Scintigraphic Imaging Research Articles

Complete Remission of Renal Scarring in Follow-Up DMSA Renal Scintigraphy After Urinary Tract Infection.

Our study aimed to investigate the association between the characteristics of patients/images and complete remission of renal scarring shown in the first chronic phase Technetium-99m dimercaptosuccinic acid (DMSA) renal scintigraphy images in children with urinary tract infection (UTI). Fifty children, who underwent the chronic phase of DMSA scintigraphy more than twice following UTI diagnosis and had renal scarring in the first chronic phase DMSA renal scintigraphy, were enrolled. They were classified into 2 groups: with and without complete remission of renal scarring on the second chronic phase DMSA renal scintigraphy. Renal scarring was classified into 3 grades based on severity per the image findings. Seven cases had complete remission from renal scarring. There were significant differences in age and severity. Renal scarring might be completely reversed in young children without severe findings on DMSA renal scintigraphy. Additional chronic phase examination may aid in follow-up completion and patients' peace of mind.

Influence of mesh nebulizer characteristics on aerosol delivery in non-human primates

Non-Human Primates (NHPs) are particularly relevant for preclinical studies during the development of inhaled biologics. However, aerosol inhalation in NHPs is difficult to evaluate due to a low lung deposition fraction and high variability. The objective of this study was to evaluate the influence of mesh nebulizer parameters to improve lung deposition in macaques. We developed a humidified heated and ventilated anatomical 3D printed macaque model of the upper respiratory tract to reduce experiments with animals. The model was compared to in vivo deposition using 2D planar scintigraphy imaging in NHPs and demonstrated good predictivity. Next, the anatomical model was used to evaluate the position of the nebulizer on the mask, the aerosol particle size and the aerosol flow rate on the lung deposition. We showed that placing the mesh-nebulizer in the upper part of the mask and in proximal position to the NHP improved lung delivery prediction. The lower the aerosol size and the lower the aerosol flow rate, the better the predicted aerosol deposition. In particular, for 4.3 ± 0.1 µm in terms of volume mean diameter, we obtained 5.6 % ± 0.2 % % vs 19.2 % ± 2.5 % deposition in the lung model for an aerosol flow rate of 0.4 mL/min vs 0.03 mL/min and achieved 16 % of the nebulizer charge deposited in the lungs of macaques. Despite the improvement of lung deposition efficiency in macaques, its variability remained high (6–21 %).

Scintigraphic signs of kidney injuries of I–IV degrees of severity and their compliance with the OIS/OI AAST classification: observational study

INTRODUCTION: Mechanical effects on the kidney result in parenchymal disruption, haemorrhage formation, classified by OIS/OI AAST. Scintigraphy with 99Tc-DMSA can determine the presence, prevalence of areas of ischaemia and implications for renal function.OBJECTIVE: By radiopharmaceutical accumulation, to assess the function of the injured kidney and to establish the consistency of the scintigraphic images with the radiological findings of the OIS/OI AAST classification.MATERIAL AND METHODS: Scintigraphy with 99Tc-DMSA was performed in the immediate posttraumatic period in 196 patients who had Grade I–IV organ damage according to the OIS/OI AAST classification. The shape, size, and contours of the kidneys were visually evaluated. Based on the calculation of the uniformity and intensity of the indicator inclusion in the parenchyma the relative (total) kidney function was established. The degree and localisation of kidney damage were revealed on the basis of primary ultrasound and MSCT results.RESULTS: In the acute period of injury, Grade I–II were characterised by diffuse irregular distribution of 99Tc-DMSA (from 75.0 to 100% of cases), but with increasing area and volume of injury, focal scintigraphic symptoms appeared (up to 25.0% of cases).In Grade III–IV, localised or extended focal deformation of the image contour and reduction of the overall kidney function prevailed. Comparative evaluation of CT findings with visual scintigraphy data demonstrated symmetry of visual information with sufficient accessibility, perceptibility, accuracy and correlated with OIS/OI AAST classification.DISCUSSION: Scintigram interpretation involves the interaction of two components: visual perception and subject-specific knowledge of human anatomical structures. This significantly differentiates it from clinicians’ conventional conception of the diagnostic process. Semiotics in the images included diffuse and focal changes, the basis of which is a disorder of haemocirculation with impaired uptake of radiopharmaceutical in the kidney parenchyma. For Grade I–II, hypoactive areas indicating the absence of significant damage are typical. Grade III–IV are characterised by localised areas due to reduced volume of functioning parenchyma.CONCLUSION: Scintigraphy in blunt kidney trauma demonstrates haemocirculatory abnormalities in the organ and a decrease in the amount of functioning parenchyma. Comparison of radionuclide images with computer imaging has a high degree of identity. The type of scintigrams allows grading them according to the OIS/OI AAST degree systematisation, which standardises the interpretation of radiological findings to improve the objectivity and quality of the study reports. Assessment of overall renal function makes it possible to predict the rehabilitative outlook of the injured kidney and the need for correction.

