Diagnostic Value of 99mTc-MIBI Myocardial Perfusion Imaging in Detecting Myocardial Ischemia of Children with Kawasaki Disease and Coronary Artery Lesions.

Pediatric patients with coronary artery lesions (CALs) after Kawasaki disease (KD) may be complicated with myocardial ischemia. Although previous studies in adults have proven the diagnostic value of 99mTc-MIBI myocardial perfusion imaging (MPI) for ischemic heart disease, its feasibility and accuracy in this pediatric population remain uncertain. In this retrospective study, we collected data of 177 pediatric patients (Age range: 6 months to 14 years) who had undergone MPI and coronary artery angiography (CAG) between July 2019 and February 2023. Using the positive result of CAG as the reference standard of myocardial ischemia, we compared the results of 99mTc-MIBI MPI with other non-invasive examinations, including cardiac magnetic resonance imaging (CMRI), echocardiogram, and comprehensive electrocardiogram-related examinations. All patients finished adenosine triphosphate stress MPI without major side effects. The sensitivity of MPI was 79.17%, which was greater than CMRI and echocardiogram (P < 0.05). The negative predictive value and the accuracy of MPI were 89.9% and 71.75%, indicating the advantages over others. Composite monitoring strategy of MPI and CMRI effectively improved the diagnostic performance (P < 0.001). In 4 cases diagnosed with myocardial ischemia by "MPI + CMRI," despite the absence of significant stenosis, multiple giant coronary artery aneurysms (GCAA) were all observed in CAG. 99mTc-MIBI MPI is the preferred non-invasive examination for detecting myocardial ischemia in pediatric patients with CAL after KD. When combined with CMRI, it can enhance diagnostic accuracy. Multiple GCAAs without stenosis may be an isolated risk factor of myocardial ischemia.

The earliest optimal timing for total-body 68Ga-fibroblast activation protein inhibitor-04 PET scans: an evidence-based single-centre study.

OBJECTIVES: To investigate the earliest optimal timing for positron emission tomography (PET) scans after 68Ga-fibroblast activation protein inhibitor-04 ([68Ga]Ga-FAPI-04) injection. METHODS: This prospective study enrolled patients who underwent 60-min dynamic 68Ga-FAPI-04 total-body PET/CT scans; the images were reconstructed at 10-min intervals (G0-10, G10-20, G20-30, G30-40, G40-50, and G50-60), and the [68Ga]Ga-FAPI-04 uptake patterns were evaluated. The standardised uptake value (SUV), liver signal-to-noise ratio (SNR), and lesion-to-background ratios (LBRs) for different time windows were calculated to evaluate image quality and lesion detectability. The period from 30 to 40 min was then split into overlapping 5-min intervals starting 1 min apart for further evaluation. G50-60 was considered the reference. RESULTS: A total of 30 patients with suspected malignant tumours were analysed. In the images reconstructed over 10-min intervals, longer acquisition times were associated with lower background uptake and better image quality. Some lesions could not be detected until G30-40. The lesion detection rate, uptake, and LBRs did not differ significantly among G30-40, G40-50, and G50-60 (all p > 0.05). The SUVmean and LBRs of primary tumours in the reconstructed images did not differ significantly among the 5-min intervals between 30 and 40 min; for metastatic and benign lesions, G34-39 and G35-40 showed significantly better SUVmean and LBR values than the other images. The G34-39 and G50-60 scans showed no significant differences in uptake, LBRs, or detection rates (all p > 0.05). CONCLUSION: The earliest optimal time to start acquisition was 34 min after injection of half-dose [68Ga]Ga-FAPI-04. CLINICAL RELEVANCE STATEMENT: This study evaluated 68Ga-fibroblast activation protein inhibitor-04 ([68Ga]Ga-FAPI-04) uptake patterns by comparing the image quality and lesion detection rate with 60-min dynamic [68Ga]Ga-FAPI-04 total-body PET/CT scans and identified the earliest optimal scan time after [68Ga]Ga-FAPI-04 injection. KEY POINTS: • A prospective single-centre study showed that the earliest optimal time point to start acquisition was 34 min after injection of half-dose [68Ga-fibroblast activation protein inhibitor-04 (68Ga]Ga-FAPI-04). • There were statistically significant differences in standardised uptake value, lesion-to-background ratios, and lesion detectability between scans before and after 34 min from the injection of [68Ga]Ga-FAPI-04, but these values did not change further from 34 to 60 min after injection. • With a reasonable acquisition time, the image quality could still meet diagnostic requirements.

