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Siraj QH. Functional Imaging of Testicular Torsion. Semin Nucl Med 2023; 53:797-808. [PMID: 37210316 DOI: 10.1053/j.semnuclmed.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/22/2023]
Abstract
This article discusses the current clinical role and scope of functional radionuclide imaging using testicular perfusion scintigraphy with 99mTc-pertechnetate in patients presenting with an acute hemiscrotum for an early and reliable diagnosis of testicular torsion. The technique of testicular perfusion scintigraphy is described, and the characteristic findings are detailed with examples. The imaging characteristics of the various phases of testicular torsion and its differentiation from epididymitis and/or epididymo-orchitis and the other related conditions presenting as an acute hemiscrotum are detailed. In some cases, further evaluation by SPECT imaging increases the clarity and accuracy of diagnosis and, on occasion, hybrid SPECT/CT in selected complicated cases improves the diagnostic yield of the perfusion scintigraphy. Ultrasonographic and color Doppler findings are described concurrently with the scintigraphic findings. The several case examples presented demonstrate the additional clinical benefit of complementing functional and structural imaging for improving the sensitivity, specificity and accuracy of testicular imaging in the diagnosis.
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Affiliation(s)
- Qaisar H Siraj
- Department of Nuclear Medicine, Farwaniya Hospital Kuwait, Kuwait City, Kuwait.
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Jo N, Edhayan G, Owji S, Villanueva-Meyer J, Bhargava P. Detection of Malpositioned VP Shunt Catheter by Radionuclide CSF Cisternography. Clin Nucl Med 2023; 48:e110-e111. [PMID: 36723893 DOI: 10.1097/rlu.0000000000004525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ABSTRACT A 37-year-old man presented with a 2-week history of abdominal pain, headaches, nausea, vomiting, and leukocytosis. Medical history includes congenital hydrocephalus, with a ventriculoperitoneal shunt placed several years ago. Radionuclide cerebrospinal fluid cisternography shows curvilinear activity in the abdomen, in the pattern of small and large bowel loops, suggesting that the tip of the catheter is inside a small bowel loop. No activity is seen in the intraperitoneal compartment. CT of the abdomen and pelvis followed by laparoscopic surgery confirmed the findings.
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Affiliation(s)
- Nahyun Jo
- From the Division of Nuclear Medicine, Department of Radiology, University of Texas Medical Branch, Galveston, TX
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Assessment of salivary gland function after 177Lu-PSMA radioligand therapy: Current concepts in imaging and management. Transl Oncol 2022; 21:101445. [PMID: 35523007 PMCID: PMC9079342 DOI: 10.1016/j.tranon.2022.101445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
The United States food and drug administration has recently granted approval to the targeted 177Lu-PSMA-617 therapy in prostate cancer patients. Salivary glands show high PSMA-ligand uptake and are prone to radiation damage secondary to accumulation of 177Lu-PSMA-617. Salivary gland scintigraphy is a noninvasive highly reproducible technique, useful for objective and quantitative assessment of salivary flow and function of parotid and submandibular glands and can help detect early changes post 177Lu-PSMA-617 therapy.
Prostate specific membrane antigen (PSMA) is a transmembrane protein that is highly expressed on prostate epithelial cells and is strongly upregulated in prostate cancer. Radioligand therapy using beta-emitting Lutetium-177 (177Lu)-labeled-PSMA-617, a radiolabeled small molecule, has gained attention as a novel targeted therapy for metastatic prostate cancer, given its high affinity and long tumor retention, and rapid blood pool clearance. In March 2022, the United States Food and Drug administration has granted approval to the targeted 177Lu-PSMA-617 therapy for treatment of patients with PSMA-positive metastatic castration resistant prostate cancer, who have been previously treated with an androgen-receptor pathway inhibitor and taxane-based chemotherapy. Studies have demonstrated the adverse effects of this treatment, mainly encountered due to radiation exposure to non-target tissues. Salivary glands show high PSMA-ligand uptake and receive increased radiation dose secondary to accumulation of 177Lu-PSMA-617. This predisposes the glands to radiation-mediated toxicity. The exact mechanism, scope and severity of radiation-mediated salivary gland toxicity are not well understood, however, the strategies for its prevention and treatment are under evaluation. This review will focus on the current knowledge about salivary gland impairment post 177Lu labeled PSMA-based radioligand therapies, diagnostic methodologies, and imaging with emphasis on salivary gland scintigraphy. The preventive strategies and known treatment options would also be briefly highlighted.