Evaluation of Pendrin Expression Using Nuclear Imaging Modalities and Immunohistochemistry in Animal Thyroid Cancer Model.

The impaired ability of thyroid cancer (TC) cells to uptake and concentrate iodine represents a major therapeutic challenge in malignant TC management. This has been reported probably due to reduced or loss of expression of pendrin in thyroid tumors. In view of this, we evaluated the pendrin expression in the chemically induced (using N-bis[2-hydroxypropyl] nitrosamine [DHPN]) TC model in Wistar rats. Uptake in the thyroid gland was evaluated by positron emission tomography with computed tomography (PET-CT) and scintigraphy imaging. Further histopathology (HP) and immunohistochemistry (IHC) were performed for confirming malignancy. The altered uptake in the thyroid gland was observed by PET-CT and scintigraphy imaging. Significant pathological changes in the thyroid were observed using 2-deoxy-2-(fluorine-18) fluoro-D-glucose PET-CT, technetium-99m pertechnetate imaging, and reduced iodine-131 uptake (n = 4) in DHPN-induced animals compared to control indicative of thyroid cell proliferation. In treated groups, tissue HP revealed hyperplastic follicular to papillary cell proliferation with variable mitotic activity. The malignant nature of the tissue and variable uptake of the tracer were further reconfirmed by IHC. IHC revealed reduced pendrin expression in malignant thyroid tissue. Hence, nuclear imaging techniques can be of aid in the early identification and evaluation of cellular changes during the early development of tumor models in laboratory animals. In conclusion, our study reveals that pendrin expression plays a vital role in thyroid uptake, and its reduction was observed in TC in a chemically induced TC model.

Sintigrafik Görüntülerden Tiroid Nodülleri için Bilgisayar Destekli Tanı Sistemi

In modern medicine, image recognition via segmentation of anatomical regions and automatic classification of diseases using medical images has a growing potential role in diagnosis of various diseases. Scintigraphy of thyroid is one of the established imaging modalities for diagnosis of thyroid gland disorders. In our study, the speckle noise was reduced in the scintigraphy images with the optimized Bayesian nonlocal mean filter. The thyroid gland was automatically segmented by local based active contour method and the thyroid gland pathologies were classified with convolutional neural networks (CNN). The proposed computer aided diagnosis (CAD) system was compared with Pyramid of Histograms of Orientation Gradients (PHOG), Gray Level Co occurrence Matrix (GLCM), Local Configuration Pattern (LCP) and Bag of Feature (BoF) methods. The common pathological patterns of scintigraphic images of the thyroid gland were successfully classified by CNN with an overall success rate of 91.19%. The comparative methods were PHOG, GLCM, LCP and BoF methods which provided overall success rates of 7.61%, 86.04%, 88.91% and 85.72% respectively. The proposed CNN based automatic diagnosis system provided promising results compared to handcrafted methods.