Semi-quantitative assessment optimized the grading of pulmonary aspiration on salivagram in children.

OBJECTIVE: Salivagram is one of the imaging modalities to detect pulmonary aspiration in children. This study aims to optimize the classification of pulmonary aspiration detected by salivagram with a semi-quantitative analytical method. METHODS: This is a retrospective study involving 737 patients (471 males, 266 females; aged 1 month to 8 years; mean age 5.3 months, median age 3.0 months old) with suspected pulmonary aspiration, who had salivagram done between January 2018 and June 2019. Positive cases were divided into 10 groups (Grade 1, R2, L2, R2L2, R3, L3, R3L2, R2L3, R3L3, and 4) according to the scintigraphic findings. Aspiration index was determined as the ratio of the count in the respiratory tract to the total count in the image field of view and compared among different groups using the receiver operating characteristics (ROC) curve analysis. RESULTS: A total of 180 cases had positive scintigraphic findings of various grades of aspiration (24.4%, 180/737). There is a high consistency among the two independent nuclear medicine physicians involved in the study, in determining both the disease gradings (κ = 0.919;95% CI: 0.915-0.923) and aspiration index (ICC = 0.994;95% CI: 0.993-0.996). There is no significant difference (p > 0.05) in aspiration index among the gradings in "mild" group (grade 1, R2, L2, L2R2), and "moderate" group (grade R3, R3L2, R3L3). After dividing the different grades into "mild", "moderate" and "severe" groups, the aspiration index of "mild" group is 4.40 ± 2.01, that of "moderate" group is 16.43 ± 8.20, and that of "severe" group is 46.94 ± 14.81. Difference in groups was statistically significant (p < 0.0001). In ROC curve analysis, AUC of "mild" and "moderate" groups is 0.970 and that of "moderate" and "severe" groups is 0.943; the cut-off value with highest diagnostic efficiency is 6.75 between "mild" and "moderate" groups and 38.00 between "moderate" and "severe" groups. CONCLUSIONS: We introduced a semi-quantitative analytical method in pulmonary aspiration on salivagram, to optimize and supplement to the current classification of pulmonary aspiration.

The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children

BACKGROUND: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS: children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS: sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS: VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis

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The diagnostic value of video capsule endoscopy for Meckel's diverticulum in children.

BACKGROUND: Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is also an important cause of bloody stool and anemia in children. However, there are few data about video capsule endoscopy (VCE) for MD in children. This study aimed to evaluate the diagnostic value of VCE for MD in children. MATERIALS AND METHODS: children who underwent VCE for obscure gastrointestinal bleeding from October 1st 2015 to August 31st 2019 at the Children's Hospital of Fudan University were included in this retrospective study. Medical data, VCE data and Meckel's scans, etc. were collected for each patient. RESULTS: sixteen patients were diagnosed with MD by VCE, including 13 males and 3 females. The age of the patients ranged from 4 years to 13 years, with an average of 7.8 ± 2.7 years. Lower gastrointestinal tract bleeding was the main symptom for patients with MD, including hematochezia (75 %) and melena (25 %). Of the VCE findings, 14 patients had double lumen signs and 2 showed protruding lesions. Among the 16 patients diagnosed with MD by VCE, 14 patients were diagnosed with MD by Meckel's scan, 3 with MD by abdominal enhanced CT and 14 patients were diagnosed with MD by surgery. During the follow-up, bleeding occurred sporadically in patient 12 and the reason is still unknown. CONCLUSIONS: VCE is useful for the diagnosis of MD and should be used as a valuable and less invasive examination to confirm or establish a diagnosis.

Effect of nasogastric tube on salivagram result in paediatric patients.

