[The reference of normal values of the sacroiliac joint index in bone scintigraphy].

Introduction: Scintigraphy of sacroiliac joints as functional imaging provides unique information on the existing disease process. By using radiopharmaceuticals that allow imaging of the metabolic activity within the joint, it is possible to assess the stage of the disease, even when there are no lesions in radiological images. Quantitative analysis of scintigrams of sacroiliac joints is performed by comparing the uptake in both of them in relation to the uptake in the sacral bone area. The values of sacroiliac (SI/S) indices are influenced by the age of the patient, sex, state of health, and a range of individual biological features. Therefore, reference values of SI/S ratios are very important for medical specialists who describe and diagnose locomotor system diseases. The aim of this paper is to develop a reference range of sacroiliac ratios. The innovativeness of this paper involves examining sacroiliac ratios for various age groups, in children and adult patients, taking their sex into consideration. Materials and methods: The study comprised a group of 335 people with proper bone scintigraphy. These people were divided into children and patients aged ≥21. Children were divided into 4 age groups (1­5; 6­10; 11­15; 16­20) and adults into 6 age groups (21­30; 31­40; 41­50; 51­60; 61­70; ≥71). Sacroiliac ratios were calculated using the method of three rectangular region of interests located on the left and right sacroiliac joint and on the sacral bone. The sacroiliac ratio was calculated for both joints by dividing the average number of counts within a selected sacroiliac joint by the average number of counts within the sacral bone. Results: SI/S borderline reference values covered the range of 1.18÷2.28 that was obtained for children aged ≤5 and for the group of 11­15-year-olds. Considerable discrepancies in the values of the coefficient for women and men were seen among 31­50-year-olds. Conclusions: Borderline reference results for the entire control group cover the range of 1.18 ±2.28. The lower reference value applies to ≤5-year-olds, whereas the higher value applies to the group of 11­15-year-olds. The standard deviation value obtained was highest in paediatric patients. The results indicate the occurrence of significant individual differences between patients in this age group.

Thyroid fine-needle aspiration biopsy: which lesions should be biopsied before 131I therapy?

INTRODUCTION: Suspicion of a neoplasm is one of the contraindications to radioiodine therapy in benign thyroid disease. The aim of this study was to present an optimal qualification scheme for fine-needle aspiration biopsy (FNAB) to rule out neoplastic lesions prior to radioiodine therapy. MATERIAL AND METHODS: 4207 patients with hyperthyroidism were referred for 131I therapy in 2000-2006. Prior to 131I therapy, all patients underwent thyroid function assessment, radioiodine uptake, scintigraphy, and ultrasound. Fine-needle aspiration biopsy with cytology was done in 578 (13.7%) patients. Therapeutic radioiodine was administered to 3564 (84.7%) patients. RESULTS: Malignancy was confirmed or suspected in 12 female patients (0.28% of all patients and 2.07% of patients who underwent FNAB). Prior to the study, cytology was done in only one patient. The diameter of the lesions was 6-28 mm. Cytology confirmed papillary carcinoma in 4 patients, follicular tumour in 6, and Hürthle's cell tumour in 1. There were indications for histopathology in one patient due to the presence of atypical cells. The primary diagnosis was toxic nodular goitre in 8 patients and Graves' disease in 4 patients. One of the patients with follicular tumour was referred for radioiodine therapy due to intolerance to thyrostatic drugs, elderly age, and comorbidities. CONCLUSIONS: 1. Thyroid scintigraphy prior to therapy is important for the choice of the site of FNAB. 2. Thyroid lesions in patients with nodular Graves' disease must be carefully investigated to exclude malignancy. 3. Preselection of patients for treatment of benign thyroid disease should be followed by cytology of the lesions at the Department of Nuclear Medicine.

Upper gastrointestinal tract scintigraphy and ultrasonography in diagnosis of gastroesophageal reflux in children.