Clinical validation of an AI-based automatic quantification tool for lung lobes in SPECT/CT

BackgroundLung lobar ventilation and perfusion (V/Q) quantification is generally obtained by generating planar scintigraphy images and then imposing three equally sized regions of interest on the data of each lung. This method is fast but not as accurate as SPECT/CT imaging, which provides three-dimensional data and therefore allows more precise lobar quantification. However, the manual delineation of each lobe is time-consuming, which makes SPECT/CT incompatible with the clinical workflow for V/Q estimation. An alternative may be to use artificial intelligence-based auto-segmentation tools such as AutoLung3D (Siemens Healthineers, Knoxville, USA), which automatically delineate the lung lobes on the CT data acquired with the SPECT data. The present study assessed the clinical validity of this approach relative to planar scintigraphy and manual quantification in SPECT/CT.MethodsThe Autolung3D software was tested on the retrospective SPECT/CT data of 43 patients who underwent V/Q scintigraphy with 99mTc-macroaggregated albumin and 99mTc-labeled aerosol. It was compared to planar scintigraphy and SPECT/CT using the manual quantification method in terms of relative lobar V/Q quantification values and interobserver variability.ResultsThe three methods provided similar V/Q estimates for the left lung lobes and total lungs. However, compared to the manual SPECT/CT method, planar scintigraphy yielded significantly higher estimates for the middle right lobe and significantly lower estimates for the superior and inferior right lobes. The estimates of the manual and automated SPECT/CT methods were similar. However, the post-processing time in the automated method was approximately 5 min compared to 2 h for the manual method. Moreover, the automated method associated with a drastic reduction in interobserver variability: Its maximal relative standard deviation was only 5%, compared to 23% for planar scintigraphy and 19% for the manual SPECT/CT method.ConclusionsThis study validated the AutoLung3D software for general clinical use since it rapidly provides accurate lobar quantification in V/Q scans with markedly less interobserver variability than planar scintigraphy or the manual SPECT/CT method.

Bone metastasis detection method based on improving golden jackal optimization using whale optimization algorithm

This paper presents a machine learning-based technique for interpreting bone scintigraphy images, focusing on feature extraction and introducing a new feature selection method called GJOW. GJOW enhances the effectiveness of the golden jackal optimization (GJO) algorithm by integrating operators from the whale optimization algorithm (WOA). The technique’s performance is evaluated through extensive experiments using 18 benchmark datasets and 581 bone scan images obtained from a gamma camera, including 362 abnormal and 219 normal cases. The results highlight the superior predictive effectiveness of the GJOW algorithm in bone metastasis detection, achieving an accuracy of 71.79% and specificity of 91.14%. The contributions of this study include the introduction of a new machine learning-based approach for detecting bone metastasis using gamma camera scans, leading to improved accuracy in identifying bone metastases. The findings have practical implications for early detection and intervention, potentially improving patient outcomes.

Explainable Artificial Intelligence Method (ParaNet+) Localises Abnormal Parathyroid Glands in Scintigraphic Scans of Patients with Primary Hyperparathyroidism

The pre-operative localisation of abnormal parathyroid glands (PG) in parathyroid scintigraphy is essential for suggesting treatment and assisting surgery. Human experts examine the scintigraphic image outputs. An assisting diagnostic framework for localisation reduces the workload of physicians and can serve educational purposes. Former studies from the authors suggested a successful deep learning model, but it produced many false positives. Between 2010 and 2020, 648 participants were enrolled in the Department of Nuclear Medicine of the University Hospital of Patras, Greece. An innovative modification of the well-known VGG19 network (ParaNet+) is proposed to classify scintigraphic images into normal and abnormal classes. The Grad-CAM++ algorithm is applied to localise the abnormal PGs. An external dataset of 100 patients imaged at the same department who underwent parathyroidectomy in 2021 and 2022 was used for evaluation. ParaNet+ agreed with the human readers, showing 0.9861 on a patient-level and 0.8831 on a PG-level basis under a 10-fold cross-validation on the training set of 648 participants. Regarding the external dataset, the experts identified 93 of 100 abnormal patient cases and 99 of 118 surgically excised abnormal PGs. The human-reader false-positive rate (FPR) was 10% on a PG basis. ParaNet+ identified 99/100 abnormal cases and 103/118 PGs, with an 11.2% FPR. The model achieved higher sensitivity on both patient and PG bases than the human reader (99.0% vs. 93% and 87.3% vs. 83.9%, respectively), with comparable FPRs. Deep learning can assist in detecting and localising abnormal PGs in scintigraphic scans of patients with primary hyperparathyroidism and can be adapted to the everyday routine.

