Ureter Metastasis From Colorectal Cancer Revealed on 18 F-FDG PET/CT

ABSTRACT

The involvement of the ureter as a site of metastasis of colorectal cancer is quite rare. Here we present FDG PET/CT findings of the right ureter metastasis from colon cancer in a patient after colectomy 6 years ago. 18 F-FDG PET/CT showed increased 18 F-FDG uptake in the right ureter with SUV max of 4.3. The pathology and immunohistochemistry confirmed the diagnosis of ureter metastasis from colon cancer.

The Xiangya equation could not replace the Asian modified CKD-EPI equation in estimating glomerular filtration rate in Chinese patients with chronic kidney disease

BACKGROUND

To evaluate the clinical practicability of the Xiangya equation in estimating glomerular filtration rate (GFR) and compare with the Asian modified Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation, assessing whether the Xiangya equation could replace the Asian modified CKD-EPI equation as the preferred method for predicting GFR in the Chinese CKD patients in an external validation study.

METHODS

The GFR was determined simultaneously by two methods: (a) the Asian modified CKD-EPI equation (GFR_CKD-EPI); (b) the Xiangya equation (GFR_Xiangya); diagnostic performance of the two models was compared by the regression analysis, the Bland-Altman plot, bias, precision and P₃₀ under the background of ^99mTc-diethylenetriaminepentaacetic acid (^99mTc-DTPA) dual plasma sample clearance method as reference method for GFR measurement (mGFR).

RESULTS

A total of 158 Chinese CKD patients were included in our external study. The GFR_Xiangya was highly related with mGFR, with the correlation coefficient of 0.92. The regression equation was GFR_Xiangya = 0.55*mGFR + 28.25, where the regression coefficient was far away from one and the intercept was wide. Compared with the Asian modified CKD-EPI equation, the performance of the Xiangya equation demonstrated a poorer bias (9.5 vs - 3.3 ml/min/1.73 m², P < 0.001), an inferior precision (23.9 vs 13.0 ml/min/1.73 m², P < 0.001), a lower P₃₀ (51.3% vs 73.4%, P < 0.001) and a wider 95% limit of agreement in Bland-Altman analysis (65.0 vs 44.9 ml/min/1.73 m²).

CONCLUSION

Due to relatively inferior performance, the Xiangya equation could not replace the Asian modified CKD-EPI equation in estimating GFR in Chinese patients with chronic kidney disease in our external cohort.

Multiple Primary Osseous B-Lymphoblastic Lymphoma/Leukemia Shown on Bone Scintigraphy

ABSTRACT

Primary osseous B-lymphoblastic lymphoma/leukemia is very rare, especially multiple bones involved. Herein, we reported the bone scintigraphy findings in a 16-year-old adolescent boy with a 20-day history of right thigh pain caused by B-lymphoblastic lymphoma/leukemia. Multiple abnormal MDP-avid foci were noted on 99mTc-MDP bone scintigraphy. Interestingly, the CT images of corresponding lesions were unrevealing. Finally, the B-lymphoblastic lymphoma/leukemia was confirmed by pathology and immunohistochemistry.

Validation of the full-age spectrum equation in the approximation of glomerular filtration rate in Chinese patients with chronic kidney disease

Introduction: To investigate the validity of the full age spectrum (FAS) equation in determining the glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and to compare the performance of FAS equation and the technetium-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) renal dynamic imaging method. Methods: The GFR was determined by three methods in the same day: (a) Tc-99m-DTPA dual plasma sample clearance method (mGFR); (b) FAS equation (eGFR1); (c) Tc-99m-DTPA renal dynamic imaging method (eGFR2). The mGFR was used as the reference standard. The Bland-Altman method, concordance correlation coefficient and regression equation were applied to evaluate the validity of the estimated glomerular filtration rate (eGFR). The bias, precision and accuracy were analyzed to compare the performances of eGFR1 and eGFR2. Results: A total of 162 subjects were enrolled in this study. The eGFR1 was correlated well with mGFR (concordance correlation coefficient was 0.896, p < 0.0001) and the regression equation was mGFR = -0.374 + 1.029eGFR1 (p < 0001). The Bland-Altman analysis proved good agreement between the eGFR1 and mGFR. In comparison with eGFR2, the eGFR1 showed better performance on bias (-1.22 vs. 8.92, p < 0001), precision (15.69 vs. 18.36, p  =  0.047) and 30% accuracy (75.31% vs. 59.26%, p  =  0.0009) in all participants. Conclusions: The FAS equation is valid in determining the glomerular filtration rate in Chinese patients with chronic kidney disease. The Tc-99m-DTPA renal dynamic imaging method is less accurate than the FAS equation and cannot be employed as the reference method in assessing the performance of FAS equation.

