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Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India logoLink to Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India
. 2013 Dec;28(Suppl 1):S16–S20.

Scintigraphy Non-Oncology

PMCID: PMC3868030
Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-01: Evaluation of gamma camera and collimator resolution using 153Sm, 99mTc, 177Lu and 131I line sources

Sutapa Rakshit, Basant Malpani, Hemant Shimpi, Nawab Singh Baghel

Radiation Medicine Centre (BARC), TMH, Parel, Mumbai, Maharashtra, India

Objective: The aim of this study is to evaluate the performance characteristics of ge infinia gamma camera collimator systems using line sources fabricated in-house.

Materials and Methods: Approximately 400 μL of radioactive solution of either 131I, 177Lu, 99mTc and 153Sm was filled in Teflon tubes (TEFZEL, Φ =1/16”, l = 50cm). These tubings were affixed onto Perspex sheets (53 cm × 8 cm × 0.2 cm). Line sources were placed facing the collimator surface for static acquisition at surface. Static images were acquired for 200 kcts (at zoom 1) in 1024 × 1024 pixels with different separation geometries. Initially, collimator was moved away by a centimeter each after acquisition up to 10 cm and later on by 2 cm. Energy and window settings used were 153Sm (103 keV, 20%), 99mTc (140 keV, 20%), 177Lu (113, 208 keV, 20%) and 131I (364 keV, 20%). Line profiles (20 pixel thick) were drawn corresponding to 10 mm thickness. FWHM in millimeters and maximum counts for each profile were noted.

Results: FWHM with LEHR collimator at surface for 153Sm, 99mTc, 177Lu were observed to be 7.5, 8.5 and 9.8 mm respectively. The same with HEGP for 177Lu and 131I were 11 and 10 mm. FWHM with LEHR for 99mTc at 1-10, 12, 14 and 15 cm distance were 8.6, 9.8, 9.6, 10.5, 11.3, 11.7, 12.2, 12.8, 13.5, 15.5, 14.0, 16.8 and 17.3 mm respectively. FWHM with LEHR for 177Lu for these distances were 9.8, 11.0, 10.5, 12.0, 13.3, 13.5, 15.8, 18.0, 15.0, 18.0, 18.0, 20.0 and 21.0 mm respectively.

Conclusions: LSF is an easy to perform method to evaluate performance characteristic of the gamma camera collimator system. Our results show the ease of rating collimators characteristics and assessing resolution characteristics with changing depths.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-02: Scintigraphic evaluation of salivary gland function in patients with xerostomia due to auto-immune aetiology

L Peethamber, K Sreenivasa Reddy, Madhur Kumar Srivastava, Madhusudhanan Ponnusamy, H Dhanapathi, Nandini Pandit

Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Objective: Salivary scintigraphy using Tc-99m pertechnetate has been used to evaluate severity of salivary gland dysfunction in Sjφgren's syndrome and post-radiotherapy patients. The aim of the study is to assess salivary gland function by analysing the tracer accumulation and excretion in patients with xerostomia secondary to autoimmune aetiology.

Materials and Methods: We did a retrospective analysis of Tc-99m pertechnetate salivary scans of 61 patients with history of xerostomia done between January 2013 and August 2013. Tracer uptake in parotid and submandibular salivary glands and the clearance of tracer after administration of sialogogue (2 ml of concentrated lemon extract) were studied. Distribution and severity of affected salivary glands were analysed.

Results: The study population included 18 patients of primary Sjögren's, 26 patients of secondary Sjögren's syndrome, 11 patients with history of undifferentiated polyarthritis and 6 patients with miscellaneous causes including diabetes mellitus. 41 patients showed at least one gland affected, 26 of them showing bilateral involvement. 36 patients had mildly reduced uptake in the affected glands and 5 had severely reduced tracer uptake. 20 patients had normal scan findings. Post-sialogogue clearance was good in 55 patients, mildly reduced in one and severely reduced in 5 patients. The mean excretion fraction for these 6 patients with reduced clearance versus the remaining patients with normal clearance were: Parotids 41.2 ± 21.3% versus 50.3 ± 14.8% and submandibular glands 19.9 ± 12% versus 35.1 ± 13.1 %. The difference in means of excretion fraction was significant only for the submandibular glands (P = 0.021).