Rapid gastric emptying during pregnancy in a rat model

Background/aimsThe effect of pregnancy on gastric emptying has not been established, although the predominant clinical assumption is that gastric emptying is delayed during pregnancy. We hypothesized that the rate of emptying of nutrients during pregnancy is not delayed, but is actually more rapid when compared to the non-pregnant state. The rate of gastric emptying is a major determinant of postprandial glucose elevations. Materials and methods24 female and 4 male Spague-Dawley rats were used. Female rats were randomly divided into two groups: eight rats for the control group and sixteen rats for the pregnant group. Using physiologic, non-traumatic nuclear medicine scintigraphy imaging methodology, the authors studied gastric emptying of a liquid mixed meal in pregnant rats and non-pregnant controls. Body weights, daily food ingestion, and the rate of nutrient gastric emptying were recorded in both groups at pre-pregnancy, early pregnancy, and late pregnancy. ResultsThe authors found that pregnancy in this rat model is associated with a 37–43% increased rate of nutrient gastric emptying from the stomach in late pregnancy as compared to non-pregnant control rats and pre-pregnancy rats. ConclusionThese findings contradict the current clinical assumption that gastric emptying is delayed in pregnancy. If further studies confirm a more rapid gastric emptying rate during human pregnancy, new therapies aimed at slowing the rate of nutrient absorption should be considered for the prevention and treatment of pregnancy-associated nausea, gestational diabetes, and other insulin-resistant pregnancy-associated states such as pre-eclampsia.

An Enigmatic Case of Skeletal Fluorosis: Inhalant-Induced Toxicity.

Skeletal fluorosis is more common in the developing world, but is occasionally seen in the United States. We present radiographic, scintigraphic, CT, and clinical images of a 26-year-old woman with rapidly progressive, debilitating, polyostotic periostitis, and diffuse osteosclerosis typical of skeletal fluorosis. Laboratory analyses supported this diagnosis. The source of excess fluoride intake was elusive until a concurrent mental health workup revealed the patient's proclivity for inhaling air-duster cans containing difluoroethane. Difluoroethane inhalant abuse is an increasingly reported cause of skeletal fluorosis that astute clinicians should recognize. Discontinuation and sobriety from this toxic agent are essential for recovery.

IgG index of cerebrospinal fluid can reflect pathophysiology associated with Lewy bodies in Parkinson's disease

BackgroundNeuroinflammation is one of the pathophysiologies of Parkinson's disease (PD). Lewy bodies, the pathological hallmark of PD, emerge as a consequence of α-synuclein aggregation, and neuroinflammation is induced concurrently with this aggregation. Imaging and cerebrospinal fluid (CSF) biomarkers that reflect PD pathophysiology have been developed or are under investigation. The IgG index of CSF is a marker of inflammation, and may also reflect the pathophysiology of PD. AimWe examined if the IgG index reflects the pathophysiology of PD in drug-naïve PD patients. MethodThe subjects were 20 consecutive PD patients who underwent 123I-MIBG scintigraphy for assessment of the heart to mediastinum (H/M) ratio and wash out rate, 123I-Ioflupane SPECT for examination of the specific binding ratio in the striatum, and lumbar puncture before treatment. The CSF IgG index and levels of pathogenic proteins (total α-synuclein, oligomeric α-synuclein, total tau, phosphorylated tau and amyloid Aβ1–42) were determined. The IgG index was compared with the other parameters using Spearman correlation analysis. ResultsThe IgG index showed a significant correlation with the H/M ratio in early (r = −0.563, p = 0.010) and delayed (r = −0.466, p = 0.038) images in 123I-MIBG scintigraphy and with the CSF total tau level (r = −0.513, p = 0.021). ConclusionNeuroinflammation is involved in PD pathophysiology in some patients, and a higher IgG index indicates the presence of neuroinflammation accompanied by emergence of Lewy bodies.

