Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma / Leucemia mieloide crónica detectada con FDG PET/TAC en un paciente con carcinoma de células renales

Es por todos conocido que la estimulación citocina hematopoyética puede causar un aumento en la acumulación de fluorodeoxiglucosa (FDG) en la medula ósea en las imágenes del PET/TAC de pacientes con metástasis en la medula ósea. Sin embargo, la captación aumentada por la medula ósea puede deberse a otras etiologías. Presentamos el caso de un paciente operado de carcinoma de células renales sin una historia de estimulación hematopoyética. Las imágenes de la FDG PET/TAC muestran la captación aumentada de FDG en la medula ósea y el paciente fue diagnosticado de leucemia mieloide crónica. Este caso muestra que la captación aumentada de FDG en la medula ósea puede relacionarse con la enfermedad neoplástica de los tejidos hematopoyéticos(AU)

It is well known that hematopoietic cytokine stimulation can cause increased fluorodeoxyglucose (FDG) accumulation in bone marrow on PET/CT imaging, which simulates that seen in patients with bone marrow metastases. However, increased bone marrow FDG uptake can be caused by other etiologies. We report a patient with operated renal cell carcinoma had no history of hematopoietic cytokine stimulation. The FDG PET/CT images showed increased bone marrow FDG uptake, and the patient was diagnosed as chronic myeloid leukemia. This case revealed that increased FDG uptake on bone marrow may be related to neoplastic disease of the hematopoietic tissues(AU)

Evaluation of hepatic metabolic activity in non-alcoholic fatty livers on 18FDG PET/CT.

OBJECTIVE: The liver has been used as a reference organ for the assessment of abnormal (18)F-fluoro-2-deoxy-d-glucose ((18)FDG) in the body. Some researchers found that hepatosteatosis significantly changed the hepatic (18)FDG uptake, while others did not. This study investigated whether the liver's (18)FDG uptake was affected by the diffuse fatty infiltration of the liver. MATERIAL AND METHODS: A total of 156 cases were included in this study. Different patient groups were defined according to the liver Hounsfield unit (HU). The HU was calculated from an unenhanced CT, for all patients, and we calculated the mean standardized uptake value (SUVmean) and maximum standardized uptake value (SUVmax) on an (18)FDG PET scan. For this purpose, we placed regions of interest (ROIs) on the liver image. We statistically compared the SUVmean and SUVmax measured in the fatty liver patients and the control group. RESULTS: The average SUVmean and SUVmax values were calculated as 2.58±0.66 and 3.94±1, respectively, in the patient group and 2.54±0.57 and 3.7±0.88, respectively, in the control group. We found the average SUVmean and SUVmax values in the fatty liver group and its subsets were not significantly different from the values in the control group (p>0.05). We also did not find any statistically significant correlation between average liver density (HU) and the average SUV values (p>0.05). CONCLUSION: Fatty infiltration may not have a significant effect on the liver's (18)FDG uptake. Thus, the liver may be used as a reference or comparator on (18)FDG PET scans in patients with fatty liver disease.

Chronic myeloid leukemia detected on FDG PET/CT imaging in a patient with renal cell carcinoma.

It is well known that hematopoietic cytokine stimulation can cause increased fluorodeoxyglucose (FDG) accumulation in bone marrow on PET/CT imaging, which simulates that seen in patients with bone marrow metastases. However, increased bone marrow FDG uptake can be caused by other etiologies. We report a patient with operated renal cell carcinoma had no history of hematopoietic cytokine stimulation. The FDG PET/CT images showed increased bone marrow FDG uptake, and the patient was diagnosed as chronic myeloid leukemia. This case revealed that increased FDG uptake on bone marrow may be related to neoplastic disease of the hematopoietic tissues.

Tc-99m polyclonal human immunoglobulin scintigraphy in brucellosis.

