فهرست مطالب arman hassanzadeh

Differentiated thyroid carcinoma (DTC) follow-up after thyroidectomy and radioiodine-ablation is performed mainly by thyroglobulin (Tg), diagnostic iodine-131 whole body scan (DxWBS) and sonography. Some patients with undetectable Tg have thyroid-bed uptake after ablation in whom decision making regarding the need for retreatment is still controversial.
In this study, we enrolled DTC patients with undetectable Tg but small thyroid residue in six-month-DxWBS following first radioiodine-ablation. Patients with detectable Tg, high TgAb, suspicious neck lymphadenopathy in sonography and metastasis were excluded. Ninety four patients were placed in two groups of cohort, i.e., radioiodine-retreatment group (n=36) versus observation (untreated) group (n=58). After six months, the clinical outcome was compared by evaluating DxWBS, Tg, TgAb and sonography.
DxWBS showed sustained thyroid remnant in 47.2% of retreated patients while 34.5% of untreated group revealed negative DxWBS over the next period of follow-up. Also, only 6 cases (16.7%) in retreatment group and 12 cases (20.7%) in observation group revealed an additional finding other than local faint RAI uptake, including detectable serum Tg, rising TgAb or suspicious ultrasound finding, favoring no significant difference of the outcome as well as relative risk of new finding incidence between treated and untreated patients (CI 95% for relative risk: 0.58-2.41; p=0.630).
Regarding sonologic and laboratory follow-up evidences, RAI-retreatment shows no significant advantage over observation in DTC patients with Tg negative, remnant positive DxWBS. In addition, residual thyroid tissue was completely disappeared in about one third of patients without retreatment.

A 60-year-old patient with testicular seminoma was referred for F-18 FDG PET/CT Study to evaluate recurrence. In addition to hypermetabolic cervical, mediastinal and hilar lymph node tumoral metastases, segmental intense FDG uptake along the lumbar spinal cord suggestive of tumoral metastasis was noted which quite an unusual presentation is. At the time of PET study the patient was symptomless, and neurological symptoms and signs associated with spinal cord metastasis developed only several days afterwards, emphasizing the role of FDG PET study in early detection of spinal cord metastasis. The patient underwent radiotherapy of the spinal cord with consequent clinical improvement.

Peripheral Vascular Disease (PVD) is a major cause of morbidity and is associated with Coronary Artery Disease (CAD). We aimed to perform Lower Limb Perfusion Scan (LLPS) in patients referred for Myocardial Perfusion Imaging (MPI) and estimate prevalence of PVD in subgroups with normal and abnormal MPI results. We also compared quantitative indices of LLPS in patients with and without abnormal MPI results with semi-quantitative QPS indices.
120 patients referred for MPI entered the study. Exercise or dipyridamole infusion was used as stress modality. After 99mTc-MIBI injection at peak stress, whole body posterior views and planar images from thighs and calves were obtained. Gated MPI was done subsequently. Rest phase was performed the following day. LLPS was analyzed visually and quantitatively.
In patients with abnormal and normal MPI results, LLPS revealed 22.58% and 1.92% prevalence of PVD in exercise subgroup (P-Value=0.004) and 50.00% and 10.52% in dipyridamole subgroup (P-Value= 0.013), respectively. Both of these different prevalence were statistically significant. In exercise subgroup, mean ranks of Stress Index (Is) for all lower limb regions were statistically significantly greater in patients with normal MPI result. Also, among patients who had ischemia in exercise-rest MPI, negative correlations were seen between Is and Rest Index (Ir) of all regions and QPS quantitative indices.
LLPS with 99mTc-MIBI, combined with MPI is a feasible method to detect lower limbs ischemia, especially in patients with abnormal MPI results. Correlating quantitative indices of LLPS with MPI-QPS also reflect coexistence of CAD and PVD.