnosis of NHS was verified and performing laparotomy was unnecessary. All patients underwent hepatobiliary scintigraphy, liver biopsy and ultrasonography and their results were compared. RESULTS: Based on the gold standards mentioned above, 46 patients (46/70 = 65.7%) had BA. The sensitivity, specificity, PPV, NPV, and accuracy of the hepatobiliary scintigraphy in diagnosis of BA were 90%, 80%, 91.8%, 76.2%, and 84.5%, respectively. The respective values for liver biopsy were 92.5%, 88.9%, 94.9%, 84.2%, and 90.1% and for ultrasonographic analysis were 41.7%, 90.9%, 90.9%, 41.7%, and 66.3%. CONCLUSION: Hepatobiliary scintigraphy is an important imaging technique in the diagnostic evaluation of infants with prolonged cholestatic jaundice. It is a convenient and reliable method of differentiating BA from NHS, with a diagnostic accuracy superior to that of US but slightly inferior to that of liver biopsy. Ultrasonography is the least sensitive and specific available modality and its findings should be confirmed by scintigraphy or liver biopsy.