The aim of this study was to evaluate the accuracy of Tc-99m polyclonal human immunoglobulin (HIG) scintigraphy for the diagnosis of brucellosis, and to compare its effectiveness in the diagnosis of osteoarticular involvement in comparison with bone scanning. Of 30 patients with brucellosis, Tc-99m HIG detected osteoarticular involvement in 18 (60%) patients, in whom the sacroiliac joints were affected most commonly (n = 13; 72.2%), with statistically predominant bilateral involvement (p < 0.05). By bone scanning, the rate of osteoarticular involvement was 70% (21 of 30 patients), and the joints affected most commonly were sacroiliac (15 of 21 patients; 71.4%). Although bilateral involvement was observed mostly by bone scanning, there was no significant difference between the rate of bilateral and unilateral involvement. The anatomical distribution of osteoarticular complications, as detected by Tc-99m HIG and bone scintigraphy, did not differ significantly. With Tc-99m HIG, orchitis was detected in two patients and paravertebral abscess in one patient. Since bone scanning did not detect these soft tissue complications, Tc-99m HIG scintigraphy might be useful for the detection of both osteoarticular and soft tissue complications resulting from brucellosis.

99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players.

OBJECTIVE: To evaluate stress fractures in leg (particularly around the knee, tibia, and femur) and knee pathology in active asymptomatic (no symptoms in the preceding month) soccer players. METHOD: The study included 42 asymptomatic soccer players (21 women, 21 men; age range 19-31 years). Players from seven teams in the major female professional and amateur male soccer leagues were examined by technetium-99m-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy during the soccer season. Four hours after intravenous injection of 20 mCi (99m)Tc-MDP, standard imaging included anterior planar spot images of the legs, lateral images of the knee, and single photon emission computed tomography (SPECT). RESULTS: Although the players were asymptomatic, increased tracer uptake, indicating stress fracture, was found in 28 (66%). Most of the stress fractures were in the tibia (62%) and femur (5%). In the 42 subjects (84 legs), 35 sites (42%) showed rupture of the posterior horn of the lateral meniscus and bone bruising of the tibial plateau, 16 sites (19%) showed rupture of the anterior horn of the medial meniscus, 11 sites (13%) showed bone bruising of the lateral femoral condyle, eight sites (10%) showed bone bruising of the medial femoral condyle, and there was avulsion injury to the infrapatellar tendon insertion in the anterior tibia in 34 sites (40%). There were 11 anterior cruciate ligament injuries. CONCLUSION: Bone SPECT is very accurate, easy to perform, cost effective, may give valuable information before magnetic resonance imaging studies in the detection of meniscal tears, and may be used successfully when magnetic resonance imaging is unavailable.

Effects of septoplasty and septal deviation on nasal mucociliary clearance.

To evaluate the effect of septal pathology and surgery on nasal mucociliary clearance. A radioisotope method was used to measure the velocity of nasal mucociliary transport. Nasal mucociliary clearance was measured before and after septal surgery using technetium-99m macroaggregated albumin. Fifteen patients (mean age: 20 +/- 8 years; 11 males, four females) were studied pre-operatively, but scintigraphy could be repeated only in 10 patients, 2 months after surgery. A group of 10 healthy volunteers were also studied. The clearance values obtained from the preoperative period (26.25 +/- 9.45 min) were significantly higher than those of the post-operative period (15.05 +/- 6.35 min). The values obtained of control group (13.30 +/- 3.15 min) were not significantly different from the post-operative values of the patient group. Septal deviation affects the mucociliary activity. It is improved by surgery. This study showed that nasal septal deviation reduced the nasal mucociliary activity, and this can easily evaluated with scintigraphy.

Evaluation of microcirculation in Buerger's disease using 201thallium/99mtechnetium macroaggregated albumin scintigraphy.

In the current study, 10 patients with Buerger's disease (thromboangiitis obliterans) and seven control patients with atherosclerosis obliterans (ASO) were evaluated for microvascular disturbance. After exercising for 1 min, patients were injected with 37 MBq 201thallium (201Tl) intra-arterially, and anterior planar images of the feet and whole body images of the lower extremities were taken. The same procedure was repeated after 1 week using 185 MBq 99mtechnetium macroaggregated albumin (99mTc-MAA). Rectangular regions of interest were drawn on the 201Tl and 99mTc-MAA images, and 201Tl/99mTc-MAA uptake ratios were calculated. 201Tl/99mTc-MAA ratios of the toes of those with Buerger's disease were significantly lower than those of ASO cases, whereas no significant difference was found for the lower limbs and feet. These findings may be explained by disturbances of microvascular regulation observed in Buerger's disease.

