The Value of SPECT-CT in Diagnosing Complex Non-Arthritic and Non-Neoplastic Conditions of the Foot and Ankle

2021 ◽  
pp. 193864002110624
Author(s):  
Yaser Ghani ◽  
Ali-Asgar Najefi ◽  
Alessio Bernasconi ◽  
Matthew Welck ◽  
Nick Cullen ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Treatment Plan ◽  
Photon Emission ◽  
Added Value ◽  
Successful Outcome ◽  
Conventional Imaging ◽  
Foot And Ankle ◽  
Ct Diagnosis ◽  
Provisional Diagnosis ◽  
Diagnostic Uncertainty

Introduction: There is little information on the value of using single photon emission computerized tomography–computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified. The aim of this study was to evaluate the value of SPECT-CT in a cohort of patients with complex F&A pathology, in whom diagnostic uncertainty existed after conventional imaging techniques, and to assess its added value in routine clinical practice. Methodology: A retrospective analysis of 297 SPECT-CTs from 2010 to 2017 found 18 SPECT-CTs (age = 16-56 years) performed for non-arthritic F&A pathology. Changes in diagnosis, management, and clinical outcome scores were recorded before and after SPECT-CT imaging. Results: The results demonstrated that the provisional diagnosis was different from the SPECT-CT diagnosis in 10 (56%) out of the 18 patients and led to a modified treatment plan, which was successful in 8 (80%) out of the 10 patients. The post-intervention Manchester Oxford Foot Questionnaire (MOX-FQ) and Visual Analogue Scale (VAS) score improved from 76 ± 18 to 58 ± 24 ( P = .02), and from 72 ± 17 to 49 ± 32 ( P = .01), respectively. The SPECT-CT scan was useful in confirming the provisional diagnosis in the remaining 8 patients where a diagnostic uncertainty existed after conventional imaging techniques. Overall, a total of 15 out of 18 patients (83%) showed an improvement in their symptoms after management led by SPECT-CT diagnosis. Conclusion: Our study highlights the added value of SPECT-CT in patients presenting with non-arthritic and non-neoplastic F&A conditions in which there is diagnostic uncertainty after conventional imaging. In 80% of cases, a change in management driven by the SPECT-CT findings led to a successful outcome. We have found SPECT-CT to be a useful investigative modality in assessing these complex F&A cases. Levels of Evidence: Level IV

scholarly journals The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements

2020 ◽  
Vol 9 (8) ◽  
pp. 2548 ◽  
Author(s):  
Carlo Luca Romanò ◽  
Nicola Petrosillo ◽  
Giuseppe Argento ◽  
Luca Maria Sconfienza ◽  
Giorgio Treglia ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Imaging Techniques ◽  
Joint Infection ◽  
Photon Emission ◽  
Clinical Signs ◽  
Added Value ◽  
Emission Tomography ◽  
Pet Ct ◽  
Consensus Statements

Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques—X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems—single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.

Evaluating and Managing the Painful Total Ankle Replacement

2021 ◽  
pp. 107110072110272
Author(s):  
Jensen K. Henry ◽  
Carson Rider ◽  
Elizabeth Cody ◽  
Scott J. Ellis ◽  
Constantine Demetracopoulos
Keyword(s):  
Single Photon ◽  
Imaging Techniques ◽  
Nerve Repair ◽  
Photon Emission ◽  
The United States ◽  
Implant Design ◽  
Emission Computed Tomography ◽  
Foot And Ankle ◽  
Contributing Factors ◽  
Level Of Evidence

The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.

Preoperative localization of parathyroid glands

2004 ◽  
Vol 43 (03) ◽  
pp. 85-90 ◽  
Author(s):  
E. Lopez Hänninen ◽  
Th. Steinmüller ◽  
T. Rohlfing ◽  
H. Bertram ◽  
M. Gutberlet ◽  
...  
Keyword(s):  
Image Fusion ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Mri Findings ◽  
99Mtc Mibi ◽  
Weighted Sequences ◽  
Mibi Scintigraphy

