Objective: To determine the values of the Sacroiliac Joint Index (SI Index) in normal population and patients with sacroiliitis (SI) and the correlation of normal values with age and gender.
Study ...Design: Prospective longitudinal study.
Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Dec 2020 to Jul 2022.
Methodology: A total of 140 patients (Group-I consisting of 129 cancer patients having no clinical or radiological evidence of SI referred for metastatic/staging workup and Group-II consisting of 11 patients with clinical, laboratory and radiological diagnosis of ankylosing spondylitis) who underwent whole body bone scintigraphy using Technetium Pertechnetate (Tc-99m) labelled Methylene Diphosphonate (MDP) were included. The SI Index was calculated for each patient using the sacroiliac joint (SIJ) to sacrum radiotracer uptake ratio using the ROI method.
Results: The mean SI Index was 1.02±0.09, (range: 0.87-1.24) in normal individuals while 1.28±0.09 (range: 1.15-1.53) in patients with SI. A significant statistical difference was observed in both groups for the SI Index (p-<0.001). In addition, the SI Index was significantly associated with age (p=0.016) in the normal population.
Conclusion: The SI Index quantification using bone scintigraphy is a sensitive and cost-effective method for detecting SI. In addition, the SI Index differs according to age, so a different cut-off value should be used for each group.
Background: The accurate sensitivity of amyloid deposition in extracardiac tissue (subcutaneous tissue and gastrointestinal tract) has not been evaluated in transthyretin amyloidosis cardiomyopathy ...(ATTR-CM) patients. This study aimed to evaluate the sensitivity of amyloid deposition in obtained endomyocardial and extracardiac biopsies.Methods and Results: This study retrospectively evaluated 175 consecutive ATTR-CM patients (wild-type ATTRwt: 134, hereditary ATTRv: 41) who had positive findings on 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy and underwent tissue biopsy of at least one organ (subcutaneous tissue, gastrointestinal tract, and endomyocardium). Amyloid deposition was observed in the subcutaneous tissue of 57/150 patients (38%), gastrointestinal tract of 80/131 patients (61%), and endomyocardium of 108/109 patients (99%). Compared to patients with ATTRv, ATTRwt had significantly lower sensitivity in subcutaneous tissue (73% vs. 25%, P<0.01) and tended to be lower in the gastrointestinal tract (74% vs. 57%, P=0.08) biopsies. Among 124 patients who underwent both subcutaneous tissue and gastrointestinal tract biopsies, amyloid was detected in at least 1 specimen in 91 (73%) patients. The sensitivity of the combination of extracardiac biopsies was 66% and 94% in ATTRwt-CM and ATTRv-CM, respectively. Multivariate analysis reveals that ATTRv was the only significant predictor of amyloid deposition in the subcutaneous tissue.Conclusions: Subcutaneous tissue and gastrointestinal tract biopsy sensitivity are inadequate, especially in patients with ATTRwt; however, the combination of these extracardiac biopsies contributes to increased sensitivity in patients with positive 99 mTc-PYP scintigraphy findings.
Background: The accurate sensitivity of amyloid deposition in extracardiac tissue (subcutaneous tissue and gastrointestinal tract) has not been evaluated in transthyretin amyloidosis cardiomyopathy ...(ATTR-CM) patients. This study aimed to evaluate the sensitivity of amyloid deposition in obtained endomyocardial and extracardiac biopsies.Methods and Results: This study retrospectively evaluated 175 consecutive ATTR-CM patients (wild-type ATTRwt: 134, hereditary ATTRv: 41) who had positive findings on 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy and underwent tissue biopsy of at least one organ (subcutaneous tissue, gastrointestinal tract, and endomyocardium). Amyloid deposition was observed in the subcutaneous tissue of 57/150 patients (38%), gastrointestinal tract of 80/131 patients (61%), and endomyocardium of 108/109 patients (99%). Compared to patients with ATTRv, ATTRwt had significantly lower sensitivity in subcutaneous tissue (73% vs. 25%, P<0.01) and tended to be lower in the gastrointestinal tract (74% vs. 57%, P=0.08) biopsies. Among 124 patients who underwent both subcutaneous tissue and gastrointestinal tract biopsies, amyloid was detected in at least 1 specimen in 91 (73%) patients. The sensitivity of the combination of extracardiac biopsies was 66% and 94% in ATTRwt-CM and ATTRv-CM, respectively. Multivariate analysis reveals that ATTRv was the only significant predictor of amyloid deposition in the subcutaneous tissue.Conclusions: Subcutaneous tissue and gastrointestinal tract biopsy sensitivity are inadequate, especially in patients with ATTRwt; however, the combination of these extracardiac biopsies contributes to increased sensitivity in patients with positive 99 mTc-PYP scintigraphy findings.
This is a case of a male patient in his 70s undergoing endocrine therapy for castration-resistant prostate cancer. On follow-up, he underwent whole-body bone scintigraphy for bone metastasis ...surveillance, and incidental cardiac uptake was identified. The findings were reported by the radiologist to the urologist, which was followed by a cardiac consultation. Late gadolinium enhancement magnetic resonance imaging did not detect typical patterns suggestive of cardiac amyloidosis. However, pyrophosphate scintigraphy identified cardiac uptake. These findings were indicative of transthyretin amyloid cardiomyopathy, and we confirmed the diagnosis by endomyocardial biopsy. In about 0.4–2.0 percentage of elderly patients, incidental cardiac uptake in bone scintigraphy has been reported. Bone scintigraphy is the most commonly utilized techniques among all scintigraphies. Thus, it is crucial that radiologists recognize and report the findings to establish a diagnosis of transthyretin amyloid cardiomyopathy.