OBJECTIVE: The aim of this study was to analyse the potential effect of indwelling nasogastric tubes (NGTs) on the positive rate of pulmonary aspiration in the salivagram of paediatric patients. METHODS: This retrospective study evaluated 290 children suffering from respiratory tract infection with clinical suspicion of pulmonary aspiration (104 cases with NGT and 186 cases without NGT). Among them, 216 had good past health, while 74 had history of oropharyngeal diseases or brain injuries. Tc-DTPA salivagrams were performed to determine whether the risk of pulmonary aspiration was different between patients with and without NGT. RESULTS: The positive rates of aspiration in salivagram were 32.3% (60/186) and 29.8% (31/104) in the patients without and with NGT, respectively. The positive rates of the two groups had not statistically significant difference [risk ratio (RR) = 0.924; 95% confidence interval (CI): 0.644-1.326; P = 0.666]. Subgroup analyses showed that the patients with good past health had the positive rates of 24.4% (19/78) with NGT and 25.4 % (35/138) without NGT. The two groups had no statistically significant difference (RR = 0.960; 95% CI: 0.592-1.559; P = 0.870). For the patients with underlying diseases, the positive rates were 46.2% (12/26) with NGT and 52.1% (25/48) without NGT. These two groups also demonstrated no statistically significant difference (RR = 0.886; 95% CI: 0.540-1.455; P = 0.626). CONCLUSION: The positive rate of pulmonary aspiration was relatively high in patients with respiratory tract infection who have underlying diseases but NGT feeding did not affect salivagram accuracy.

Use of Static Imaging as a Substitute for Conventional Dynamic Imaging for Salivagrams in Children.

OBJECTIVE: Salivagrams are commonly used for detecting pulmonary aspiration. However, conventional dynamic imaging is relatively time-consuming and could be difficult to perform in children with poor compliance. We analyzed the characteristics of conventional dynamic imaging to obtain a simple protocol suitable for use in children. METHODS: We conducted a retrospective analysis of salivagram data from 1163 patients (783 males, 380 females; age, 1 month to 9.0 years; mean age, 5.7 months) obtained in the past 4.5 years (January 2014 to June 2018). The various timepoint images were used for diagnosis. The positivity rate, missed diagnosis rate, and sensitivity were calculated and compared. RESULTS: Dynamic imaging revealed 353 cases of pulmonary aspiration (248 males, 105 females; age, 1 month to 4.5 years; mean age, 6.2 months). The positivity rate was 30.4% (353/1163), and 95.8% (338/353) of patients presented with continuous positive images after pulmonary aspiration. Only 4.2% (15/353) of positive cases showed clearance of pulmonary aspiration. The positivity rates were 11.8%, 18.2%, 21.9%, 25.0%, 27.0%, and 29.2% at 5, 10, 15, 20, 25, and 30 minutes, respectively. About 4.2% (15/353) of positive cases on earlier images showed clearance of pulmonary aspiration on later images, which indicate both early 15-minute and later 30-minute images were necessary. CONCLUSIONS: Two static images acquired at 15 and 30 minutes might be an effective alternative to conventional salivagram, which mandates dynamic imaging.

Elongated Appearance of Meckel's Diverticulum on 99mTcO4 Scintigraphy.

A Meckel's scintigraphy using TcO4 was performed in a 9-year-old boy. The images revealed an elongated abnormal radiotracer accumulation in the right abdomen, which was confirmed as Meckel diverticulum combined with an omphalomesenteric cyst.

Pulmonary aspiration only increases the risk of right-sided pneumonia in children: comparison of salivagrams and chest radiographs.

PURPOSE: A salivagram is often used to detect pulmonary aspiration, whereas chest radiography is often used to diagnose pneumonia. This study analysed the relationship between pulmonary aspiration and aspiration pneumonia in children, and the differences between lungs. PATIENTS AND METHODS: The salivagram and chest radiography results of 696 children (466 boys and 230 girls; aged 1-54 months; mean age, 4.7 months; median age, 3 months) diagnosed with respiratory tract infections between December 2013 and June 2017 were retrospectively analysed. Patients were classified as positive or negative on the basis of their salivagram results, and the radiography positivity rates were analysed. RESULTS: Among all paediatric patients, 197 were salivagram positive and 499 were salivagram negative. The positivity rate was 28.3% (197/696); the positivity rate of the right side was 98.0% (193/197). The radiography positivity rates of the right side in the positive group, negative group and the total sample were 84.3% (166/197), 69.5% (347/499) and 73.7% (513/696), respectively. The radiography positivity rates of the left side were 69.5% (137/197), 68.5% (342/499) and 68.8% (479/696), respectively. Inter-group comparisons of the radiography positivity rates of the right side showed significant differences between the positive group and the total sample, as well as between the positive and negative groups (P=0.001 and 0.000, respectively). There were no significant differences in the radiography positivity rates of the left side (P=0.846 and 0.796, respectively). The radiography positivity rate of the right side in the positive group was 14.8% higher than that in the negative group. CONCLUSION: Pulmonary aspiration tends to occur in the right side and only increases the risk of right-sided pneumonia.