Summary Aim: Minimally invasive resection of hyperfunctional parathyroid glands is an alternative to open surgery. However, it requires a precise preoperative localization. This study evaluated the diagnostic use of magnetic resonance (MR) imaging, parathyroid scintigraphy, and consecutive image fusion. Patients, methods: 17 patients (9 women, 8 men; age: 29-72 years; mean: 51.2 years) with primary hyperparathyroidism were included. Examination by MRI used unenhanced T1- and T2-weighted sequences as well as contrast-enhanced T1-weighted sequences. 99mTc-MIBI scintigraphy consisted of planar and SPECT (single photon emission tomography) imaging techniques. In order to improve the anatomical localization of a scintigraphic focus, SPECT-data were fused with the corresponding MR-data using a modified version of the Express 5.0 software (Advanced Visual Systems, Waltham, MA). Results of image fusion were then compared to histopathology. Results: In 14/17 patients, a single parathyroid adenoma was found. There were 3 cases with hyperplastic glands. MRI detected 10 (71%), scintigraphy 12 (86%) adenomas. Both modalities detected 1/3 patients with hyperplasia. Image fusion improved the anatomical assignment of the 13 scintigraphic foci in five patients and was helpful in the interpretation of inconclusive MR-findings in two patients. Conclusions: Both MRI and 99mTc-MIBI scintigraphy sensitively detect parathyroid adenomas but are less reliable in case of hyperplastic glands. In case of a scintigraphic focus, image fusion considerably improves its topographic assignment. Furthermore, it facilitates the evaluation of inconclusive MRI findings.

Clinical Implications of the Center of Balance for a Veteran with Traumatic Brain Injury

2015 ◽  
pp. 280-289
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Benign Paroxysmal Positional Vertigo ◽  
Medical Center ◽  
Treatment Plan ◽  
Successful Outcome ◽  
Model Case ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: It is known that traumatic brain injury (TBI), even of the mild variety, can cause diffuse multisystem neurological damage. Coordination of sensory input from the visual, vestibular and somatosensory pathways is important to obtain proper balance and stabilization in the visual environment. This coordination of systems is potentially disrupted in TBI leading to visual symptoms and complaints of dizziness and imbalance. The Center of Balance (COB) at the Northport Veterans Affairs Medical Center (VAMC) is an interprofessional clinic specifically designed for patients with such complaints. An evaluation entails examination by an optometrist, audiologist and physical therapist and is concluded with a comprehensive rehabilitative treatment plan. The clinical construct will be described and a case report will be presented to demonstrate this unique model. Case Report: A combat veteran with a history of a gunshot wound to the skull, blunt force head trauma and exposure to multiple explosions presented with complaints of difficulty reading and recent onset dizziness. After thorough evaluation in the COB, the patient was diagnosed with and treated for severe oculomotor dysfunction and benign paroxysmal positional vertigo. Conclusion: Vision therapy was able to provide a successful outcome via improvement of oculomotor efficiency and control. Physical therapy intervention was able to address the benign paroxysmal positional vertigo. The specific evaluation and management as pertains to the aforementioned diagnoses, as well as the importance of an interprofessional rehabilitative approach, will be outlined.

scholarly journals Standardization of the [68Ga]Ga-PSMA-11 Radiolabeling Protocol in an Automatic Synthesis Module: Assessments for PET Imaging of Prostate Cancer

2021 ◽  
Vol 14 (5) ◽  
pp. 385
Author(s):  
Leonardo L. Fuscaldi ◽  
Danielle V. Sobral ◽  
Ana Claudia R. Durante ◽  
Fernanda F. Mendonça ◽  
Ana Cláudia C. Miranda ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Pet Imaging ◽  
Saline Solution ◽  
Serum Proteins ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Lncap Cells ◽  
Automatic Synthesis

Prostate-specific membrane antigen (PSMA) is a glycoprotein present in the prostate, that is overexpressed in prostate cancer (PCa). Recently, PSMA-directed radiopharmaceuticals have been developed, allowing the pinpointing of tumors with the Positron Emission Tomography (PET) or Single Photon Emission Computed Tomography (SPECT) imaging techniques. The aim of the present work was to standardize and validate an automatic synthesis module-based radiolabeling protocol for [68Ga]Ga-PSMA-11, as well as to produce a radiopharmaceutical for PET imaging of PCa malignancies. [68Ga]Ga-PSMA-11 was evaluated to determine the radiochemical purity (RCP), stability in saline solution and serum, lipophilicity, affinity to serum proteins, binding and internalization to lymph node carcinoma of the prostate (LNCaP) cells, and ex vivo biodistribution in mice. The radiopharmaceutical was produced with an RCP of 99.06 ± 0.10%, which was assessed with reversed-phase high-performance liquid chromatography (RP-HPLC). The product was stable in saline solution for up to 4 h (RCP > 98%) and in serum for up to 1 h (RCP > 95%). The lipophilicity was determined as −3.80 ± 0.15, while the serum protein binding (SPB) was <17%. The percentages of binding to LNCaP cells were 4.07 ± 0.51% (30 min) and 4.56 ± 0.46% (60 min), while 19.22 ± 2.73% (30 min) and 16.85 ± 1.34% (60 min) of bound material was internalized. High accumulation of [68Ga]Ga-PSMA-11 was observed in the kidneys, spleen, and tumor, with a tumor-to-contralateral-muscle ratio of >8.5 and a tumor-to-blood ratio of >3.5. In conclusion, an automatic synthesis module-based radiolabeling protocol for [68Ga]Ga-PSMA-11 was standardized and the product was evaluated, thus verifying its characteristics for PET imaging of PCa tumors in a clinical environment.

