mahdi haghighatafshar

False positive radioiodine uptake may pose difficulties in diagnosis and subsequent management of thyroid cancer. Combined imaging techniques, such as SPECT/CT, play a crucial role in accurately identifying the specific location of radioiodine uptake, thereby avoiding potential diagnostic error. This is particularly important in situations where unexpected uptake could lead to unnecessary treatment interventions such as surgery or radioiodine treatment. In this study, we discuss a case involving a 38-year-old female with a history of thyroid cancer and I-131 treatment. Approximately six years later, her course was complicated by left sided epiphora leading to dacryocystorhinostomy and subsequently elevation of thyroglobulin (Tg) levels prompting retreatment by radioiodine.  The post-therapy whole-body scan revealed false-positive radioiodine uptake on the left side of the skull, conclusively confirmed through SPECT/CT imaging to be localized in the patient's left eye.

A bone scan was performed on a 69-year-old man with small cell lung carcinoma (limited stage) following 2nd course of adjuvant chemotherapy using etoposide and cisplatin demonstrating extra-osseous tracer accumulation in the right lower abdominal cavity originally thought to be in the ascending colon, was proven to be an ectopically located gallbladder extending to the right lower quadrant (RLQ). Otherwise, the bone scan did not show abnormal skeletal uptake. The precise reason for gallbladder excretion of [99mTc]Tc-MDP derivatives is unknown. None of the other patients injected with the same [99mTc]Tc-MDP kit demonstrated any gallbladder or other abnormal soft tissue tracer accumulation. In the interpretation of non-osseous uptakes in the right abdominal cavity, ectopic and/or abnormal shaped gallbladder should be taken into consideration.

The standard treatment for differentiated thyroid carcinoma is post-surgical radioiodine ablation; however, salivary gland damage is prevalent. This study aimed to evaluate the efficacy of Zataria multiflora Boiss. (ZM) aerial part essential oil in protecting salivary glands from post-radioiodine therapy damage in differentiated thyroid cancer patients.

In this randomized clinical trial, 24 patients with differentiated thyroid cancer were randomly allocated to two groups: 11 patients in the ZM essential oil group and 13 in the placebo group. Patients in the intervention and placebo groups received 20 oral drops three times a day of ZM essential oil or placebo respectively, starting from one week before radioiodine therapy to 4 weeks afterward. Salivary gland function was assessed using scintigraphic parameters before and six months following radioiodine therapy.

Follow-up scintigraphy demonstrated significant decrease in parotid UI in the placebo group (P=0.032) while significant increase in UI (P=0.025) and EF (P=0.042) of the parotid was observed in the ZM group. Comparing changes in functional indices of salivary glands between the two groups after six months revealed significantly better function in parotid UI (P=0.005) and parotid EF (P=0.006) in the ZM group. Substantial damage to parotid UI was significantly less in the ZM group (P=0.044).

Results of this study demonstrated that administration of ZM essential oil to patients with differentiated thyroid cancer may protect the salivary glands from radioiodine injury.

A 43-year-old female known case of Systemic Lupus Erythematous was presented with chief complaints of pain and morning stiffness in her joints since 3 months ago. Her pain was intensified after Covid-19 pneumonia. She was referred to our nuclear medicine center to rule out active arthritis with three-phase bone scan. An interesting finding was abnormal large tracer accumulation in the pelvis, which was proved to be due to myoma.

 For the interpretation of myocardial perfusion imaging, considering non-perfusion variables, such as transient ischemic dilatation (TID), are also important in diagnostic and prognostic evaluation of a patient. TID has a relatively high false positive and false negative results, which reduces its diagnostic and prognostic values. In this study, we aimed to compare the accuracy of TID after normalization based on changes in LV wall mass.

 Patients referred for dipyridamole myocardial perfusion imaging single-photon emission computed tomography (MPI/SPECT), one to two year prior to the study with TID ratio >1 were enrolled. Patients with any previous history of revascularization and structural heart disease were excluded. Follow-up was done by phone call. The occurrence of cardiac death, myocardial infarction, revascularization or evidence of abnormal angiography during one year after MPI was considered positive for short-term cardiac events. The corrected TID (cTID) was calculated by the following formula: cTID = TID/(Wallstress/Wallrest).