Sex differences in 123I-mIBG scintigraphy imaging techniques in patients with heart failure

ABSTRACT Background 123I-mIBG-scintigraphy could be a useful stratifying tool for patients with heart failure (HF). The purpose of this retrospective study is to evaluate whether there are differences between men and women with HF in terms of the prediction of cardiac arrhythmic events (AE). Research and methods A total of 306 patients, before implantable-cardioverter-defibrillator (ICD) implantation, were evaluated. They underwent 123I-mIBG-scintigraphy and an evaluation of the results was performed after 85 months of follow-up. Early and late planar and SPECT cardiac images were acquired. Heart-to-mediastinum ratio (HM) for planar images and the sum of the segmental scores (SS) for SPECT were calculated. Results In the general population, age, early SS (ESS), late SS (LSS), and ejection fraction (EF) were statistically significant for the prediction of AE at Cox regression, while early and late HM (eHM,lHM) were not significative for the prediction of AE. Population was divided into females and males and univariate analysis was conducted separately for the two cohorts: no significant variables for prediction of AE were found in females. For males, ESS, LSS, EF, and late HM were statistically significant predictors of AE. The overall survival was similar in males and females, but the risk of AE is lower in males than in females. Conclusions 123I-mIBG represents a more effective tool for the prediction of AE in male patients than in women.

Integrated catecholamine imaging in heart and lung across different cardiopulmonary disorders: A systems-based pilot analysis

BackgroundAutonomic nervous system deregulation is key in the progression of different cardiovascular diseases, and scintigraphic imaging with metaiodobenzilguanidine (MIBG) is the gold-standard its non-invasive evaluation. While heart catecholamine handling has been more extensively evaluated, fewer data are available on lung or combined cardiopulmonary MIBG uptake. The aim of this short communication is the simultaneous analysis of cardiopulmonary MIBG uptake to improve patients' characterization. Methods126 subjects were retrospectively analyzed based on the underlying etiology (systolic heart failure -HF, n = 52; myocardial infarction - MI, n = 26; pulmonary arterial hypertension - PAH, n = 13; cardiac amyloidosis - CA, n = 14; candidates to transcatheter aortic valve replacement - pre-TAVI, n = 21). The cut-off values of 1.6 and 1.62 were chosen for cardiac and lung/mediastinum ratios, respectively. ResultsCombined alterations of MIBG uptake were found in 37% of patients. In HF and MI, simultaneous cardiopulmonary derangement was found in 40 and 46% of the patients, respectively, while in CA up to 65% of patients showed combined cardiopulmonary alterations. Conversely, patients with PAH mainly showed lung-only involvement (54%) and pre-TAVI patients cardiac-only alterations (24%). ConclusionsSimultaneous cardiopulmonary alterations of catecholamines handling are highly prevalent and may help to better characterize concurrent end-organ dysfunction in different diseases.

Evaluation of sentinel lymph node localization in malignant melanoma by preoperative semiconductor gamma camera and planar lymphoscintigraphy.