scholarly journals Treatment of nonmetastatic castration-resistant prostate cancer: focus on second-generation androgen receptor inhibitors

2021 ◽  
Author(s):  
Fred Saad ◽  
Martin Bögemann ◽  
Kazuhiro Suzuki ◽  
Neal Shore
Keyword(s):  
Prostate Cancer ◽  
Androgen Receptor ◽  
Second Generation ◽  
Imaging Techniques ◽  
Specific Antigen ◽  
Conventional Imaging ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Therapeutic Decisions ◽  
Consensus Statements

Abstract Background Nonmetastatic castration-resistant prostate cancer (nmCRPC) is defined as a rising prostate-specific antigen concentration, despite castrate levels of testosterone with ongoing androgen-deprivation therapy or orchiectomy, and no detectable metastases by conventional imaging. Patients with nmCRPC progress to metastatic disease and are at risk of developing cancer-related symptoms and morbidity, eventually dying of their disease. While patients with nmCRPC are generally asymptomatic from their disease, they are often older and have chronic comorbidities that require long-term concomitant medication. Therefore, careful consideration of the benefit–risk profile of potential treatments is required. Methods In this review, we will discuss the rationale for early treatment of patients with nmCRPC to delay metastatic progression and prolong survival, as well as the factors influencing this treatment decision. We will focus on oral pharmacotherapy with the second-generation androgen receptor inhibitors, apalutamide, enzalutamide, and darolutamide, and the importance of balancing the clinical benefit they offer with potential adverse events and the consequential impact on quality of life, physical capacity, and cognitive function. Results and conclusions While the definition of nmCRPC is well established, the advent of next-generation imaging techniques capable of detecting hitherto undetectable oligometastatic disease in patients with nmCRPC has fostered debate on the criteria that inform the management of these patients. However, despite these developments, published consensus statements have maintained that the absence of metastases on conventional imaging suffices to guide such therapeutic decisions. In addition, the prolonged metastasis-free survival and recently reported positive overall survival outcomes of the three second-generation androgen receptor inhibitors have provided further evidence for the early use of these agents in patients with nmCRPC in order to delay metastases and prolong survival. Here, we discuss the benefit–risk profiles of apalutamide, enzalutamide, and darolutamide based on the data available from their pivotal clinical trials in patients with nmCRPC.

Full-field X-ray diffraction microscopy using polymeric compound refractive lenses

2014 ◽  
Vol 47 (6) ◽  
pp. 1882-1888 ◽  
Author(s):  
J. Hilhorst ◽  
F. Marschall ◽  
T. N. Tran Thi ◽  
A. Last ◽  
T. U. Schülli
Keyword(s):  
Imaging Techniques ◽  
Light And Electron Microscopy ◽  
Added Value ◽  
Acquisition Time ◽  
Imaging Method ◽  
X Ray Diffraction ◽  
Polymeric Compound ◽  
Full Field ◽  
X Ray ◽  
Diffraction Imaging

Diffraction imaging is the science of imaging samples under diffraction conditions. Diffraction imaging techniques are well established in visible light and electron microscopy, and have also been widely employed in X-ray science in the form of X-ray topography. Over the past two decades, interest in X-ray diffraction imaging has taken flight and resulted in a wide variety of methods. This article discusses a new full-field imaging method, which uses polymer compound refractive lenses as a microscope objective to capture a diffracted X-ray beam coming from a large illuminated area on a sample. This produces an image of the diffracting parts of the sample on a camera. It is shown that this technique has added value in the field, owing to its high imaging speed, while being competitive in resolution and level of detail of obtained information. Using a model sample, it is shown that lattice tilts and strain in single crystals can be resolved simultaneously down to 10−3° and Δa/a= 10−5, respectively, with submicrometre resolution over an area of 100 × 100 µm and a total image acquisition time of less than 60 s.