BACKGROUND: Gastroesophageal reflux (GER) is one of the most common gastrointestinal tract disorders both in adults and children. The study was undertaken to assess the usefulness of gastrointestinal upper tract (GUT) scintigraphy and GUT ultrasonography in detection of GER in children. MATERIAL/METHODS: The investigated group comprised of 76 children, aged 1-204 months (mean 74 months) with clinical signs and symptoms of GER. All of them underwent GUT scintigraphy, and 42 children had also GUT ultrasonography. RESULTS: GUT scintigraphy confirmed reflux in 60/76 children (78.9%), GUT ultrasonography - in 17/42 children (40.5%). Airways tract aspiration was detected in one child. CONCLUSIONS: Scintigraphy was found to be a very useful method in detection of GER, as it confirmed the presence of GER in most of the children with signs and symptoms suggestive of GER. It also allows for the detection of airways tract aspiration. GUT ultrasonography showed a lower sensitivity. Both investigations are simple, noninvasive, not changing the physiology of the gastrointestinal tract and can be performed in out-patient conditions.

Occupational exposure at the Department of Nuclear Medicine as a work environment: A 19-year follow-up.

BACKGROUND: This study assessed the radiation safety at Nuclear Medicine Department being a work environment. Ionizing radiation exposure of the employees in the last 19 years and the effects of legislative changes in radiological protection were analyzed. MATERIAL/METHODS: All employees of the investigated department were regularly and individually monitored using chest badges equipped with Kodak film type 2. Overall, 629 annual doses of the employees of nuclear medicine department, registered in the period 1991-2009, were analyzed statistically. RESULTS: Technicians were found to be the largest exposed professional group, whereas nurses received the highest annual doses. Physicians received an average annual dose at the border detection methods. Ancillary and administration staff occasionally received doses above the method detection limit (MDL). The average annual dose for all dosimetry records was 0.7 mSv, and that for dosimetry records equal and higher than MDL was 2.2 mSv. CONCLUSIONS: There was no case of an exceeded dose limit for a worker. Furthermore, improvement of radiological protection had a significant impact on the reduction of doses for the most exposed employees.

The application of SPECT/CT scintigraphy with MIBI-Tc99(m) in the diagnosis of thyroid nodules - a preliminary report.

INTRODUCTION: Thyroid cancer diagnosis is based mainly on fine needle aspiration biopsy (FNAB) performed under ultrasonography guidance. Questions arise in cases of an inconclusive FNAB result - when there is no clear evidential data to support the existence of a malignant lesion or when there are any other reasons which make the decision process difficult, such as the patient's age or coexisting diseases. To clarify this issue the patient should be encouraged to undergo surgery treatment or to be followed up. Thyroid scintigraphy with an oncophilic tracer such as MIBI-Tc99(m) may be helpful. MATERIAL AND METHODS: The study comprised a group of 12 patients, aged 54-75 (av. 63.5) years, who, in 2009, underwent planar and SPECT/CT thyroid scintigraphy with MIBI-Tc99(m) using washout method. The tumour/background ratio in early and delayed images was calculated and the wash-out ratio was estimated. Patients with increased focal lesion uptake were operated on and the lesions were histopathologically verified. RESULTS: Abnormal scintigraphy results were obtained in 8 patients (10 lesions) and normal results in 4 patients (5 lesions). Out of 15 studies, in 13 cases the washout from the lesion was observed within 2 hours. It was noticed that the images obtained with SPECT/CT washout method were clearer and easier to read in comparison to planar studies. Three patients with an abnormal results underwent surgery and had benign histopathology results after the operation, in 3 patients the observation is being confirmed without any increase in malignancy suspicions, and 2 were lost for observation. CONCLUSIONS: Our preliminary results do support the use of MIBI-Tc99m in the evaluation of indeterminate thyroid nodules. To validate the hypothesis that MIBI-Tc99(m) may be used to exclude malignancy in lesions indeterminate by FNAB we propose to use SPECT-CT derived images and standardized evaluation criteria.

The occurrence of malignant thyroid lesions in patients after radioiodine treatment due to benign thyroid diseases.