Conclusion: Salivary scintigraphy is an objective and effective non-invasive tool to assess salivary gland function in cases of xerostomia due to auto-immune disorders. Quantification of uptake and clearance will further improve the diagnostic accuracy.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-03: Effect of mirtazapine on gastric emptying in patients with skeletal metastasis complaining of cancer related anorexia

Narvesh Kumar, S Barai, S Gambhir

Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India

Objective: Mirtazapine, a tetracyclic antidepressant widely used in cancer patients suffering from anorexia. Though it is known to restore appetite but the exact mechanism remains unknown. Aim of the study was to evaluate, if mirtazapine has any effect on gastric emptying in patients suffering from cancer related anorexic.

Materials and Methods: Gastric emptying study using the 3 h static protocol with radiolabeled solid meal was performed in 30 patients suffering from cancer anorexia once at baseline and repeated after 15 days intake of mirtazapine 7.5 mg orally.

Results: Anorexia was reported by all the patients. it was of mild in nature in 3 (10.3%), moderate in 12 (41.4%) and severe in 14 (48.3%) patients., after intervention anorexia was completely resolved in 7(23.3%), remained mild in 18 (62.1%) and moderate in 4 (13.8%) patient. None of the patients reported severe anorexia after initiation of mirtazapine therapy. At baseline, only 4 (13.8%) patients had gastric emptying >75% whereas after treatment 9 (31.0%) patients achieved this limit. Mean % gastric emptying increased from 55.0 ± 21.7% to 64.5 ± 21.4%, thus showing a statistically significant change in percentage gastric emptying (P = 0.004). Mean gastric emptying time (t1/2) before intervention was 300.9 ± 428.5 min which decreased to 64.5 ± 21.4 min after intervention. Delayed emptying was present in 25 (83.3%) patient before therapy and in 20 (66.7%). patients after therapy with a P of 0.016.

Conclusion: Mirtazapine promptly restores appetite in patients with cancer associated anorexia and this effect is partly due to correction of delayed gastric emptying.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-04: Improvement in image quality of low dose computed tomography (single-photon emission computed tomography) using filtration

SC Kheruka, UC Naithani1, NK Painuly2, LM Aggarwal3, S Gambhir

Departments of Nuclear Medicine, SGPGIMS, 2Radiotherapy, CSMMU, Lucknow, Uttar Pradesh, 1Department of Physics, HNB University, Srinagar, Jammu and Kashmir, 3Departments of Radiotherapy and Radiation Medicine, IMS, BHU, Varanasi, Uttar Pradesh, India

Objective: The output of the X-ray tube used in computed tomography (CT) provides a spectrum of photon energies. Filtering of the beam may be used to remove low-energy photon component. The accuracy of attenuation coefficient calculation by bilinear model depends highly upon accuracy of hounsfield units. Therefore, we have made an attempt to minimize the beam-hardening effects using additional copper filter in the X-ray beam. The quantitative evaluation were made to see the effect of additional filters on resulting CT images.

Materials and Methods: This study was performed on dual-head SPECT (HAWKEYE 4, GE Healthcare) with low-dose CT. For the evaluation of image quality, we used CT QA phantom having six different density pins of water, polyethylene, nylon (aculon), lexan, acrylic (perspex) and teflon. The axial images were acquired using copper filters of various thicknesses ranging from 1 to 5 mm in steps of 1 mm. First set of images was acquired without putting any filter into the beam. Then, successively, filters of different thicknesses were placed into the beam and calibration of the CT scanner was performed before acquiring the images. Jaszak's SPECT phantom after removing the spheres was used to see the different contrast intensities by inserting the different contrast materials of iodine and bismuth in water as background media. Images were analyzed for visibility, spatial resolution and contrast.

