Brain laterality evaluated by F-18 fluorodeoxyglucose positron emission computed tomography in autism spectrum disorders.

Background and rationale: Autism spectrum disorder (ASD) is a neuropsychiatric disorder that has no curative treatment. Little is known about the brain laterality in patients with ASD. F-18 fluorodeoxyglucose positron emission computed tomography (F-18 FDG PET/CT) is a neuroimaging technique that is suitable for ASD owing to its ability to detect whole brain functional abnormalities in a short time and is feasible in ASD patients. The purpose of this study was to evaluate brain laterality using F-18 FDG PET/CT in patients with high-functioning ASD. Materials and methods: This case-control study recruited eight ASD patients who met the DSM-5 criteria, the recorded data of eight controls matched for age, sex, and handedness were also enrolled. The resting state of brain glucose metabolism in the regions of interest (ROIs) was analyzed using the Q.Brain software. Brain glucose metabolism and laterality index in each ROI of ASD patients were compared with those of the controls. The pattern of brain metabolism was analyzed using visual analysis and is reported in the data description. Results: The ASD group's overall brain glucose metabolism was lower than that of the control group in both the left and right hemispheres, with mean differences of 1.54 and 1.21, respectively. We found statistically lower mean glucose metabolism for ASD patients than controls in the left prefrontal lateral (Z = 1.96, p = 0.049). The left laterality index was found in nine ROIs for ASD and 11 ROIs for the control. The left laterality index in the ASD group was significantly lower than that in the control group in the prefrontal lateral (Z = 2.52, p = 0.012), precuneus (Z = 2.10, p = 0.036), and parietal inferior (Z = 1.96, p = 0.049) regions. Conclusion: Individuals with ASD have lower brain glucose metabolism than control. In addition, the number of ROIs for left laterality index in the ASD group was lower than control. Left laterality defects may be one of the causes of ASD. This knowledge can be useful in the treatment of ASD by increasing the left-brain metabolism. This trial was registered in the Thai Clinical Trials Registry (TCTR20210705005).

Incidence of and risk factors for post-parathyroidectomy hungry bone syndrome in patients with secondary hyperparathyroidism.

BACKGROUND: Hungry bone syndrome (HBS) following parathyroidectomy is associated with severe hypocalcemia and increased morbidity. This study aims to determine the incidence and risk factors of post-parathyroidectomy HBS in dialysis patients with secondary hyperparathyroidism (SHPT). METHODS: A retrospective cohort study was conducted, and medical records of patients with SHPT requiring parathyroidectomy between January 2014 and January 2020 were reviewed. HBS was defined as the requirement of intravenous calcium administration due to hypocalcemia-related symptoms and/or reductions in serum calcium concentration (<8.4 mg/dL) within 72 h after parathyroidectomy. RESULTS: A total of 130 dialysis patients were enrolled. The majority of patients (85.4%) received hemodialysis and the remaining patients (14.6%) received peritoneal dialysis. Ectopic parathyroid glands were identified in 6.6% of patients by preoperative parathyroid scintigraphy. Diffuse parathyroid hyperplasia was the most common histopathological characteristic of SHPT (90.8%). HBS occurred in 82.3% of patients following parathyroidectomy. Preoperative serum intact parathyroid hormone (iPTH) concentration was significantly correlated with serum calcium (r = -0.48, p < 0.01) and alkaline phosphatase (ALP) concentration (r = 0.71, p < 0.01). Patients with HBS had significantly longer hospital stays than patients without (8 versus 3 days, p < 0.01). Based on multiple logistic regression analysis, young age (≤45 years), high preoperative serum ALP (>420 IU/L) and iPTH (>1,000 pg/mL), and absence of preoperative hypercalcemia (>10.2 mg/dL) were significantly associated with HBS. CONCLUSIONS: Post-parathyroidectomy HBS is common in dialysis patients with SHPT. Young age, high preoperative serum ALP and iPTH, and low preoperative serum calcium concentrations were important risk factors for HBS.

An impact of microscopic positive margin on incomplete response after I-131 treatment in differentiated thyroid cancer.