Performing lymphoscintigraphy in a separate room, frees up the conventional gamma camera, coupled with the desire to directly localize sentinel lymph nodes (SLN) in the operating theatre has led to the development of high-resolution semiconductor-detector based handheld gamma-cameras, CrystalCam. This work consists of phantom and clinical studies. For the first part, a Jaszczak phantom with hollow spheres of various volumes were filled with the 99m Tc and the camera's sensitivity was measured at various distances to assess the possibilities and limitations of the device. The clinical study evaluates the effectiveness of CrystalCam in localizing SLN in 40 consecutive malignant melanoma patients compared to both conventional planar lymphoscintigraphy and hybrid SPECT/CT. SLNs detected by planar lymphoscintigraphy were marked on the patients' skin using a UV-marker. CrystalCam images were acquired in another room by another examiner and the SLNs were marked with a felt pen. The detected nodes by both camera systems were evaluated using UV-lamp and normal light to visualize the UV- and felt pen marks respectively. The concordance rate of the SLNs and higher-echelon nodes localized by both planar scintigraphy and CrystalCam imaging with respect to the total SLNs and higher-echelon nodes detected by SPECT/CT imaging are compared and statistically analyzed. The results of the phantom study show a good correlation between activity and count-rates for all distancesSPECT/CT, CrystalCamm, and planar lymphoscintigraphy detected 69, 58, and 61 SLNs respectively. The concordance rate of 95.65% by the CrystalCam and planar scintigraphy implies both cameras are statistically coequal in preoperative SLN detection of malignant melanoma. For the higher-echelon nodes, SPECT/CT, planar and CrystalCam imaging systems identified 82, 48, and 13 respectively; thus, CrystalCam was statistically inferior to planar imaging. The handheld CrystalCam is a reliable instrument for localizing SLNs in surgical centers without an on-site nuclear medicine department.

New thyroid scintigraphy datasets: Construction and benchmark assessment in diagnosis of residual thyroid tissue

Thyroid scintigraphy, a type of single photon emission computed tomography (SPECT) imaging technique that uses radioactive isotopes to capture images of the thyroid gland, helps detect thyroid abnormalities and diagnosing thyroid cancer. A promising research direction for machine learning applications to assist in diagnosis. Most algorithms for detecting and predicting uptake in the thyroid region rely on proprietary or published datasets with unspecified information. This makes comparing the performance among different methods and developing solutions for various problems challenging. To address this issue, we have constructed two standardized datasets of thyroid scintigraphy images for identifying and quantifying the depth. The purpose of designing the models is to establish a benchmark assessment for developing CADx models on the datasets in the future.

Evaluation of Distal Occlusions accompanying Punctal Stenosis using Radionuclide Imaging in patients with Unilateral Epiphora

Objective: Our objective was to evaluate distal occlusions accompanying punctal stenosis, which can lead to impaired nasolacrimal drainage in patients with punctal stenosis, using radionuclide imaging. Material and Methods: Our study enrolled 42 patients who had unilateral punctal stenosis and experienced epiphora on the same side. None of the patients had previously undergone surgical intervention for this condition. Ophthalmological examination results were normal on the unaffected side. Dacryoscintigraphy was performed bilaterally, and specific regions of interest were identified. The scintigraphic images were assessed quantitatively and qualitatively by two nuclear medicine specialists. Evaluation between the nuclear medicine specialists was conducted using the McNemar Bowker test and the Kappa test. Results: Eighty-one percent (34) of the patients were female. The mean age of the patients was 68.23±9.67 years. In patients with punctal stenosis, the punctal area exhibited edematous features. The lacrimal drainage pathway from the punctum was assessed by two nuclear medicine specialists using two different methods. In the visual quantitative evaluation to determine the localization of the stenosis, there was a low to moderate agreement between the two observers (p=0.018, kappa value=0.252). In the quantitative evaluation, there was excellent agreement between the observers (p=0.0001, kappa value=1). Conclusion: Dacryoscintigraphy is preferred as an imaging method due to its non-invasive nature that does not disturb the physiological processes. It offers advantages such as lower radiation exposure and higher patient compliance compared to dacryocystography. However, it should be noted that the anatomical correlation in dacryoscintigraphy is relatively low compared to radiological methods. By incorporating quantitative data into the visual assessment of dacryoscintigraphy, it may be possible to enhance anatomical correlation and improve observer agreement, particularly in patients presenting with a combination of functional and anatomical obstructions.

