The Correlation Between the D-Dimer Values and Anatomical Distribution of Pulmonary Embolism.

Background: Pulmonary Embolism (PE) represents a life-threatening medical emergency that, given the serious complications, requires urgent application of anticoagulant therapy. In addition to other factors that are taken into account when choosing a therapy for treatment of PE, the anatomical distribution of thrombi is also considered-whether it is a central, lobar, segmental or subsegmental PE. D-dimer is an intermediate product of degradation of fibrin molecules and its values in the plasma are increased in the case of PE, but also in other diseases. Objective: To determine whether there is a difference in D-dimer values in subjects with different anatomical distribution of PE. Methods: The study included 100 subjects with diagnosed PE by using MSCT and/or V/P SPECT and with measured values of D-dimer. Results: Out of 100 subjects, PE was not diagnosed in 37 subjects, while 63 subjects PE was diagnosed. All subjects with diagnosed PE were divided into 3 groups regarding the anatomical localization of thrombus: lobar, segmental or subsegmental. Average D-dimer values were calculated for all 3 groups. Statistical analysis showed that there was no significant difference in D-dimer values between subjects with different anatomical distribution of PE. Conclusion: There is no significant difference in D-dimer values between subjects with different anatomical distribution od PE-lobar, segmental and subsegmental PE.

Impact of Reduced Acquisition Time on Bone Single-photon Emission Computed Tomography Images in Oncology Patients.

Background: The use of resolution recovery (RR) in bone and myocardial perfusion imaging is becoming increasingly popular in nuclear medicine departments. RR produces reconstructed images that show improved spatial resolution and signal-to-noise ratio compared with conventional single-photon emission computed tomography (SPECT) images. Objective: To evaluate the impact of the ordered subset expectation maximization (OSEM) RR modality on preserving noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for short SPECT acquisition. Methods: This prospective study was conducted on 80 patients. Full SPECT acquisition was performed as a standardized protocol, while reduced acquisition was achieved with the Poisson resampling method. Noise, SNR, and CNR were measured for different reconstruction parameters for the same image levels. The impact of surface area and body mass index was also measured for the same reconstruction parameters. Results: The results show significantly higher SNR and CNR for the Evolution for Bone protocol compared to the other two reconstruction protocols for full and reduced SPECT acquisition. With the shortening of the SPECT acquisition, an increase in the value of noise was recorded. SNR and CNR decreased with the reduction in SPECT acquisition. Conclusion: The Evolution for Bone protocol for all three analyzed acquisition protocols had the lowest noise values. The highest SNR and CNR were recorded in the Evolution for Bone protocol for the three acquisition protocols and SPECT acquisition time can be reduced from 20 to 10 min for bone SPECT.

Evaluation of Thyroid Hormone Status and Bone Density Ratio in Euthyroid Postmenopausal Women in Early and Late Stage of Bone Loss.

INTRODUCTION: Osteoporosis is a consequence of reduction in bone mass and disorders of bone structure, which makes the bones prone to fractures. Physiological variations of thyroid-stimulating hormone (TSH) may be an early indicator of the predisposing basis of the emergence of osteoporosis. AIM: To evaluate the thyroid hormone status and bone density ratio in euthyroid postmenopausal women in early and late stage of bone loss. METHODS: The research is an observational, intersected, controlled study involving postmenopausal women admitted to the Clinic for Nuclear medicine and endocrinology of the Clinical Center University of Sarajevo (CCUS). The study included a total of 120 postmenopausal subjects divided into two groups. First group included 60 postmenopausal patients with osteoporosis, 30 of them were at the early stage of postmenopause, and 30 were in the late postmenopausal phase. The second group consisted of 60 postmenopausal patients with preserved bone mass, 30 of which were in the early stage of postmenopause and 30 in the late postmenopausal phase. For all patients included in the study follicle-stimulating hormone (FSH), TSH, free thyroxine (FT4), free triiodothyronine (FT3) were analyzed. RESULTS: The mean duration of the postmenopausal period was statistically significantly higher in the group of women with osteoporosis (11.4 ± 1.1 years). The mean values of FSH were statistically significantly higher in the group of women with osteoporosis (54.0 ± 2.6 IU / L). The mean level of TSH and FT3 did not statistically significantly differ in the group of women with osteoporosis compared to the control group of women. The mean FT4 level in women with osteoporosis was statistically significantly lower (14.7 ± 0.29 pmol / L) compared to the control group of women (15.95 ± 0.3 pmol / L) (p = 0.004). CONCLUSION: In our examined group, the FT4 patient (mean) was significantly lower in the serum of women with osteoporosis compared to subjects with preserved bone mass. It would be most effective to recognize risk factors in order to influence them on time, and to alleviate and slow down the consequences of osteoporosis. One of these possible factors is the hormonal status of the thyroid gland, that is, TSH whose physiological variations may be an early indicator of the predisposing basis for the emergence of osteoporosis. The frequency and prevalence of these medical problems require additional research, and it is also a great challenge to understand the effects of thyroid hormone on bone tissue.

Impact of ventilation/perfusion single-photon emission computed tomography on treatment duration of pulmonary embolism.

PURPOSE: The aim of the study was to establish whether the duration of anticoagulant (AC) therapy can be tailored, on an objective basis, by using ventilation/perfusion single-photon emission computed tomography (V/P SPECT) and to assess the extent of residual perfusion defects over time. In particular, we addressed the following: (a) is the extent of perfusion recovery at 3 months of initial pulmonary embolism (PE) diagnosis a satisfactory criterion for deciding the duration of oral AC? (b) Is it safe to withdraw AC at 3 months if perfusion recovery is complete? PATIENTS AND METHODS: Of 269 consecutive patients with suspected PE, 100 patients were diagnosed with PE using V/P SPECT. Sixty-seven patients with acute PE were followed up clinically and with V/P SPECT at 3 months. Sixty-four patients were subject to review and examination using V/P SPECT for a period of 6 months and 33 were followed up only clinically. Therapy was terminated after 3 months if perfusion was normalized, and patients were free of symptoms and the risk of hypercoagulability. Initial extension of PE did not have an impact on decision making. RESULTS: PE extension varied from 10 to 70% in the acute stage. After 3 months, complete resolution of PE was found in 48 patients. The treating pulmonologist decided to terminate therapy in 35 (73%) patients and to continue AC in 13 patients because of persistent risk factors. Six months later, at the second control stage, 53 patients had complete recovery of pulmonary perfusion. Eleven patients still had perfusion defects at 6 months. No recurrence was identified at 6 months in the 35 patients whose therapy was terminated after 3 months. No bleeding effects were observed in any of the patients during the 6-month follow-up. CONCLUSION: This study shows that AC therapy can be tailored, on an objective basis, by using V/P SPECT. Normalization of perfusion at 3 months of initial PE diagnosis was a reliable indicator that AC could be safely withdrawn in patients who were without hypercoagulability risk.