OBJECTIVE: To find an impact of microscopic positive margin on incomplete response after initial I-131 therapy in differentiated thyroid cancer. METHODS: We retrospectively recruited patients with differentiated thyroid cancer who underwent total thyroidectomy and received the first dose of radioiodine during January 2014-February 2018. Patients with grossly incomplete tumor resection or distant metastasis at the time of radioiodine therapy were excluded. Thyroid specimens were re-evaluated by one pathologist who was blinded to clinical information to determine microscopic margin status. Treatment response was evaluated at 6-12 months after therapy and was categorized according to the 2015 American Thyroid Association guidelines. Univariable and multivariable analyses were used to find an association between microscopic positive margin and incomplete response. RESULTS: A total of 101 patients (78 females; mean age 50.3 years) were enrolled. Ninety-four patients (93.1%) had papillary thyroid carcinoma. Microscopic positive margin was found in 27 patients (26.7%). After the median follow-up time of 10.3 months, incomplete response was observed in 13 patients (48.5%) and 17 patients (23.0%) with positive and negative margins, respectively. Multivariable analysis showed a significant association between microscopic positive margin and incomplete response after adjusting for tumor size, ETE, and cervical lymph node metastasis with adjusted odds ratio of 3.04 (95% CI 1.05-8.75, p value = 0.04). Moreover, after adding pre-ablative Tg as a covariate in 69 patients with negative TgAb, positive margin had a trend toward being associated with incomplete response with adjusted odds ratio of 3.43 (95% CI 0.73-16.07, p value = 0.118). CONCLUSIONS: Microscopic positive margin was found to be significantly associated with incomplete response after I-131 therapy in patients with differentiated thyroid cancer after adjusting for tumor size, ETE, and cervical lymph node metastasis and also had a trend toward being associated with incomplete response after adjusting for pre-ablative Tg.

Value of SPECT/CT in Diagnostic I-131 MIBG Scintigraphy in Patients with Neuroblastoma.

PURPOSE: Diagnostic I-131 MIBG scintigraphy is an important imaging modality for evaluation of patients with neuroblastoma (NB) especially in centers where I-123 MIBG is not available. Single photon emission computed tomography/computed tomography (SPECT/CT) could potentially improve lesion detection over planar scintigraphy, but studies regarding its usefulness as an add-on to diagnostic I-131 MIBG scintigraphy are limited. This study aimed to determine the usefulness and factors related to usefulness of SPECT/CT in diagnostic I-131 MIBG scintigraphy in NB patients. METHODS: Usefulness of SPECT/CT for lesion detection, lesion localization, resolving suspicious findings, and clarifying the nature of lesions on anatomical imaging were retrospectively reviewed in 86 diagnostic planar I-131 MIBG scintigrams with add-on SPECT/CT. RESULTS: SPECT/CT detected additional lesions in 23.2%(20/86), helped localize lesions in 21.1%(8/38), resolved suspicious findings in 85.7%(6/7), determined functional status of lesions on anatomical imaging in 94.4%(17/18), and changed diagnosis from a negative to a positive study in 19.5%(8/41). Independent predictors of SPECT/CT being useful included presence of suspicious findings on planar imaging (OR 99.08; 95% C.I. 6.99-1404.41; p = 0.001), positive findings on planar imaging (OR 4.61; 95% C.I. 1.05, 20.28; p < 0.001), and presence of structural lesions on anatomical imaging (OR 32.54; 95% C.I. 5.37-196.96; p < 0.001). CONCLUSION: SPECT/CT is a useful add-on to diagnostic planar I-131 MIBG scintigraphy. Predictors of usefulness of SPECT/CT include suspicious or positive findings on planar scintigraphy and the presence of structural lesions on anatomical imaging.

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism.

BACKGROUND: Several parathyroid scintigraphy protocols have been used for preoperative localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. The aim of this study is to compare the diagnostic accuracy of various parathyroid scintigraphy protocols. MATERIAL AND METHODS: A retrospective diagnostic accuracy study with histopathology as the reference standard was done. Five imaging protocols were investigated including planar dual tracer Tc-99m pertechnetate/Tc-99m sestamibi (DT), planar dual phase Tc-99m sestamibi (DP), and combined dual tracer dual phase (DTDP) protocols, as well as add-on single photon emission computed tomography (SPECT), and single photon emission computed tomography/computed tomography (SPECT/CT). RESULTS: A total of 63 patients underwent parathyroid scintigraphy and subsequent parathyroid surgery with a total of 106 excised lesions with histopathological diagnosis. On a lesion-based analysis, sensitivity and specificity (with 95% confidence interval) of protocols were as follows. DT protocol: 69.4% (53.1-82.0%) and 80.0% (49.0-94.3%); DP protocol: 78.6% (52.4-92.4%) and 33.3% (9.7-70.0%); DTDP protocol: 64.7% (47.9-78.5%) and 50.0% (18.8-81.2%); SPECT: 92.3% (66.7-98.6%) and 75.0% (30.1-95.4%); SPECT/CT: 80.0% (49.0-94.3%) and 75.0% (30.1-95.4%). All protocols had perfect sensitivity for detection of parathyroid adenoma whereas SPECT was the most sensitive method for detection of hyperplastic parathyroid glands. CONCLUSION: Planar parathyroid scintigraphy using the DT protocol has a trend towards being more accurate than DP and DTDP protocols. Additional imaging with SPECT and SPECT/CT had a trend towards being more accurate than planar imaging.