Effect of cisapride on gastric emptying in patients with gastro-oesophageal reflux disease.

To investigate the effect of cisapride in gastro-oesophageal reflux disease (GERD), gastric emptying time, measured using scintigraphy, and reflux symptoms were compared before and after cisapride therapy in 30 patients with endoscopically proven GERD. Gastric emptying time was also measured in 20 age-matched controls. Patients with GERD were treated with 30 mg cisapride orally three times daily for 7 days. Gastric emptying time was significantly reduced following cisapride therapy in 28 of these patients (71.6 +/- 18.1 min versus 57.9 +/- 13.9 min), although it was still longer than the gastric emptying time of the control group (i.e. 46.2 +/- 8.1 min). In addition, cisapride relieved heartburn, which is a representative symptom of GERD. These findings suggest that cisapride may be useful in treating reflux symptoms and oesophagitis in patients with GERD.

Effects of eradication therapy on gastric emptying in patients with Helicobacter pylori-positive duodenal ulcers.

In this study 28 patients with Helicobacter pylori-positive duodenal ulcers were treated with a 7-day triple-therapy regimen (omeprazole, clarithromycin, amoxycillin). Gastric emptying time was measured scintigraphically before and after therapy. Only 13 patients attended regularly for their endoscopic and scintigraphic follow-ups. Gastric emptying time was 57.6+/-16.5 min in 28 patients before therapy, and 44.4+/-13.9 min after therapy (44.7+/-7.9 min in the control group). The present study demonstrated gastric emptying time to be longer in the ulcer patients compared with healthy controls and that, after eradication therapy, gastric emptying time became almost normal in the ulcer patients.

Evaluation of active and passive transport mechanisms in genital tracts of IUD-bearing women with radionuclide hysterosalpingoscintigraphy.

The objective of this study was to evaluate the active and passive transport mechanisms in the genital tracts of copper T-200 intrauterine device (IUD)-bearing women. (Tc-99m)HMPAO-labeled spermatozoa and (Tc-99m)-labeled albumin macrospheres were placed into the vagina at midcycle. Serial scintigraphic images were obtained over a period of 2 h. Migration of spermatozoa and particles in the genital tract and the direction of transport related to dominant follicle were evaluated. While active sperm migration was greatly inhibited, the passive transport of the particles was not affected in IUD-bearing women. The direction of radiolabeled particles and spermatozoa was toward the dominant follicle side. Passive transport was not affected, whereas active transport of spermatozoa was strongly inhibited in the genital tract by the presence of the IUD. However, the direction of active and passive transport related to dominant follicle side was unchanged in IUD-bearing women and was preferentially toward the tube ipsilateral to the dominant follicle.

Differences between right- and left-femoral bone mineral densities in right- and left-handed men and women.

To test whether handedness has an asymmetric effect on femur bone mineral density (BMD), the right- and left-proximal femur BMDs were compared in 124 right- and 23 left-handed university students. In the right-handed men, the mean left-femur BMD was significantly greater than the right-femur. In the left-handed men, the mean right-femur BMD was significantly greater than the left-femur. There were no significant differences between BMDs from the right- and left-femurs in women. These results suggest that hand preference may be related to asymmetry in BMD, but only for men.

Evaluation of eustachian tube function with ventilation scintigraphy by using 133Xe gas.

The aim of this study was to evaluate Eustachian tube function by ventilation scintigraphy. In 13 patients with normal tube function and 16 with one-sided tube dysfunction, 50 MBq 133Xe was applied into the nasopharyngeal space through a tube inserted into the nasal cavity. Immediately after the insufflation, the patients were asked to perform three Valsalva manoeuvres. The visualization of the middle ear was possible in 10 of the 13 patients (77 per cent) with normal tube function. Decreased uptake of the middle-ear region in the side of dysfunction was demonstrated in 11 of the 16 patients (68.7 per cent) with one-sided tube dysfunction. Quantitative evaluation by region of interest technique revealed that by using percentage retention of activity and uptake rates, there were significant differences between the sides of dysfunction and sides of normal tube function (p < 0.05) and also between sides of dysfunction and both sides of controls (p < 0.05). There was no significant differences between normal sides of patients and both sides of controls (p > 0.05). As a conclusion, this method is non-invasive, easy- to perform and has a low radiation burden in the evaluation of Eustachian tube function. Although the number of patients is limited, the test seems to be applicable with a success rate of about 74 per cent.

Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition.

Protein-energy malnutrition (PEM) is a problem which concerns about half the world's children. We investigated the effects of malnutrition on thyroid gland weight and thyroid hormone levels. 22 children suffering from malnutrition (14 children suffering from marasmus and 8 children suffering from kwashiorkor) and 7 healthy controls were studied. Malnutrition was confirmed clinically and according to the Wellcome classification definition of malnutrition. Serum thyroid hormone concentrations were measured by radioimmunoassay and the weights of the thyroid gland were evaluated scintigraphically. In the groups with marasmus and kwashiorkor the mean TT4, TT3 and FT3 levels were significantly lower, and TSH levels were significantly higher, compared to controls. FT4 was not influenced by PEM. The mean thyroid gland weights of the groups with marasmus and kwashiorkor were higher than that of the control group. We found no significant differences in all these parameters between groups with marasmus and kwashiorkor. In each of the three groups, the most marked positive correlation was between thyroid gland weight and ratio of thyroid gland weight to body surface area.

Quantitative evaluation of renal parenchymal mass with 99mtechnetium dimercapto-succinic acid scintigraphy after nephrolithotomy.

PURPOSE: We detected renal parenchymal damage after nephrolithotomy. MATERIALS AND METHODS: We studied 12 patients with renal stones treated with nephrolithotomy. Renal function was determined with serum blood urea nitrogen (BUN) and creatinine values, and 99mtechnetium dimercapto-succinic acid scintigraphy of renal parenchymal tissue was performed before, and 7 days and 3 months after nephrolithotomy. Qualitative and quantitative analyses were done with the Wilcoxon signed rank test. RESULTS: There was no visual difference in size and appearance of the nephrotomy site between preoperative and postoperative visual scintigraphic evaluations. Quantitative data did not reveal any significant difference between kidneys with and without a nephrotomy incision (p > 0.05), as well as between nephrotomy regions and intact parenchyma within the same kidney (p > 0.05) 3 months after nephrolithotomy. There was no significant difference in serum BUN and creatinine levels between values preoperatively and 3 months postoperatively (p > 0.05). CONCLUSIONS: There was no significant change in renal cortical function and functioning renal parenchymal mass after nephrolithotomy as shown by serum BUN and creatinine levels, and 99mtechnetium dimercapto-succinic acid scintigraphy.

Assessment of thyroid nodules by technetium-99m-tetrofosmin scintigraphy.

Thyroid nodularity is a common finding. The incidence of thyroid cancer in the general population is estimated at 0.1%. Thyroid nodules are evaluated by palpation, ultrasonography, radionuclide scintigraphy and fine-needle aspiration cytology. Routine thyroid scintigraphy is made by using Tc-99m-pertechnetate or the I-131 and I-123 scintigraphic method. Tc-99m-tetrofosmin accumulates in the myocardium, skeletal muscle, liver, spleen breast tissue, kidney and normal and pathological thyroid tissue. We investigated 36 patients (28 females and 8 males) with solitary and/or multiple thyroid nodules. All the patients were euthyroid, and their thyroid nodules were diagnosed by palpation and ultrasound examination. Thyroid scintigraphy was applied by Tc-99m-pertechnetate, then thyroid fine-needle aspiration biopsy was performed. Finally, Tc-99m-tetrofosmin scintigraphy was carried out. Five patients (14.8%) had differential thyroid carcinoma, 23 (63.8%) had thyroid adenoma, 1 (0.02%) had Riedel's thyroiditis and 7 (19.4%) had follicular cyst. We detected 80% uptake in the early phase and 100% in the late phase by Tc-99m-tetrofosmin scintigraphy in the differentiated thyroid carcinoma group. In summary, we claim that Tc-99m-tetrofosmin may be an important scintigraphic method to identify thyroid malignancy from benign thyroid pathologies.