1
|
Gunther RS, Farrell MB, Banks KP. Got the Munchies for an Egg Sandwich? The Effects of Cannabis on Bowel Motility and Beyond. J Nucl Med Technol 2024; 52:8-14. [PMID: 38443102 PMCID: PMC10924153 DOI: 10.2967/jnmt.123.266816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/11/2023] [Indexed: 03/07/2024] Open
Abstract
The use of medicinal cannabis has a long history dating back thousands of years. Recent discoveries have shed light on its mechanism of action with the identification of cannabinoid receptors and endocannabinoids, which make up the body's endocannabinoid system. Cannabinoid receptors, particularly the cannabinoid 1 and 2 receptors, play a crucial role in modulating the gut-brain axis and serve as potential therapeutic targets for gastrointestinal motility and inflammatory disorders. With increasing legalization of cannabis and a rising number of users, understanding the effects of cannabis on gut motility is essential for nuclear medicine providers. Although tetrahydrocannabinol, the principal psychoactive constituent of cannabis, may decrease gut motility in experimental settings, it appears to paradoxically improve symptoms in gastroparesis. Treatment effects are difficult to measure given the large number of variables that could significantly alter outcomes, such as cannabinoid type, potency, and route of intake. Another consideration is the highly personalized gut microbiome, which directly interacts with the endocannabinoid system. Further research is required to delineate these multifaceted, complex cannabinoid interactions. The goal of this article is to explore the knowns and unknowns of the impact of cannabis on the alimentary system.
Collapse
Affiliation(s)
- Rutger S Gunther
- Uniformed Services University of the Health Sciences, Bethesda, Maryland;
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; and
| | - Mary B Farrell
- Intersocietal Accreditation Commission, Ellicott City, Maryland
| | - Kevin P Banks
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas; and
| |
Collapse
|
2
|
Gunther RS, Banks KP, McWhorter NE. Universal Fasting Glucose Screening Before Gastric Emptying Scintigraphy and the High Prevalence of Undiagnosed Diabetes and Prediabetes. J Nucl Med Technol 2024; 52:52-54. [PMID: 38443110 PMCID: PMC10924154 DOI: 10.2967/jnmt.123.266808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/05/2024] [Indexed: 03/07/2024] Open
Abstract
The aim of this study was to assess the rates of undiagnosed diabetes mellitus (DM) and pre-DM in patients undergoing gastric emptying scintigraphy (GES). Diabetes is an epidemic in the United States, and the disease is associated with altered gut motility. As a result, we suspected that a significant number of patients referred for GES may have undiagnosed DM or pre-DM. Given that established procedure standards for GES require all patients to prepare with an 8-h fast, an opportunity is provided to measure the fasting blood glucose (FBG) in all individuals before they undergo the examination. Methods: The charts of patients undergoing GES were reviewed for a history of DM and correlated with FBG and GES results. FBG values, obtained by point-of-care testing, were categorized as normal, pre-DM, or DM. Results: Patients with known DM made up 23% of those referred for GES, and most (55%) had a normal FBG. In those without a history of DM, there were a significant number with undiagnosed pre-DM (12%) and DM (33%). Conclusion: Our study provides the first measure of the likely prevalence of undiagnosed DM and pre-DM and characterizes the different gastric emptying patterns among patients with normal FBG, likely undiagnosed pre-DM, likely undiagnosed DM, and known DM.
Collapse
Affiliation(s)
- Rutger S Gunther
- Nuclear Medicine Service, Department of Radiology, San Antonio Military Medical Center, San Antonio, Texas; and Uniformed Services University, Bethesda, Maryland
| | - Kevin P Banks
- Nuclear Medicine Service, Department of Radiology, San Antonio Military Medical Center, San Antonio, Texas; and Uniformed Services University, Bethesda, Maryland
| | - Nathan E McWhorter
- Nuclear Medicine Service, Department of Radiology, San Antonio Military Medical Center, San Antonio, Texas; and Uniformed Services University, Bethesda, Maryland
| |
Collapse
|
3
|
Wood CA, Gunther RS, O'Gorman KJ, Kelly F, Lisanti CJ. An Intramyocardial Lipoma Mimicking Post-infarction Fatty Changes: Discussion of Key Distinguishing Imaging Findings and Clinical Implications. Cureus 2023; 15:e46955. [PMID: 38022295 PMCID: PMC10640719 DOI: 10.7759/cureus.46955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiac lipomas are benign primary cardiac tumors that are most often asymptomatic and diagnosed incidentally. Cardiac magnetic resonance imaging (MRI) is the imaging modality of choice when aiming to characterize these tumors. A minority of cardiac lipomas are intramyocardial, which, when combined with the much more common post-infarction fatty metaplasia, makes diagnosing these lipomas very challenging. We review a case of intramyocardial lipoma in the distal interventricular septum that was initially detected on a low-dose computed tomography for lung cancer screening and the subsequent findings on cardiac MRI that made the diagnosis. Additionally, this case also helps to support the conservative management of intramyocardial lipomas that are more distal in the left ventricle and subsequently at lower risk for conduction arrhythmias.