Clinical value of 99Tcm-MIBI gated myocardial perfusion imaging in evaluating sarcoglycanopathy

AIM

The purpose of this study was to analyse the diagnostic value of gated myocardial perfusion imaging (G-MPI) in the evaluation of myocardial injury in sarcoglycanopathy.

MATERIALS AND METHODS

Twenty-eight patients diagnosed with sarcoglycanopathy were evaluated using 99m- -methoxyisobutylisonitrile(99Tcm-MIBI) G-MPI. The data was processed into tomographic images, and the left ventricular function was analysed using quantitative gated SPECT (QGS) to assess the degree of impairment in myocardial and cardiac function.

RESULTS

The images of 23 of the patients (82.1%) were positive. Two hundred and twenty-nine sub-segments with abnormal lesions were detected out of 391 cardiac sub-segments of these 23 positive cases. According to the segmental abnormalities, the cases were divided into two cases (8.7%) with single abnormal wall segment, six cases (26.1%) with two abnormal wall segments, and 15 cases (65.2%) with three or more abnormal wall segments or scattered lesions.

CONCLUSIONS

99Tcm-MIBI G-MPI can objectively show impaired myocardium in patients with sarcoglycanopathy. Therefore, this method is helpful for early diagnosis and follow-up of myocardial damage.

Incidental bone metastases identified by renal dynamic scintigraphy: A case report

INTRODUCTION

The Technetium-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) renal dynamic scintigraphy is widely used to evaluate the split renal function and continuously demonstrate the whole urinary collecting system. Furthermore, the extrarenal uptake of technetium-99m DTPA can provide useful information for the patients.

CASE PRESENTATION

We described a 72-year-old male with a history of flank pain for 8 months and gross hematuria for 3 days. The technetium-99m diethylenetriaminepenta-acetic acid (DTPA) renal dynamic scintigraphy was performed to evaluate the split renal function. Unexpectedly, there were 2 foci of abnormal increased tracer uptake in the midline of the abdomen. The diagnosis of renal cancer was made on the basis of the imaging characteristics on the ultrasonography. The 2 foci with elevated DTPA activity were consistent with bone metastases on the images of computed tomography and magnetic resonance.

CONCLUSION

The bone metastasis is one of the etiologies of the extrarenal uptake of technetium-99m DTPA, especially for the patients with several foci.

Evaluation of hyperbaric oxygen effects on slow coronary flow patients using gated myocardial perfusion imaging tomography

Hyperbaric oxygen (HBO2) is widely used in clinical settings for many disease treatments. To investigate the potential effects of hyperbaric oxygen on patients with slow coronary flow (SCF) we retrospectively analyzed 98 patients who were diagnosed with SCF by coronary artery angiography. Of these, 50 patients received conventional treatment only (control group; the other 48 patients received hyperbaric oxygen treatment for four weeks in addition to the routine therapy (HBO2 group). By using gated myocardial perfusion tomography examination before and after treatment, we observed that 71 out of 148 (47.9%) subsegments of injured myocardium improved in the control group, while 108 out of 151 (71.5%) subsegments of injured myocardium improved in the HBO2 group (P ⟨ 0.05). Furthermore, the peak filling rate (PFR), time of peak filling rate (TPFR) and mean filling rate during the first one-third of the filling time (MFR/3) were all significantly improved in HBO2-treated patients compared to those who received conventional treatment only. However, we did not detect any significant effects of only treatment on left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), nor on left ventricular ejection fraction (LVEF). Our results indicate that hyperbaric oxygen therapy can be a beneficial and effective medication to improve myocardial perfusion and left ventricular diastolic function in SCF patients.