Results: Successive improvement in the image quality was noticed when we increased the filter thickness from 1 to 3 mm. The images acquired with 3 mm filter appeared almost with no artifacts and were visibly sharper. The spatial resolution for image matrix of 512 × 512 was found to be 1.29, 1.07, 0.64 and 0.54 mm for without filter, with 1, 2 and 3 mm filters, respectively. The image quality was further analyzed for signal-to-noise ratio (SNR). It was found to be 1.72, 1.78, 1.98 and 1.99 for open, with 1, 2 and 3 mm filters respectively. This shows that 3 mm filter results in an improvement of 15.7% in SNR.

Conclusion: On the basis of this study, we could conclude that use of 3 mm copper filter in the X-ray beam is optimal for removing the artifacts without causing any significant reduction in the photon flux of the resulting X-ray beam.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-05: Brain single-photon emission computed tomography analysis using Scenium software

Sarika Sharma, Komalpreet Kaur, Anish Bhattacharya, Bhagwant Rai Mittal

Department of Nuclear Medicine, PGIMER, Chandigarh, India

Introduction: Brain SPECT is a powerful diagnostic tool for evaluating neurologic and psychiatric diseases. It also provides a measure of cerebral blood flow (CBF) and is very useful for functional imaging of subcortical structures of the brain. It is generally analysed visually or through sophisticated, dedicated analysis softwares. Scenium, a new brain analysis software which statistically compares a patient's brain SPECT against a normal reference image acquired with 99mTc-ECD.

Aim: To quantitavely analyse 99mTc-ECD brain SPECT scans using Scenium software and compare the relative perfusion patterns in different regions of the brain.

Materials and Method: The Scenium software was used to analyse 28 patients (15F:13M, mean age 35 ± 5 years, 21-60 years) referred to our department from August 2012 to March 2013. All these patients underwent brain SPECT-CT post administration of 20 mCi of 99mTc ECD, on a dual head SPECT-CT gamma camera (Siemens, Germany). The acquired data was reconstructed and processed using Scenium software (Siemens Ltd.). The processing of the reconstructed data included the analysis of uptake in different regions of interest (ROI) such as frontal lobe, occipital lobe, parietal lobe, temporal lobe, basal ganglia and cerebellum.

Results: The mean asymmetric index of −0.0119, 0.0185, 0.02489, 0.017, −0.0697, 0.03779 was recorded for frontal lobe, occipital lobe, parietal lobe, temporal lobe, basal ganglia and cerebellum, respectively. On the average asymmetric index was higher in the cerebellum in the present study.

Conclusion: (a) The 99mTc-ECD brain SPECT scans was quantitatively analysed using the Scenium brain analysis software with minimal observer intervention. (b) The differential perfusion indices identified by this software may be useful for correlation with different brain pathologies.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-06: Local factors causing intriguing patterns of contamination during large dose scan with 131-iodine

Basant Malpani, Sunita Sonawane, Ramesh Asopa

Radiation Medicine Centre (BARC), TMH Annexe Building, TMH, Parel, Mumbai, Maharashtra, India

Objective: This study aims to share the unusual scan findings from three 131-iodine large dose scan seen at RMC and discuss other such factors reported in literature to sensitise the imaging technologists and the interpreting physician.

Materials and Methods: Diagnostic large dose scan with 131-iodine is a standard practice for follow-up evaluation of Ca thyroid patients who have received an ablative therapy. Our protocol is to perform a whole body scan on day 3 following oral administration of 3-5 mCi 131-iodine. Unusual scan findings in three such patients is reported here along with causative local factors.

Results: A young female patient showed an abnormal uptake in the anterior chest view corresponding to lateral border of chest. An “arms up” repeat chest view confirmed uptake to be caused due to sweat adsorbed on Taweez (or Talisman) made of cloth rug. Another 45-year-old male showed unusual uptake on both shoulders. A repeat view next day confirmed it to be due to contamination of his under-shirt (vest/banian). The patient had come to Mumbai for this study with just a pair of clothes. In an another case the abnormal uptake in chest region was identified to be due to a rose petal kept in the shirts pocket. The patient had prayed at a holy place of worship immediately after the radioiodine dose was administered and often repeatedly kissed the petal for blessings during the intervening stay in Mumbai.