Prediction of Recurrence after HCC Resection

1994 ◽  
Vol 35 (4) ◽  
pp. 329-334 ◽  
Author(s):  
M. Yamamoto ◽  
Y. Iimuro ◽  
M. Mogaki ◽  
K. Kachi ◽  
H. Fujii ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Tumor Vasculature ◽  
The Other ◽  
High Recurrence Rate ◽  
Small Hepatocellular Carcinoma ◽  
Conventional Imaging ◽  
Cumulative Survival ◽  
Preoperative Ct ◽  
Small Hcc ◽  
Better Than

In trying to clarify the high recurrence rate after removal of small hepatocellular carcinoma (HCC), we assessed the postoperative evolution of minute hepatic Lipiodol deposits which had been diagnosed as artifacts on the preoperative Lipiodol-CT. Of 27 patients with solitary HCC less than 5 cm in diameter, 14 had such Lipiodol deposits in the preoperative CT and 9 of them (64%) developed recurrent tumors. On the other hand, 6 of the 13 patients without deposits (46%) suffered recurrence, but in 5 of these 6 patients the HCC was metachronous multicentric. The cumulative survival rate of the non-deposit group was better than that of the deposit group (p < 0.1). The present study suggested that, even in patients with small HCC, minute concomitant tumors invisible by conventional imaging techniques may exist at the time of surgery. Some of these lesions without sufficient tumor vasculature showing a hypervascular blush on angiography appear to retain small, vague Lipiodol deposits.

scholarly journals Diabetes, Obesity, and Inflammation: Impact on Clinical and Radiographic Features of Breast Cancer

2021 ◽  
Vol 22 (5) ◽  
pp. 2757
Author(s):  
Braden Miller ◽  
Hunter Chalfant ◽  
Alexandra Thomas ◽  
Elizabeth Wellberg ◽  
Christina Henson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Imaging Techniques ◽  
Growth Factor Receptor ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Imaging Modalities ◽  
Conventional Imaging ◽  
Obese Women ◽  
Detection Rates ◽  
Therapeutic Decision Making

Obesity, diabetes, and inflammation increase the risk of breast cancer, the most common malignancy in women. One of the mainstays of breast cancer treatment and improving outcomes is early detection through imaging-based screening. There may be a role for individualized imaging strategies for patients with certain co-morbidities. Herein, we review the literature regarding the accuracy of conventional imaging modalities in obese and diabetic women, the potential role of anti-inflammatory agents to improve detection, and the novel molecular imaging techniques that may have a role for breast cancer screening in these patients. We demonstrate that with conventional imaging modalities, increased sensitivity often comes with a loss of specificity, resulting in unnecessary biopsies and overtreatment. Obese women have body size limitations that impair image quality, and diabetes increases the risk for dense breast tis-sue. Increased density is known to obscure the diagnosis of cancer on routine screening mammography. Novel molecu-lar imaging agents with targets such as estrogen receptor, human epidermal growth factor receptor 2 (HER2), pyrimi-dine analogues, and ligand-targeted receptor probes, among others, have potential to reduce false positive results. They can also improve detection rates with increased resolution and inform therapeutic decision making. These emerg-ing imaging techniques promise to improve breast cancer diagnosis in obese patients with diabetes who have dense breasts, but more work is needed to validate their clinical application.

Diagnostic Imaging Techniques

2017 ◽  
Author(s):  
Gerald W. Staton Jr ◽  
Phuong-Anh T. Duong
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Diagnostic Imaging ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Chest Radiographs ◽  
Medical Community ◽  
Multidetector Row Computed Tomography ◽  
Resonance Imaging

Chest imaging techniques are evolving with recent advances in computed tomography, magnetic resonance imaging, and ultrasonography. While conventional radiography remains an important screening tool because of its low relative cost, ease of acquisition, general availability, and familiarity, physicians must understand all techniques so as to provide patients with the most appropriate diagnostic imaging. Consultation with radiologists, use of online clinical decision support, and adherence to national guidelines such as the American College of Radiology Appropriateness Criteria®, can help clinicians make imaging decisions, especially in light of medical imaging risks that are of concern in the medical community and the general population. Choosing appropriate imaging, including whether or not to image, requires careful consideration. This review contains 6 figures, 3 tables, and 6 references. Key Words: Chest Radiographs, Dual-Energy Chest Radiographs, Computed Tomography, High-Resolution Chest Computed Tomography, Multidetector Row Computed Tomography, Computed Tomographic Angiography for Pulmonary Embolism, Magnetic Resonance Imaging, Single-Photon Emission Tomography (SPECT), Ultrasonography 

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