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Derenoncourt PR, Felder GJ, Royal HD, Bhalla S, Lang JA, Matesan MC, Itani M. Ventilation-Perfusion Scan: A Primer for Practicing Radiologists. Radiographics 2021; 41:2047-2070. [PMID: 34678101 DOI: 10.1148/rg.2021210060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung scintigraphy, or ventilation-perfusion (V/Q) scan, is one of the commonly performed studies in nuclear medicine. Owing to variability in clinical applications and different departmental workflows, many trainees are not comfortable interpreting the results of this study. This article provides a simplified overview of V/Q imaging, including a review of its technique, interpretation methods, and established and emerging clinical applications. The authors review the role of V/Q imaging in evaluation of acute and chronic pulmonary embolism, including the role of SPECT/CT and comparing V/Q scan with CT angiography. In addition, a variety of other applications of pulmonary scintigraphy are discussed, including congenital heart disease, pretreatment planning for lung cancer and emphysema, posttransplant imaging for bronchiolitis obliterans, and less common vascular and nonvascular pathologic conditions that may be detected with V/Q scan. This article will help radiologists and residents interpret the results of V/Q scans and understand the various potential clinical applications of this study. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Paul-Robert Derenoncourt
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Henry D Royal
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Manuela C Matesan
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (P.R.D., H.D.R., S.B., J.A.L., M.I.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.C.M.)
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Bermo MS, Khalatbari H, Parisi MT. Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr Radiol 2018; 48:1130-1138. [PMID: 29737381 DOI: 10.1007/s00247-018-4150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Successful shunt access is the first step in a properly performed nuclear medicine cerebrospinal fluid (CSF) shunt study. OBJECTIVE To determine the significance of the radiotracer configuration at the injection site during initial nuclear medicine CSF shunt imaging and the lack of early systemic radiotracer activity as predictors of successful shunt access. MATERIALS AND METHODS With Institutional Review Board approval, three nuclear medicine physicians performed a retrospective review of all consecutive CSF shunt studies performed in children at our institution in 2015. Antecedent nuclear medicine CSF shunt studies in these patients were also assessed and included in the review. The appearance of the reservoir site immediately after radiotracer injection was classified as either figure-of-eight or round/ovoid configuration. The presence or absence of early systemic distribution of the tracer on the 5-min static images was noted and separately evaluated. RESULTS A total of 98 nuclear medicine ventriculoperitoneal CSF shunt studies were evaluated. Figure-of-eight configuration was identified in 87% of studies and, when present, had 93% sensitivity, 78% specificity, 92% accuracy, 98% positive predictive value (PPV) and 54% negative predictive value (NPV) as a predictor of successful shunt access. Early systemic activity was absent in 89 of 98 studies. Lack of early systemic distribution of the radiotracer had 98% sensitivity, 78% specificity, 96% accuracy, 98% PPV and 78% NPV as a predictor of successful shunt access. Figure-of-eight configuration in conjunction with the absence of early systemic tracer activity had 99% PPV for successful shunt access. CONCLUSION Figure-of-eight configuration at the injection site or lack of early systemic radiotracer activity had moderate specificity for successful shunt access. Specificity and PPV significantly improved when both signs were combined in assessment.
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Affiliation(s)
- Mohammed S Bermo
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Hedieh Khalatbari
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Aksoy SY, Vatankulu B, Uslu L, Halac M. Depiction of ventriculoperitoneal shunt obstruction with single-photon emission computed tomography/computed tomography. Indian J Nucl Med 2016; 31:246-7. [PMID: 27385906 PMCID: PMC4918499 DOI: 10.4103/0972-3919.181832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An 83-year-old male patient with ventriculoperitoneal shunt underwent radionuclide shunt study using single-photon emission computed tomography/computed tomography (SPECT/CT) to evaluate the shunt patency. The planar images showed activity at the cranial region and spinal canal but no significant activity at the peritoneal cavity. However, SPECT/CT images clearly demonstrated accumulation of activity at the superior part of bifurcation level with no activity at the distal end of shunt as well as no spilling of radiotracer into the peritoneal cavity indicating shunt obstruction. SPECT/CT makes the interpretation of radionuclide shunt study more accurate and easier as compared with traditional planar images.
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Affiliation(s)
- Sabire Yılmaz Aksoy
- Department of Nuclear Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Betül Vatankulu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Lebriz Uslu
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Metin Halac
- Department of Nuclear Medicine, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
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Ahmadzadehfar H, Rahbar K, Kürpig S, Bögemann M, Claesener M, Eppard E, Gärtner F, Rogenhofer S, Schäfers M, Essler M. Early side effects and first results of radioligand therapy with (177)Lu-DKFZ-617 PSMA of castrate-resistant metastatic prostate cancer: a two-centre study. EJNMMI Res 2015; 5:114. [PMID: 26099227 PMCID: PMC4477007 DOI: 10.1186/s13550-015-0114-2] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/05/2015] [Indexed: 01/14/2023] Open
Abstract
Background Radioligand therapy (RLT) with 177Lu-DKFZ-617 PSMA (Lu-PSMA) (prostate-specific membrane antigen) is a novel targeted therapy of metastatic prostate cancer. We analysed retrospectively the early side effects and the response rate in the first patients, who received a therapy with Lu-PSMA in our departments. Methods RLT was performed in ten hormone- and/or chemo-refractory patients with distant metastases and progressive disease (mean age 73.5 years). 68Ga-PSMA HBED-CC PET/CT was performed in all patients prior to RLT. The median PSA level prior to the therapy was 298.5 ng/ml (range 5–853 ng/ml). All patients received CBC, renal and liver function tests the day before and 2 days after application (mean administered activity 5.6 GBq, range 4.1–6.1 GBq), followed by further tests every 2 weeks. All patients were contacted by telephone every week regarding side effects or any positive and negative changes. Results Eight weeks after the therapy, seven patients (70 %) experienced a PSA decline, of whom six experienced more than 30 % and five more than 50 %. Three patients showed a progressive disease according to the PSA increase. No patient experienced any side effects immediately after injection of Lu-PSMA. Relevant hematotoxicity (grade 3 or 4) occurred 7 weeks after the administration in just one patient. The same patient showed a leucopenia grade 2. Two patients showed a disturbance of only 1 hematologic cell line, whereas one patient showed a reduction of grades 1 and 2 in leucocytes and thrombocytes, respectively. Six patients did not show any hematotoxicity during the 8 weeks after therapy. There was no relevant nephrotoxicity (grade 3 or 4). Conclusions Our initial results indicate that RLT with Lu-PSMA is safe and seems to have low early side-effect profile. A relevant PSA decline was detected in 70 % of patients.