Unexpected Pyelonephritis Incidentally Revealed on 99mTc MDP Bone Scintigraphy.

A 5-year-old girl had intermittent fever for 4 months. A Tc MDP bone scintigraphy was performed to evaluate possible occult osteomyelitis, which revealed no bone lesion. However, abnormal MDP activity in the upper poles of both kidneys was noted, which was confirmed as pyelonephritis subsequently.

Image characteristics and classification of salivagram in the diagnosis of pulmonary aspiration in children.

PURPOSE: A salivagram is a common method capable of detecting pulmonary aspiration. This investigation focused on describing the characteristics of salivagram and classifying the image to increase the clinical value of this imaging method. MATERIALS AND METHODS: A retrospective analysis was carried out of 428 patients (aged 1-36 months, mean age 4.5 months) diagnosed with respiratory tract infection and suspect pulmonary aspiration subjected to a salivagram, and the resulting images were classified on the basis of their features. RESULTS: The positive rate of aspiration was 24.5% (105 of 428); 53.3% (56 of the 105) of the aspiration patients showed unilateral aspiration and 46.7% (49 of the 105) of the aspiration patients showed bilateral aspiration. In the initial images (appearing within the first 10 min) from the 105 patients showing aspiration, 59% (62 of 105) were from the airway and 82.9% (87 of 105) were from the stomach. The images were classified by grade (0-4) according to the degree of the aspiration, where a higher grade of aspiration is related to a longer course of disease (P=0.041; R=0.919). CONCLUSION: A deeper understanding of the image characteristics is helpful for those seeking to further utilize salivagram. The creation of an image classification system allows for image information to be more accurately expressed and can guide clinical diagnosis and treatment.

Reconsideration of the primary and secondary diagnostic criteria of Meckel's diverticulum scintigraphy. A study of 93 confirmed cases.

OBJECTIVE: Meckel's diverticulum scintigraphy (MDS) is a common method for diagnosing ectopic gastric mucosa (EGM), but atypical images are difficult to diagnose. This study aimed to improve the understanding of the existing diagnostic criteria through a review of confirmed cases. SUBJECTS AND METHODS: A total of 352 patients underwent MDS. Among 120 patients with a positive diagnosis, 106 underwent surgery. This study analyzed the imaging presentation, surgical records, and pathological results. The existing diagnostic criteria included the location, shape, and radioactive appearance of the lesions. Data from surgical records with typical or atypical images were compared. RESULTS: One hundred cases (100/106) were surgically confirmed to be Meckel's diverticulum (MD). The remaining 6 were intestinal polyps, intestinal duplication, duodenal ulcer, non-Hodgkin's lymphoma (NHL) and hiatal hernia. Out of the 100 MD cases, 93 had complete operation records and 59/93 of the MDS 63.4% MD were located in the right lower quadrant, and 81.7% had a round shape in the scintiscan. The onset of the lesions activity in 96.8% (90/93) of the cases corresponded with the onset of the gastric activity. The radioactivity of 97.8% (91/93) of the lesions gradually increased during the examination. There were no significant differences between the typical and atypical scintiscan images: in the distance of MD from the ileocecal valve, in the MD length, and the basal diameter of MD for lesions at different scintiscans (P>0.05), or of different shapes (P>0.05). CONCLUSION: Location in the right lower quadrant and round shape of the lesions are not the primary diagnostic factors for Meckel's diverticulum. The establishment of the diagnosis of MD requires careful consideration of other imaging characteristics such as: a) The onset of lesions' radioactivity to correspond with the onset of the gastric activity and b) The lesions' radioactivity to gradually increase during the scan procedure.

Traditional preparations of kava (Piper methysticum) inhibit the growth of human colon cancer cells in vitro.