The therapy response of osseous metastases (OM) is commonly monitored by bone scintigraphies (BS). The aim of this study was to compare visual evaluation of changes in tracer uptake with quantitation ...in absolute units in OMs; 52 OMs from 19 patients who underwent BS with SPECT/CT at time points one and two (TP1/2) were analyzed retrospectively, with an average of 10.3 months between TP1 and 2. Tracer uptake in lesions was visually compared by two independent readers in both planar scintigraphies and SPECT/CT across both TPs and classified as regressive, stable, or progressive. Quantitative analysis was performed by measuring peak standardized uptake values (SUV). Based on quantitation, lesions were similarly classified as regressive (>30 % decrease), progressive (>30 % increase), or stable (rest). If available, uptake in reference regions in the lower thoracic or lumbar spine was used for normalization.
In OMs at TP1 and TP2, mean SUVpeak (±SD) was found to be 20.4 (±20.8) and 16.4 (±11.5), respectively. For the reference region, mean SUVmean was 5.6 (±1.9) and 4.9 (±2.2). Agreement between quantitative and visual assessment was only moderate, with an average Cohen's kappa of 0.42 for planar scintigraphy and 0.62 for SPECT/CT. Discrepancies occurred in between 11 and 22 of the 52 lesions, depending on the reader and whether planar or SPECT imaging was considered.
Compared to measuring uptake in absolute units, visual evaluation of skeletal scintigraphies for change in tumor metabolism yields inconsistent results in roughly one third of the cases.
The purpose of this work is to develop a medical system that optimizes the sensitivity of the bone scintigraphy in the diagnosis to patients with bone cancer problems, bone disease, infections, bone ...wear, or malignancies like bone metastasis which will monitor the deterioration of the bones caused by the disease in case. In this work the sensitivity of bone scintigraphy was improved to help in their interpretation and therefore we aid in the radiological digitization, which consists of a process that allows to obtain a digitalized image from an analogue image. Which means it is susceptible to being stored in the form of a number representing the position of a pixel point, elementary surface unit. This can be done using the means of digitization and digital image processing (PDI), in addition to the enhancement tools offered by various processes, a greater sensitivity is projected in the radiological images, to evaluate the results potential gain in the diagnostic probability offered by this digitization process. The picture formats that can be used are JPG, BMP or DICOM. To have an improvement in the radiological diagnostic sensitivity, a conversion of a grayscale image to the color map in RGB (Red, Green and Blue) must be done, representing the values of the pixels of the grayscale image as follows: (1) The lowest values will be displayed in shades of blue, (2) Intermediate values are represented in shades of green, and (3) The lowest values will be displayed in shades of red. When using this color map, the image will be different tones by the combination of the above-mentioned colors.
Technetium-labeled cardiac scintigraphy (i.e., Tc-PYP scan) has been repurposed for the diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). Validated in cohorts of patients with heart ...failure and echocardiographic and/or cardiac magnetic resonance imaging findings suggestive of cardiac amyloidosis, cardiac scintigraphy can confirm the diagnosis of ATTR-CM only when combined with blood and urine testing to exclude a monoclonal protein. Multisocietal guidelines support the nonbiopsy diagnosis of ATTR-CM using cardiac scintigraphy, yet emphasize its use in the appropriate clinical context and the crucial need to rule out light chain amyloid cardiomyopathy. Although increased awareness of ATTR-CM and the advent of effective therapy have led to rapid adoption of diagnostic scintigraphy, there is heterogeneity in adherence to consensus guidelines. This perspective outlines clinical scenarios wherein findings on technetium-labeled cardiac scintigraphy have been misinterpreted, reviews causes of false-negative and false-positive results, and provides strategies to avoid costly and potentially fatal misdiagnoses.
Background
The application of deep learning methods in rapid bone scintigraphy is increasingly promising for minimizing the duration of SPECT examinations. Recent works showed several deep learning ...models based on simulated data for the synthesis of high‐count bone scintigraphy images from low‐count counterparts. Few studies have been conducted and validated on real clinical pairs due to the misalignment inherent in multiple scan procedures.
Purpose
To generate high quality whole‐body bone images from 2× and 3× fast scans using deep learning based enhancement method.
Materials and Methods
Seventy‐six cases who underwent whole‐body bone scans were enrolled in this prospective study. All patients went through a standard scan at a speed of 20 cm/min, which followed by fast scans consisting of 2× and 3× accelerations at speeds of 40 and 60 cm/min. A content‐attention image restoration approach based on Residual‐in‐Residual Dense Block (RRDB) is introduced to effectively recover high‐quality images from fast scans with fine‐details and less noise. Our approach is robust with misalignment introduced from patient's metabolism, and shows valid count‐level consistency. Learned Perceptual Image Patch Similarity (LPIPS) and Fréchet Inception Distance (FID) are employed in evaluating the similarity to the standard bone images. To further prove our method practical in clinical settings, image quality of the anonymous images was evaluated by two experienced nuclear physicians on a 5‐point Likert scale (5 = excellent) .
Results
The proposed method reaches the state‐of‐the‐art performance on FID and LPIPS with 0.583 and 0.176 for 2× fast scans and 0.583 and 0.185 for 3× fast scans. Clinic evaluation further demonstrated the restored images had a significant improvement compared to fast scan in image quality, technetium 99m‐methyl diphosphonate (Tc‐99 m MDP) distribution, artifacts, and diagnostic confidence.
Conclusions
Our method was validated for accelerating whole‐body bone scans by introducing real clinical data. Confirmed by nuclear medicine physicians, the proposed method can effectively enhance image diagnostic value, demonstrating potential for efficient high‐quality fast bone imaging in practical settings.
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