Changes in Oesophageal Transit, Macro-Reflux Events, and Gastric Emptying Correlate with Improvements in Gastro-Intestinal Symptoms and Food Tolerance Early Post Sleeve Gastrectomy

PurposeThere are significant alterations in gastro-intestinal function, food tolerance, and symptoms following sleeve gastrectomy (SG). These substantially change over the first year, but it is unclear what the underlying physiological basis for these changes is. We examined changes in oesophageal transit and gastric emptying and how these correlate with changes in gastro-intestinal symptoms and food tolerance.Material and MethodsPost-SG patients undertook protocolised nuclear scintigraphy imaging along with a clinical questionnaire at 6 weeks, 6 months, and 12 months.ResultsThirteen patients were studied: mean age (44.8 ± 8.5 years), 76.9% females, pre-operative BMI (46.9 ± 6.7 kg/m2). Post-operative %TWL was 11.9 ± 5.1% (6 weeks) and 32.2 ± 10.1% (12 months), p-value < 0.0001. There was a substantial increase of meal within the proximal stomach; 22.3% (IQR 12%) (6 weeks) vs. 34.2% (IQR 19.7%) (12 months), p = 0.038. Hyper-accelerated transit into the small bowel decreased from 6 weeks 49.6% (IQR 10.8%) to 42.7% (IQR 20.5%) 12 months, p = 0.022. Gastric emptying half-time increased from 6 weeks 19 (IQR 8.5) to 12 months 27 (IQR 11.5) min, p = 0.027. The incidence of deglutitive reflux of semi-solids decreased over time; 46.2% (6 weeks) vs. 18.2% (12 months), p-value < 0.0001. Reflux score of 10.6 ± 7.6 at 6 weeks vs. 3.5 ± 4.4 at 12 months, (p = 0.049) and regurgitation score of 9.9 ± 3.3 at 6 weeks vs. 6.5 ± 1.7, p = 0.021 significantly reduced.ConclusionsThese data demonstrate that there is an increase in the capacity of the proximal gastric sleeve to accommodate substrate over the first year. Gastric emptying remains rapid but reduce over time, correlating with improved food tolerance and reduced reflux symptoms. This is likely the physiological basis for the changes in symptoms and food tolerance observed early post-SG.Graphical

Synchronous Ectopic Thyroid Gland and Ectopic Parathyroid Adenoma on 99mTc-Sestamibi Scintigraphy and Correlative Imaging.

99mTc-sestamibi scintigraphy localizes parathyroid adenoma as a persistent focus of uptake on delayed images, whereas thyroid glands in normal or ectopic locations are seen on only early images and wash out on delayed images. We report a case of absence of eutopic neck thyroid activity and synchronous ectopic lingual thyroid and mediastinal parathyroid adenoma on scintigraphy confirmed with CT.

Comparison of phase contrast magnetic resonance imaging and scintigraphy for determination of split pulmonary blood flow in children and young adults with congenital heart disease.

Measurement of differential blood flow to the lungs is important to understanding flow dynamics in the setting of congenital heart disease. Split blood flow via the pulmonary arteries guides and demonstrates the effect of interventions. Minimally invasive imaging of pulmonary blood flow can be achieved with scintigraphy or magnetic resonance imaging (MRI). To assess agreement of pulmonary blood flow measurements obtained by scintigraphy and MRI in children and young adults. We performed a retrospective review of patients < 21years of age who had undergone both nuclear medicine pulmonary perfusion scans (Tc-99m MAA) and cardiac MRI examinations from January 2012 to August 2021 at our tertiary pediatric hospital. Patient demographics, medical/surgical information, and estimates of split blood flow by both modalities were recorded. Pearson's correlation coefficient was used to determine the relationship between split blood flow measured by the two examinations. Agreement was calculated using interclass correlation coefficient (ICC) for absolute agreement and Bland-Altman difference analysis. Correlation between split blood flow measured by scintigraphy and MRI using net flow was 0.90 (95% CI: 0.83-0.94, P< 0.001) and the ICC for agreement on split blood flow was 0.90 (95% CI: 0.84-0.94). Mean difference in split blood flow by Bland-Altman analysis was 0.79% with 95% limits of agreement (-11.2 to 12.8%). There is excellent agreement between Tc-99m scintigraphy and phase contrast MRI for quantification of split pulmonary blood flow in children and young adults with congenital heart disease.

Ascites and liver cirrhosis diagnosed on cardiac scintigraphic imaging.

Ascites and liver cirrhosis diagnosed on cardiac scintigraphic imaging.