Collapse
Affiliation(s)
- Charles A Wood
- Radiology, New York Institute of Technology College of Osteopathic Medicine at Arkansas State, Jonesboro, USA
| | - Rutger S Gunther
- Nuclear Medicine/Radiology, Brooke Army Medical Center, Fort Sam Houston, USA
| | | | - Faith Kelly
- Cardiology, Brooke Army Medical Center, Fort Sam Houston, USA
- Cardiology, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Christopher J Lisanti
- Radiology, Brooke Army Medical Center, Fort Sam Houston, USA
- Radiology, Uniformed Services University of the Health Sciences, Bethesda, USA
| |
Collapse
|
4
|
Banks KP, Farrell MB, Gunther RS, McWhorter NE, Byerly DW, Peacock JG. Improving DXA Quality by Avoiding Common Technical and Diagnostic Pitfalls: Part 1. J Nucl Med Technol 2023; 51:167-175. [PMID: 36195442 DOI: 10.2967/jnmt.122.264885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Dual-energy x-ray absorptiometry (DXA) is an accurate means to assess bone mineral density, determine the risk of a fragility fracture, and monitor response to therapy. Despite its seemingly straightforward nature-the review of 2-to-3 nondiagnostic images and a few automatically generated numbers-the proper performance and interpretation of DXA can often be complex. It is complex because it is highly dependent on many factors, such as image acquisition, processing, analysis, and subsequent examination interpretation. Each step is subject to potential errors, artifacts, and diagnostic pitfalls; hence, meticulous attention must be paid to the technique by both the technologist and the interpreting physician to provide high-quality results and, in turn, maximize the examination's clinical utility. This article is part 1 of a 2-part series. Part 1 will begin with a review of bone physiology and osteoporosis etiology, followed by a discussion of the principles underlying DXA and the technical procedure. Part 2 will focus on DXA interpretation and discuss scanning pitfalls and clues to recognizing issues and improving scan quality.
Collapse
Affiliation(s)
- Kevin P Banks
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | | | - Rutger S Gunther
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
| | - Nathan E McWhorter
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | - Doug W Byerly
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | - Justin G Peacock
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| |
Collapse
|
5
|
Shen-Gunther J, Gunther RS, Cai H, Wang Y. A Customized Human Mitochondrial DNA Database (hMITO DB v1.0) for Rapid Sequence Analysis, Haplotyping and Geo-Mapping. Int J Mol Sci 2023; 24:13505. [PMID: 37686313 PMCID: PMC10488239 DOI: 10.3390/ijms241713505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
The field of mitochondrial genomics has advanced rapidly and has revolutionized disciplines such as molecular anthropology, population genetics, and medical genetics/oncogenetics. However, mtDNA next-generation sequencing (NGS) analysis for matrilineal haplotyping and phylogeographic inference remains hindered by the lack of a consolidated mitogenome database and an efficient bioinformatics pipeline. To address this, we developed a customized human mitogenome database (hMITO DB) embedded in a CLC Genomics workflow for read mapping, variant analysis, haplotyping, and geo-mapping. The database was constructed from 4286 mitogenomes. The macro-haplogroup (A to Z) distribution and representative phylogenetic tree were found to be consistent with published literature. The hMITO DB automated workflow was tested using mtDNA-NGS sequences derived from Pap smears and cervical cancer cell lines. The auto-generated read mapping, variants track, and table of haplotypes and geo-origins were completed in 15 min for 47 samples. The mtDNA workflow proved to be a rapid, efficient, and accurate means of sequence analysis for translational mitogenomics.
Collapse
Affiliation(s)
- Jane Shen-Gunther
- Gynecologic Oncology & Clinical Investigation, Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA
| | - Rutger S. Gunther
- Nuclear Medicine & Molecular Imaging, Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX 78234, USA;
| | - Hong Cai
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Yufeng Wang
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, TX 78249, USA
| |
Collapse
|
6
|
Banks KP, Gunther RS, Farrell MB, Peacock JG, Costello M, Gordon LL. U.S. Diagnostic Reference Levels and Achievable Administered Activities for Adult Renal Scintigraphy: An Analysis of the Intersocietal Accreditation Committee Nuclear Laboratories. J Nucl Med Technol 2021; 49:246-249. [PMID: 33820862 DOI: 10.2967/jnmt.120.261552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
The goal of this work was to determine U.S. diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult renal scintigraphy. Methods: Under an Institutional Review Board-approved protocol, data were collected from the Intersocietal Accreditation Commission during one 3-y accreditation cycle encompassing 110 facilities. Elements included radiopharmaceutical, administered activity, practice type, and examination volume. DRLs and AAAs were calculated and compared with non-U.S. values and societal recommendations as available. Results: Ninety-three facilities provided data on 99mTc-mercaptoacetyltriglycine (99mTc-MAG3), and 15 provided data on 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) for adult renal scintigraphy exams. Analysis demonstrated a DRL of 392.2 MBq (10.6 mCi) for 99mTc-MAG3 and 531.7 MBq (14.4 mCi) for 99mTc-DTPA, with an AAA of 370 MBq (10 mCi) for 99mTc-MAG3 and 445.9 MBq (12.1 mCi) for 99mTc-DTPA. Conclusion: The resultant calculated novel U.S. DRLs and AAAs may serve as benchmarks that nuclear medicine facilities may use to refine renal scintigraphy protocols, reduce patient doses, and potentially guide future societal guideline recommendations.
Collapse
Affiliation(s)
- Kevin P Banks
- U.S. Army Brooke Army Medical Center, San Antonio, Texas;
| | | | - Mary B Farrell
- Intersocietal Accreditation Commission, Ellicott City, Maryland; and
| | | | - Maria Costello
- Intersocietal Accreditation Commission, Ellicott City, Maryland; and
| | - Leonie L Gordon
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
7
|
Clutter CA, Gunther RS, Tate JM. Visual Vignette. Endocr Pract 2019; 25:1235. [PMID: 30865524 DOI: 10.4158/ep-2019-0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Courtney A Clutter
- From the Division of Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Rutger S Gunther
- Division of Radiology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Joshua M Tate
- Division of Endocrinology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| |
Collapse
|