BACKGROUND: Epidemiological studies indicate there is low incidence of colon cancer in the South Pacific islands, including Fiji, West Samoa, and Vanuatu. Cancer incidence has been shown to be inversely associated with kava (Piper methysticum G. Forst.) ingestion. Hypothesis/Purpose: Kava prepared traditionally will inhibit the growth of human cancer cells. This investigation entails preparation and analysis of kava extracts and study of the growth inhibitory activity of the extracts, alone and combined with hibiscus. STUDY DESIGN: We will prepare kava as in Micronesia - as a water extract, high in particulate content, alone or combined with sea hibiscus (Hibiscus tiliaceus L.) - and examine the components and growth inhibitory activity. METHODS: We obtained ground kava prepared in the traditional way from lateral roots and sea hibiscus mucilage and sap from different sources in Micronesia, and prepared water extracts (unfiltered, as well as filtered, since in traditional use the kava beverage contains a high particulate content) and partitions. We used the MTT assay to determine the growth inhibitory activity of the preparations on colon and breast cancer cells and nonmalignant intestinal epithelial cells. LC-MS analysis was used to examine the components of the kava and sea hibiscus extracts and partitions. RESULTS: Traditional preparations of kava inhibit the growth of breast and colon cancer cells. Among the kava preparations, the order of decreasing activity was Fiji(2), Fiji(1), Hawaii; the unfiltered preparations from Fiji were more active than the filtered. Phytochemical analysis indicated that filtering reduced most kavalactone and chalcone content. For example, for Fiji(2), the ratio of dihydromethysticin in filtered/unfiltered kava was 0.01. Thus, for the extracts from Fiji, growth inhibitory activity correlates with the content of these compounds. Unfiltered and filtered kava from Fiji(1) were more active on malignant than nonmalignant intestinal epithelial cells. Since kava is prepared in Micronesia by squeezing the extract through sea hibiscus bark, we assayed the growth inhibitory activity of combinations of kava and sea hibiscus sap and found that sea hibiscus enhanced the growth inhibitory effect of kava. CONCLUSION: Our results show that traditional kava, alone or combined with sea hibiscus, displays activity against human cancer cells and indicate it will be worthwhile to develop and further analyze these preparations to prevent and treat colon and other cancers. Our findings suggest it is important to examine the activity of plants in the form that people consume them.

Detection of an Infant's Duodenal Atresia by Milk Scan.

Duodenal membranous atresia is a rare congenital disease. Here, we present a case of 6-month-old girl referred to us for repeated vomiting since birth. Milk scan was performed, and the results revealed a typical "double-bubble" sign. In addition, only very little activity was shown in the small intestine even at the end of the scintigraphy. These results led to the diagnosis of duodenal atresia, which was subsequently confirmed by gastroenterography and laparotomy. Our case demonstrated the potential value of milk scan in the diagnosis of this congenital disorder.

Atorvastatin improves cardiac function of rats with chronic cardiac failure via inhibiting Rac1/P47phox/P67phox-mediated ROS release.

OBJECTIVE: To discuss the protective mechanisms of atorvastatin treatment for isoproterenol (ISO)-induced chronic heart failure. MATERIALS AND METHODS: The rats were randomly divided into three groups: normal group (n = 15, age-matched normal adult rats), ISO group (n = 11, ISO induced heart failure) and atorvastatin group (n = 14, ISO induced lesion but received atorvastatin treatment). The cardiac function was evaluated by echocardiography and hemodynamics analysis. In addition, the Rac1 activity in the myocardium and the expression levels of Rac1, p47phox and p67phox were measured by RT-PCR and western blot. RESULTS: Rats in ISO group developed into heart failure with decreased cardiac function. The Rac1, p47phox and p67phox mRNA expressions and ROS release were increased in ISO group. Atorvastatin treatment improved cardiac function of rats with isoproterenol-induced chronic heart failure and decreased the Rac1, p47phox and p67phox mRNA expressions. Also, membrane protein expression of Rac1 and ROS release decreased significantly. CONCLUSIONS: Atorvastatin may improve cardiac function of rats with heart failure via inhibiting Rac1/P47phox/P67phox-mediated ROS release.

A case of congenital giant pigmented nevus

No abstract available.