INTRODUCTION: Radioiodine treatment (RT) of benign thyroid diseases is a well-known, safe, and effective treatment. In a group of patients after RT, who remained in long-term follow-up, sporadic cases of malignant thyroid lesions occurred. The aim of the study was to estimate how often it happened despite the exclusion of malignancy before RT. MATERIAL AND METHOD: A group of 4314 patients (7438 person-years) underwent RT and subsequently were followed-up for 1-8 years (mean 20.69 months). Apart from thyroid function estimation, if needed, fine needle aspiration biopsy (FNAB) of the thyroid or neck focal lesions was performed based on ultrasonographic or clinical examination. Patients with pathological FNAB were analyzed and histopathologically verified. RESULTS: In 12 out of 4314 cases (0.27%) suspicious FNAB results were found. Suspicious thyroid lesion results were found in 9 patients (8 F, 1 M), aged 46-73 (average 56 years) followed up for 3-57 months after RT: papillary cancer in two patients, Hürthle cell tumour in one patient, and suspicious cells in two patients (with benign lesions on postoperative histopathology). Two patients refused surgery (a suspicion of papillary cancer in one case and suspicious cells in FNAB in the second case). A follicular tumour in FNAB was suspected in two cases (no data about the first, and the second with lung cancer was not operable). In the remaining 3 cases FNAB revealed lymph node metastases due to other cancers. CONCLUSIONS: Malignant thyroid lesions in patients after RT due to benign thyroid diseases are seldom detected. However, periodical clinical and ultrasonographic evaluation is recommended.

[The association between gastroesophageal reflux and recurrent lower respiratory tract infections and bronchial asthma in children]. / Zaleznosc miedzy odplywem zoladkowo-przelykowym a nawracajacymi zakazeniami dolnych dróg oddechowych i astma oskrzelowa u dzieci.

INTRODUCTION: It is well known that gastroesophageal reflux (GER) coincides with chronic diseases of the lower respiratory tract. However, the impact of effective management of gastroesophageal reflux on the course of coexisting pathologies of the lower respiratory tract has not been unequivocally evaluated. This study was undertaken to assess the impact of treatment of gastroesophageal reflux on the course of recurrent lower respiratory tract infections and bronchial asthma in children. MATERIAL AND METHODS: We enrolled 76 children, 38 boys and 38 girls, aged 1-204 months (median: 66.5 months). All children had clinical symptoms of gastroesophageal reflux. The children were allocated to three groups: Group I: recurrent lower respiratory tract infections (33 children); Group II: bronchial asthma (23 children); Group III: no chronic respiratory tract disease (20 children). Groups were similar with respect to age and gender. Upper gastrointestinal tract scintigraphy and endoscopy were performed in all children. The children were followed for 1-23 months (mean: 7 months). In most cases, GER was managed conservatively, except for four children who were operated. RESULTS: Complete or partial resolution of GER symptoms was seen in 89% of patients, no change was noted in 9%, and progression was seen in the remaining 2% of children. Treatment of GER was accompanied by alleviation of respiratory symptoms in 84% of children (group I and II). CONCLUSIONS: Effective therapy of gastroesophageal reflux decreases the frequency of recurrent lower respiratory tract infections and improves asthma control.

[Occurrence of malignant lesions in patients referred to 131I therapy due to benign thyroid diseases]. / Analiza wystepowania zmian nowotworowych w tarczycyu pacjentów kierowanych do leczenia 131I w przebiegulagodnych chorób tego gruczolu.

INTRODUCTION: (131)I therapy should be performed after exclusion of any morphological pathology that needs surgery--usually malignancy or its suspicion. The aim of the study was to evaluate the range of this problem in patients considered for radioiodine therapy due to benign thyroid diseases. MATERIAL AND METHODS: In 2000-2005 year 3663 patients with hyperthyreosis were referred to (131)I therapy. All patients were subjected to routine procedure which comprised of thyroid function assessment, radioiodine uptake, thyroid scan, ultrasound examination. In 505 (13.8%) patients according to indications fine needle biopsy (FNAB) with cytological examination was performed. (131)I therapy dose was given to 3083 (84.2%) patients. RESULTS: Eight patients (1.6%) were positive or with suspicion of malignancy on FNAB. All but one had no cytological examination before referral. The diameter of the lesions ranged from 6 to 28 mm. Cytological diagnosis was: in 3 patients--ca papillare, in 3--follicular tumour, in 1--Hürthle'a cell tumour, and in one patient histopathological examination was required without definitive cytological diagnosis. In six patients primary diagnosis was toxic nodular goiter, in three patients Graves' disease. CONCLUSION: 1. Obtained data underline the need for bigger malignancy alert of nuclear medicine physicians during qualification of patients for (131)I treatment despite of patients preselection by referring doctors. 2. Performing FNAB is a very important part of qualification to radioiodine treatment. 3. Thyroid scan is supportive in choosing a proper place for FNAB.