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Affiliation(s)
- Hojjat Ahmadzadehfar
- Department of Nuclear Medicine, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany,
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Nuclear medicine and the emergency department patient: an illustrative case-based approach. Radiol Med 2014; 120:158-70. [PMID: 25115293 DOI: 10.1007/s11547-014-0451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/16/2014] [Indexed: 12/07/2022]
Abstract
Radiologists are familiar with the use of radiographs, computed tomography, magnetic resonance imaging and ultrasound in the acute clinical setting. However, there are some specific clinical scenarios which may be found in nuclear medicine imaging problem-solving tools. These clinical scenarios and imaging techniques are less frequent, and the referring clinician from the emergency department may not consider these alternatives. It is important for the radiologist to be aware of these techniques to be able to guide the clinician to use those tools, which may result in optimal patient care. In this article, we will discuss those nuclear medicine studies which have application in the setting of an emergency radiology practice.
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Jain R, Sharma A, Uliel L, Mellnick V, McConathy J. An overview of nuclear medicine studies for urgent and emergent indications. Semin Roentgenol 2014; 49:210-24. [PMID: 24836495 DOI: 10.1053/j.ro.2014.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rashmi Jain
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Akash Sharma
- Mallinckrodt Institute of Radiology, St. Louis, MO
| | - Livnat Uliel
- Mallinckrodt Institute of Radiology, St. Louis, MO
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Uliel L, Mellnick VM, Menias CO, Holz AL, McConathy J. Nuclear Medicine in the Acute Clinical Setting: Indications, Imaging Findings, and Potential Pitfalls. Radiographics 2013; 33:375-96. [DOI: 10.1148/rg.332125098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sicca complex among Egyptian patients with chronic hepatitis C virus infection. Clin Rheumatol 2011; 30:1299-304. [DOI: 10.1007/s10067-011-1746-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/25/2011] [Accepted: 04/01/2011] [Indexed: 01/27/2023]
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Abstract
OBJECTIVE To determine the reliability and safety of the apneic oxygenation test to diagnose brain death for the purpose of organ donation. DATE SOURCES Published scientific literature in Medline database, organ donation guidelines and neurophysiological principles described in medical textbooks. STUDY SELECTION Articles on brain death, apnea testing, and radionuclide scintigraphy. DATA EXTRACTION AND SYNTHESIS Hypercarbia with a target Paco2 of 60 mm Hg (8.0 kPa) must be reached before apnea is deemed consistent with brain death in some clinical guidelines, whereas a level of 50 mm Hg (6.7 kPa) is required in another. However, the sensitivity and specificity of the test are doubtful because some patients have commenced spontaneous respiration >60 mm Hg (8.0 kPa) and high levels of Paco2 may cause CO2 narcosis. Furthermore, the test may be harmful if the brain stem is responsive because hypercarbia may also cause intracranial hypertension and contribute to brain damage. Although guidelines for organ donation recommend the test as an essential component of brain death diagnosis, it is often not performed or performed inadequately. Wide variation in conduct of the test has prompted calls for standardization. CONCLUSIONS : The apneic oxygenation test is unreliable in the diagnosis of brain death. It is scientifically flawed and hypothesized to cause brain death. In lieu of this test, a reliable test of brain perfusion should be mandatory, whereas the apneic oxygenation test, if performed at all, should be restricted to demonstration of apnea after brain perfusion has been shown to be absent.
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Jiménez-Heffernan A, Gómez-Millán J, Sánchez De Mora E, Delgado Moreno J, Delgado Gil MM, Salgado C, Contreras Puertas P, Bermúdez Morales MC, López J, Paz Expósito J. [Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2010; 29:165-171. [PMID: 20462671 DOI: 10.1016/j.remn.2010.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/22/2010] [Accepted: 02/24/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT). MATERIAL AND METHODS We studied 19 patients (17 men), mean age 62.4 years (44-75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7 MBq/kg of (99m)Tc-pertechnetate with lemon juice at the end of minute 15. Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG. RESULTS EF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05). CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters. CONCLUSIONS EF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time.
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Affiliation(s)
- A Jiménez-Heffernan
- Unidad de Gestión Clínica de Diagnóstico por la Imagen, Hospital Juan Ramón Jiménez, Huelva, España.
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