Conclusion: As discussed above, apart from being familiar with the normal physiologic distribution of iodine or the more frequently encountered physiologic and pathologic variants of radioiodine uptake, it is necessary to be alert to such local factors that can cause intriguing findings.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-07: Gamma scintigraphic evaluation of colon targeted combined formulation of tindazole and lactobacillus spore

Braj Gaurav Sharma, Neeraj Kumar, Dhruv K Nishad, Thakuri Singh, Gaurav Mittal, Amit Tyagi, Farhan J Ahmad1, Aseem Bhatnagar

Department of Nuclear Medicine, INMAS (DRDO), Timarpur, 1Faculty of Pharmacy, Jamia Hamdard, Delhi, India

Objective: The aim of present study was to evaluate the retention of a novel colon release formulation of Tinidazole and lactobacillus in animal and healthy human volunteer using Gamma scintigraphy techniques. Tinidazole is a versatile anti-amoebic and anti-anaerobic drug used in treatment of intestinal infection, while Lactobacillus spores act as probiotic, which are significantly maintained in aerobic commensals throughout the GIT.

Materials and Methods: Tinidazole and lactobacillus were procured from Hindustan Chemical Pvt. Ltd., Mumbai and all other chemical used in the study were of analytical grade. Tinidazole was radiolabeled with 99mTc-pertechnetate using stannous chloride as a reducing agent. Radiolabelled Tinidazole was characterized for its stability at room temperature and in physiological conditions (serum). Radiolabeled tinidazole was further used for in-vitro and in-vivo studies. Guar gum based matrix Tablet of tinidazole and lactobacillus was developed and optimized for formulation development. Radiolabeled Tinidazole-Lactobacillus tablet was given through oral route to rabbit (n = 6) and gamma scintrigraphic images were taken in static mode up to 24 h using gamma camera (Symbia T2). Similar set of study was conducted in healthy human volunteers (n = 6) to evaluate the retention of optimized tablet in the GIT using gamma scintigraphy.

Results: Tinidazole was radiolabeled with 99mTc with Radiolabelling efficiency of >95%, which was stable up to 24 h at room temperature in normal saline (in-vitro) as well as in serum (in-vivo). In-vivo studies on animal model showed control release pattern up to 24 h. Scintigraphic images of healthy human volunteer showed retention of optimized formulations in stomach up to 60 min, from where it moved to duodenum further and reached ilium in around 5 h. However the drug was arrived in colon in 7 h. Complete dissolution of tablet was observed at 24 h in colon. Data with respect to percent deposition of 99mTc-Tinidazole in different segments of intestine and colon was calculated by drawing region of interest (ROI) on scintigraphic images.

Conclusions: Results drawn from scintigraphy images indicate that radiolabelled 99mTc-Tinidazole-Lactobacillus tablet passed through upper part of GI without disintegration. Complete disintegration and a uniform distribution of 99mTc-Tinidazole was observed across the entire colon at 24 h. The in-vivo studies in animals and human, clearly demonstrate that the developed (guar gum based system) tablet could deliver the drug at infection sites (target site) of GI tract.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-08: Experimental study on role of alpha ketoglutarate as hepatoprotective agent: A 99mTc sulphur colloid hepatobiliary imaging in CCl4 fibrotic rat model

Lalita Mehra, Amit Kumar, Aashish Gambhir, Mita Dutta, Yasha Hasija1, Aseem Bhatnagar, Gaurav Mittal

Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Science, DRDO, 1Department of Biotechnology, Delhi Technological University, Delhi, India

Objective: To evaluate the hepatoprotective efficacy of alpha-ketoglutarate using 99mTc sulphur colloid hepatobiliary imaging in CCl4 fibrotic rat model.