Incidentally polycystic kidney disease identified by SPECT/CT with post-therapy radioiodine scintigraphy in a patient with differentiated thyroid carcinoma: A case report

RATIONALE

Post-therapy or diagnostic whole-body radioiodine scintigraphy is widely employed to evaluate the residual, recurrence, or metastases of differentiated thyroid carcinoma because of the high sensitivity and accuracy. However, it has pitfalls.

PATIENT CONCERNS

We described a 63-year-old male with a history of papillary thyroid carcinoma who was referred for iodine-131 ablation therapy. The post-therapy iodine-131 whole-body images demonstrated abnormal increased uptake of the tracer in the regions of bilateral upper abdomen.

DIAGNOSES

The single photon emission computed tomography/computed tomography (SPECT/CT) showed the abnormal Iactivity was corresponded to multiple irregular cystic low densities in the both kidneys on the low-dose computed tomography images, so the diagnosis of polycystic kidney disease was confirmed.

INTERVENTIONS AND OUTCOMES

The patient responded well to the lifestyle-based treatments.

LESSONS

Polycystic kidney disease was one of the etiologies of the false-positive findings in the radioiodine scintigraphy.

Camurati-Engelmann disease-a rare cause of tetany identified on bone scintigraphy: A case report

RATIONALE

Camurati-Engelmann disease (i.e., progressive diaphyseal dysplasia) is an extremely rare autosomal dominant bone disorder. The most common clinical manifestations were chronic skeletal pain, waddling gait, muscular weakness.

PATIENT CONCERNS

We described that a 27-year-old male with a 1-year history of intermittent tetany was referred for bone scintigraphy. The whole body bone scan images showed abnormal increased uptake of the tracer in the long bones of the upper and lower extremities as well as in the skull.

DIAGNOSES

Combined the family history, the findings of the images and the genetic study, the diagnosis of Camurati-Engelmann disease was confirmed.

INTERVENTIONS AND OUTCOMES

The patient responded well to the treatment of calcium gluconate.

LESSONS

Bone scintigraphy would be helpful in the diagnosis and assessing the severity of Camurati-Engelmann disease.

Iodine-131: An Effective Method for Treating Lymph Node Metastases of Differentiated Thyroid Cancer

Background

The aim of this study was to assess the efficacy of radioactive iodine-131 (¹³¹I) therapy for lymph node metastasis of differentiated thyroid cancer (DTC) and to identify influential factors using univariate and multivariate analyses to determine if identified factors influence the efficacy of treatment.

Material/Methods

This study included a retrospective review of 218 patients with histologically proven DTC in the post-operation stage. After thyroid tissue remnants were eliminated with ¹³¹I therapy, patients’ lymph node status was confirmed by ultrasound and by ¹³¹I whole body scan regarding lymph node metastasis, and then patients were treated with ¹³¹I as appropriate. The treatment efficacy was assessed and possible influencing factors were identified using univariate and multivariate analyses.

Results

The total effective rate of ¹³¹I therapy was 88.07% (including a cure rate of 20.64% and an improvement rate of 67.43%). The non-effective rate was 11.93%. Of the total 406 lymph nodes of 218 patients, 319 lymph nodes (78.57%) were judged to be effectively cured, including 133 (32.75%) lymph nodes that were totally eliminated and 186 (45.82%) lymph nodes that shrank. Eighty-seven (21.43%) of the 406 lymph nodes had no obvious change. No lymph nodes were found to be in a continuously enlarging state. Distant metastasis, size of lymph node, human serum thyroglobulin (HTG) level, and condition of thyroid remnants ablation were identified as the independent factors influencing the efficacy of treatment using univariate and multivariate analyses.