 Among 196 participants, 30 (15%) had cardiovascular events during the follow-up. The area under the receiver operating characteristic (ROC) curve for the short-term prognosis of the cardiac events were 0.57 and 0.50 for cTID and TID with a p-value of 0.17 and 0.92, respectively. Considering the best cut-off points that were achieved by ROC curves, cTID showed significant odds ratio (OR: 2.53) for prediction of short-term cardiac events, while respecting, TID failed to be statistically significant.

 Making correction on TID using LV wall volumes can improve short-term prognostic value of this variable.

Considering that quantitative methods are usually more reproducible with lower inter-observer variability, the purpose of this research was to compare the prognostic value of the two quantitative method with quantitative perfusion SPECT (QPS) software. This study was performed prospectively and included 200 participants who were referred for myocardial perfusion imaging. These participants were selected by the convenience sampling method. All patients were followed up after one year. Patients were classified as those with and without major cardiac events, including cardiac death, non-fatal myocardial infarction, open-heart surgery, abnormal angiographic findings, and unstable angina. There were 62 male (31.0%) and 138 female (69.0%) patients, ranging in age from 30 to 86 years. The results indicated that the major cardiac events were significantly higher in moderate and severe categories based on summed stress score (SSS) (P=0.024) and total perfusion deficit (TPDs) (P=0.002) scores. SSS score with TPDs score (P = 0.764), summed rest score (SRS) with TPDr score (P = 0.583) and SDS with ΔTPD (P = 0.118) were compatible for predicting major heart events within a year. Total perfusion deficits obtained from QPS software is a useful method for predicting major cardiac events in patients with suspected cardiovascular disease (CVD). Predictive ability of TPD was similar to that of the semi-quantitative method with an expert interpreter's help. Moreover, this method can be helpful for CAD diagnosis and therapeutic evaluation of patients.

Endometriosis is a gynecological disease and disorder that occurs when endometrial cells are shed through the fallopian tubes and are implanted on the surfaces of pelvis and abdomen. They form lesions that respond to hormones of the menstural cycle and will stimulate inflammation. It is controversial whether [99mTc]Tc-RBC scan would be sufficient for localizing bleeding sites. This study evaluated the value of [99mTc]Tc-RBC in diagnosing endometriosis. Twenty patients were included in the study for endometriosis localization. Between the 2nd and the 5th days of menstruation, when the lesions were highly activated, [99mTc]Tc-RBC scan was performed and compared with TVUS, pelvic MRI and laparoscopic surgery findings. Scans of the patients were reported by two nuclear medicine specialists who were blind to patients’ history. The patients’ age range was 21-48 years (mean age: 35±8.79). The sensitivity, specificity, positive predictive value and negative predictive value for the right pelvic bleeding sites were 73.3%, 80.0%, 91.7% and 50%, respectively while the corresponding indices on the opposite pelvic site were find to be 87.5%, 75.0%, 93.0% and 60%, respectively. Radiolabeled red blood cell scintigraphy has the potential to be used as an alternative procedure for diagnosing endometriosis.

Eating fatty food is a common technique for decreasing extra cardiac activity, but sometimes patients refuse to eat fatty foods due to various reasons during myocardial perfusion imaging. The aim of this study is to introduce an alternative method for patients who are not able to use fatty foods to accelerate the transit of radiotracer from the liver. A total of 100 patients were randomized into four groups to take 200 cc of lemon juice, 200 cc of pomegranate juice, 200 cc of secanjabin, and 100 mg of fatty meal, 10 min after injection of 20 mCi 99mTc-MIBI, respectively in groups A, B, C, and D. The study is carried out in both rest and stress imaging at 30 and 50 min post-injection. Using ROI- based analysis, means of activity counts in heart and liver and, then the mean of heart/liver (H/L) ratios were calculated. According to data analysis of both rest and stress imaging at min 30 and 50, A and D groups had significantly higher H/L ratio than groups B and C. Comparing the images of groups in both rest and stress protocol at minutes 30 and 50, A and D groups had significantly higher H/L ratio at 50 minutes in comparison with 30 minutes. In patients who refrain from eating fatty foods, drinking of diluted lemon juice may be recommended as a simple technique and the best alternative to decrease extra-cardiac activity and increase the H/L ratio.

A 10-year-old boy with a history of bloody discoloration of urine following recent appendectomy was referred to our department for urinary leakage/fistula evaluation. A renal Technetium-99m-L,L-ethylenedicysteine (99mTc-EC) scintigraphy was performed. After injection of radiotracer, a focus of activity appeared in the supralateral part of the right kidney which was confirmed as accumulation of radiotracer in the gall bladder by SPECT and delayed images. Although it is stated that the biliary excretion of 99mTc-EC is negligible, in some cases it could be prominent and potential source of misinterpretation.