Materials and Methods: Eighteen matched Sprague Dawley rats were randomly divided into 3 groups. Group I, Vehicle control: With intraperitoneal (i.p) olive oil but no CCl4 or AKG. Group II, CCl4 group: Which were treated on two consecutive days with 1 ml/kg CCl4 (1:1 olive oil) intraperitoneally but no AKG. Group III, treatment group was given CCl4 as in group II followed by AKG treatment at a dose of 2 g/kg dissolved in 2 ml of distilled water thrice a day for two weeks. 99mTc sulfur colloid (99mTc-SC) imaging was performed in all the three groups of rats. After the 99mTc-SC scan, organ/tissue uptake was determined by drawing regions of interest (ROI) over the liver and also the whole body (WB). The ratio of the ROI of organ to the WB ROI was calculated. Statistical analysis was performed to compare the ratios of organ/tissue uptake to WB uptake in vehicle, CCl4 and treatment groups. Further to evaluate the efficacy studies animals were sacrificed at the end of the experiment, blood samples were collected and biochemical assays were performed especially LFT (Liver Function Test), ALT, AST and ALP.

Results: 99mTc-SC uptake ratios (mean ± SD) showed a lower Liver-to-WB uptake ratio in the “CCl4 group” compared to “vehicle control” while the “treatment group” showed higher Liver-to-WB uptake as compared to “CCl4 group”. Liver function test were correlative to imaging study with higher level of ALT, AST and ALP in CCl4 group compared to treatment group which indicates the hepatoprotective efficacy of Alpha ketoglutarate.

Conclusion: From this functional imaging study it is concluded that alpha keto glutarate protects rat liver against CCl4 induced hepatotoxicity. The Serum enzymatic analysis also supported the data.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-09: Evaluation of chitosan topical gel formulation for skin permeation assessment using radiometry and gamma scintigraphy

Priyanka Chhabra, Lalita Mehra, Rashid Ali, Gaurav Mittal, Aseem Bhatnagar, Amit Kumar

Institute of Nuclear Medicine and Allied Sciences, Defence R and D Organization, Brig. S K Mazumdar Marg, Delhi, India

Objective: The present study was carried out to evaluate permeation/diffusion of chitosan topical gel formulation through skin. The permeation evaluation was carried out using radiometry and gamma Scintigraphy.

Materials and Methods: Chitosan was procured from Sigma Chemical Company, St. Louis, MO, USA. All other excipients and reagents were purchased from Merck, India. Technetium-99m pertechnetate was obtained from BRIT, BARC, India. Chitosan gel was prepared by dissolving chitosan powder in mixture of electrolyte and glacial acetic acid solution using magnetic stirrer for 24 h at 37°C. A highly viscous gel in homogenous nature was obtained. The obtained chitosan gel was radiolabelled with 99mTc. The binding efficiency of obtained chitosan gel with 99mTc was evaluated by thin layer chromatography i.e. 93%. In vitro studies, Male Albino Wistar rats (250-300 g) were sacrificed for obtaining their epidermis. The excised skin of animal was placed in phosphate buffer saline, pH 7.4 (PBS) at 60°C for 2 min. The radiolabeled gel was then spreaded over the skin and mounted on vertical Franz diffusion cell apparatus. Aliquots (1 ml) withdrawn at various intervals were immediately analyzed at 202 nm using UV Spectrometer. In vivo studies were performed on New Zealand white Rabbit. 99mTc chitosan gel is spreaded over the shaved skin of rabbit and scintigraphic images were taken by gamma camera.

Results: A highly viscous gel in homogenous nature was obtained. The binding efficiency of obtained chitosan gel with 99mTc was 93%. In vitro studies does not revealed any peaks in UV spectrum showing its non permeability through the rat skin and In vivo scintigraphic images established the fact that chitosan gel formulation do not permeates through skin with radiotracer labelled 99mTc Chitosan gel. The results were further confirmed with scintigraphic images.