Conclusions

The use of ¹³¹I is a promising treatment for lymph node metastasis of DCT. Distant metastasis, size of lymph nodes, HTG level, and condition of thyroid remnant ablation were independent factors influencing the treatment efficacy.

The new Asian modified CKD-EPI equation leads to more accurate GFR estimation in Chinese patients with CKD

OBJECTIVE

To verify whether the new Asian modified CKD-EPI equation improved the performance of original one in determining GFR in Chinese patients with CKD.

METHOD

A well-designed paired cohort was set up. Measured GFR (mGFR) was the result of ^99mTc-diethylene triamine pentaacetic acid (^99mTc-DTPA) dual plasma sample clearance method. The estimated GFR (eGFR) was the result of the CKD-EPI equation (eGFR1) and the new Asian modified CKD-EPI equation (eGFR2). The comparisons were performed to evaluate the superiority of the eGFR2 in bias, accuracy, precision, concordance correlation coefficient and the slope of regression equation and measure agreement.

RESULTS

A total of 195 patients were enrolled and analyzed. The new Asian modified CKD-EPI equation improved the performance of the original one in bias and accuracy. However, nearly identical performance was observed in the respect of precision, concordance correlation coefficient, slope of eGFR against mGFR and 95 % limit of agreement. In the subgroup of GFR < 60 mL min^-1/1.73 m², the bias of eGFR1 was less than eGFR2 but they have comparable precision and accuracy. In the subgroup of GFR > 60 mL min^-1/1.73 m², eGFR2 performed better than eGFR1 in terms of bias and accuracy.

CONCLUSION

The new Asian modified CKD-EPI equation can lead to more accurate GFR estimation in Chinese patients with CKD in general practice, especially in the higher GFR group.

The new Asian modified CKD-EPI equation leads to more accurate GFR estimation in Chinese patients with CKD

OBJECTIVE

To verify whether the new Asian modified CKD-EPI equation improved the performance of original one in determining GFR in Chinese patients with CKD.

METHOD

A well-designed paired cohort was set up. Measured GFR (mGFR) was the result of ^99mTc-diethylene triamine pentaacetic acid (^99mTc-DTPA) dual plasma sample clearance method. The estimated GFR (eGFR) was the result of the CKD-EPI equation (eGFR1) and the new Asian modified CKD-EPI equation (eGFR2). The comparisons were performed to evaluate the superiority of the eGFR2 in bias, accuracy, precision, concordance correlation coefficient and the slope of regression equation and measure agreement.

RESULTS

A total of 195 patients were enrolled and analyzed. The new Asian modified CKD-EPI equation improved the performance of the original one in bias and accuracy. However, nearly identical performance was observed in the respect of precision, concordance correlation coefficient, slope of eGFR against mGFR and 95 % limit of agreement. In the subgroup of GFR < 60 mL min^-1/1.73 m², the bias of eGFR1 was less than eGFR2 but they have comparable precision and accuracy. In the subgroup of GFR > 60 mL min^-1/1.73 m², eGFR2 performed better than eGFR1 in terms of bias and accuracy.

CONCLUSION

The new Asian modified CKD-EPI equation can lead to more accurate GFR estimation in Chinese patients with CKD in general practice, especially in the higher GFR group.

Early myocardial damage assessment in dystrophinopathies using (99)Tc(m)-MIBI gated myocardial perfusion imaging

Background

Early detection of muscular dystrophy (MD)-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (⁹⁹Tc^m-MIBI) gated myocardial perfusion imaging (G-MPI) for MD.

Methods and results

Ninety-one patients underwent ⁹⁹Tc^m-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD) (n=77) or Becker muscular dystrophy (BMD; n=14). ⁹⁹Tc^m-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using ⁹⁹Tc^m-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (r_s=0.534 [P<0.05] and r_s=0.784 [P<0.05], respectively). Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05), but not in BMD patients.

Conclusion

⁹⁹Tc^m-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD, and can serve as a candidate method for the evaluation of progression, prognosis, and assessment of the effect of glucocorticoid treatment in these patients.