Gallbladder agenesis (GA) is a rare congenital anomaly. Only 50% of the cases with GA are symptomatic, presenting mostly in the 4th or 5th decade of life. The clinical presentation of GA and imaging findings are non-specific and often misinterpreted as other diseases such as ectopic gall bladder. This can lead to unnecessary surgery when the final diagnosis is usually made. Although GA can cause an identical pattern to acute cholecystitis in hepatobiliary scintigraphy, in certain clinical settings, scintigraphy can be helpful as a confirmatory study, especially to rule out the possibility of ectopic gall bladder. In our case, the combination of imaging findings including ultrasonography, computed tomography, and hepatobiliary scintigraphy led to accurate diagnosis avoiding further surgeries.

Proton magnetic resonance spectroscopy (MRS) is a well-known device for analyzing the biological fluids metabolically. Obtaining accurate and reliable information via MRS needs a homogeneous magnetic field in order to provide well-defined peaks and uniform water suppression. There are lots of reasons which can disturb the magnetic field homogeneity which can be corrected by a process known as shimming. This study is intended to recall the importance of shimming and also the significant role of quality control (QC) in achieving an accurate quantification.
An acrylic cylindrical quality control phantom was designed as an analog of brain MRS test phantoms in order to control the accuracy of the obtained signal of a 1.5 T Siemens MRI system which belonged to one of Shiraz hospitals. The signal of NAA, Cho, Cr, the combination of these metabolites and also the distilled water, which was used in this study, was evaluated using separate phantoms. A QC test was performed using Siemens QC phantom and a standard test phantom.
The spectrum of our home- made phantom had a significant difference with the expected spectrum. The results of checking the spectrum of metabolites separately also confirmed that there was a systemic problem that affects all the signals originated from all metabolites and even the pure distilled water. The MRS system could not pass QC tests, and peak broadening was common in all spectra. The complex spectrum of standard test phantom was not produced successfully by the MRS system.
By a simple check of the water peak characteristics, lots of information can be obtained, one of which is the status of shimming that has a considerable effect on the accuracy of the spectrum. Thus, performing an automatic or manual shimming is not a criterion of the spectrum accuracy, and performing a periodic quality control using a test phantom by a specialist is necessary. Briefly, the quality control of MRS and all the other clinical device must be taken seriously. Sometimes QC can be the boundary of a right or a wrong decision for the patient.

In recent years, a wide variety of researches are performed in the field of novel technologies to stop severe bleeding. Finally, an effective combination of a mineral called Zeolite has been introduced. Bentonite and Halloysite ores are very common in Iran. Likewise, coagulation properties of these minerals have been proven in several studies. In this study, the effect of new recombinant gauze, containing Bentonite and Halloysite minerals was studied on blood coagulation and wound healing time in male rats. In this exprimental study, new sterile gauze was prepared from mixture of Bentonite and Halloysite minerals and Vaseline. Then the effect of gauze was studied on the wound healing process in the Wistar rat. Finally, SPSS software was used for data analysis (T-test and the nonparametric Mann-Whitney). Differences with P <0.05 were considered as significant. In the first phase, the study was carried out on 40 blood samples of mice tails. The coagulation time of 81.31 ± 19.12 sec in control group and 33.2 ± 2.18 sec in study group (Bentonite-Halloysite treated) were reported. In the second phase, the time of complete wound healing was considered. This figure was observed between 9 and 13 days in the control group and 5 to 6 days in study group which is treated with recombinant sterile gauze. According to the results of the present study, topical application of the new sterile gauze, combined with Bentonite and Halloysite minerals decrease clotting and wound healing time significantly

A 57-year-old male with history of prostatectomy, cyctectomy, cecal urinary diversion for invasive prostate cancer and with a recent rise in PSA level, was referred for bone scintigraphy to rule out osseous metastatic disease. An interesting finding was abnormal tracer accumulation throughout the large bowel, which was proved to be due to urinary diversion.

A 29- year old female with bone pain and history of precocious puberty was referred for bone scintigraphy. On physical examination café au lait macular spots were noted on her neck, buttocks and left leg. Bone scan showed multiple areas of intense increased activity which was in favour of polyostotic fibrous dysplasia. Considering the presence of polyostotic fibrous dysplasia, precocious puberty and café au lait macular spots, MacCune-Albright syndrome was confirmed in this patient.