Conclusion: The results of this investigation confirmed the non permeability of the developed chitosan gel and thus this bioactive product can be used in dressings which deliver substances in wound healing. From this study it is concluded that the formulation is safe for wound healing.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-10: Development and gamma scintigraphic evaluation of curcumin based microspheres for the treatment of Crohn's disease

Nazish Khan, Braj Gaurav Sharma1, Thakuri Singh1, Gaurav Mittal1, Aseem Bhatnagar1

Department of Pharmacy, Mahamaya Technical University, Noida, Uttar Pradesh, 1Department of Nuclear Medicine, INMAS, DRDO (Ministry of Defence), Timarpur, Delhi, India

Objective: Crohn's disease is a chronic inflammatory disease of the intestines. Curcumin, is a polyphenolic compound derived from dietary spice turmeric, possesses diverse pharmacologic effects including antioxidant, anti-inflammatory, antitumor and chemo protective effects. The aim of present study was to develop the slow release microsphere of curcumin and evaluate its release pattern in animal models by gamma scintigraphy.

Materials and Methods: Pure extracted curcumin was procured from Arbro Pharmaceutical Private Ltd. (New Delhi, India) and all other chemicals and reagents used were of analytical grade and purchased from Merck Chemicals (India). Curcumin was radiolabelled with 99mTc-pertechnetate by reduction method using stannous chloride as a reducing agent. Radiolabelled Curcumin was characterized for its radiolabeling stability at room temperature and as well as in biological fluid (serum). Optimized radiolabeled curcumin was used for microsphere preparation using gaur gum. Biodistribution studies of radiolabled microsphere was carried out at different time intervals (1 h, 2 h, 4 h, 6 h and 8 h) in six albino Wistar rats after oral administration. Subsequently the scintigraphic study was performed in healthy New Zealand white rabbits for confining the release of radiolabeled curcumin inside the gastrointestinal tract.

Result: Curcumin was radiolabeled with 99mTc showing radiolabling efficiency more then 96% in which approx 6% degradation was observed at a4 hour and found stable up to 24 h in-vitro as well as in-vivo studies. Biomembrane permeability of radiolablled curcumine was found to be 0.028 ± 0.001% and Bio-distribution study suggested, maximum concentration of drug was acumlated in stomach (39.45 ± 2.6%) and small intestine (6.237 ± 0.64%) after 1 h of oral administration. With time concentration of radiolabelled curcumin increased in small intestine and in colon. While at the end of 4 h, 39.59 ± 8.8% of administered dose was found in colon.

Conclusion: Present studies demonstrated that microspheres are capable of retarding the release of Curcumin until it reaches the colon, an environment rich in bacterial enzymes that degrade the polymer and allow drug release to occur at the desired site. Developed colon targeted microspheres of curcumin will be immense significant in the management of Crohn's disease.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-11: Quantitative assessment of lymphoscintigraphy in filarial lymphedema using 99mTc nanocolloid

K Shilpa, M Indirani, G Manokaran1, S Shelley

Departments of Nuclear Medicine, and 1Plastic Surgery, Apollo Hospital, Chennai, Tamil Nadu, India

Objective: To highlight the role of quantitative lymphoscintigraphy in the early diagnosis of filarial lymphedema.

Materials and Methods: Ninety-six patients were included in this prospective study with filarial lymphoedema of lower limbs referred by lymphologist (57 unilateral, 39 bilateral). The other leg of unilateral lymphedema considered clinically as normal. Twenty volunteers were also included in the study. 99mTc-nanocolloid 0.8 mCi was administered intradermally into first web space of both feet. Dynamic acquisition of inguinal region for 15 min with 1 min/frame rate followed by immediate, post exercise and 3 h delayed sweep images were acquired. All patients were graded clinically, qualitatively and quantitatively for both lower limbs. Time taken for radioactivity to reach inguinal region was measured with the help of time activity curve. Comparison of transit time of control group and all patients was done. Distribution of unilateral and bilateral clinical lymphoedema was assessed.

Results: Of 57 clinically normal legs 36 showed evidence of lymphedema on lymphoscintigraphy. Total 7 clinically affected limbs showed upgradation on qualitative lymphoscintigraphy. Transit time range of control group was 40.56-262.42 s. Based on this, of 57 clinically normal legs, 42 legs were abnormal. As compared to qualitative study 6 more limbs were considered abnormal. Transit time of all affected limbs was high as compared to control group. Data obtained from quantitative assessment used to calculate mean and range in each qualitative group.

Conclusion: Quantitative lymphoscintigraphy diagnosed subclinical lymphedema earlier than qualitative lymphoscintigraphy. In lower grades of lymphedema quantitative lymphoscintigraphy confirms findings of qualitative lymphoscintigraphy. Quantitative lymphoscintigraphy provides objective criteria for grading and avoids subjective variation as in qualitative lymphoscintigraphy.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-12: Phase analysis from gated myocardial perfusion single-photon emission computed tomography imaging: Application in patients with left bundle branch block

Labeeb Abrar

Department of Nuclear Medicine, PGIMER, Chandigarh, India

Aim: The aim was to study the application of phase analysis to identify those patients who could benefit from cardiac resynchronization therapy in patients with left bundle block (LBBB).

Materials and Methods: The study consisted of normal population of 50 patients with a low likelihood of conduction abnormalities and coronary artery disease and with normal stress myocardial perfusion (MPI) imaging findings. The LBBB population consisted of 68 patients with ECG evidence of LBBB and suspected or known coronary artery disease. They underwent adenosine stress MPI and processed using SyncTool™ (Emory Cardiac Toolbox™). The phase analysis of LBBB patients was defined as abnormal when the histogram bandwidth and/or the SD exceeded normal values of LV mechanical synchrony obtained from normal population.

Results: The phase standard deviation and histogram bandwidth were 17.9 ± 5.9 (mean ± 2 SD) and 34.6 ± 18.1 respectively for stress in normal population which were considered as normal values for LV mechanical synchrony. Left ventricular mechanical dyssynchrony (LVMD) was present in 47/68 patients (69%) of LBBB with phase standard deviation and histogram bandwidth of 34.5 ± 23 (P < 0.001) and 82.3 ± 44.1 (P < 0.001) respectively. Out of 24 patients who had prior myocardial infarction (MI), LVMD was present in 20 patients. 21/68 patients of LBBB had no LVMD. The mean left ventricular ejection fractions (LVEF) in patients with LVMD and in those without LVMD were 47.4 ± 13.1 and 69.3 ± 12.6 respectively and the difference was significant (P < 0.001).

Conclusion: In patients with LBBB, long QRS duration reflecting electrical dyssynchrony is not necessarily associated with the presence of LVMD. The semi-automatic and non-subjective phase analysis procedure helps in detecting LVMD in these patients, while giving additional information about LV perfusion and function, notably the LVEF, thereby helps in identifying subset of patients of LBBB who could benefit from cardiac resynchronisation therapy.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-13: To elucidate the genotype-phenotype relationship in non-syndromic craniosynostosis by analysing the mutations of the FGFR1 and FGFR2 gene with nuclear imaging test

Mayadhar Barik, Minu Bajpai, A Malhotra, JC Samantaray, SN Dwvedi

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Introduction: Non-syndromic Craniosynostosis (NSC) is a very heterogeneous group of disorders. Its etiology and pathophysiology play an important role in molecular genetics. Chromosomal alterations, mutation and polymorphism are causative mechanisms of non-syndromic forms of craniosynostosis, mutations of several genes are unequivocally associated with non-mendelian principles. Its inheritance patterns is strictly different fashion.

Materials and Methods: We performed a retrospective analysis of 120 subjects attending from 2007 to 2013. Clinically decided NSC cases in All India Institute of Medical Sciences, New Delhi, India. Genetic test done for FGFR 1, FGFR 2, FGFR2IIIa, FGFR2IIIb, FGFRIIIc, FGFR3 (FGFR group gene only). We compare with 99m Tc ECD SPECT/CT, MRI Brain, NCCT Skull and X-ray skull.

Results: 80% of gene in FGFR2 family (FGFR2IIIa, FGFR2IIIb, FGFR2IIIc genes) responsible rather than FGFR1, FGFR3, MSX2, TWIST1, RECQUL4, EFNB1, RAB23, FBN1, POR, TGFBR1 and TGFBR2 in previous results. 99m Tc ECD SPECT/CT gives better results and correlation with optimum perfusion level in both genotypic as well as phenotypic.

Conclusion: Elucidating the genotype-phenotype, genetic pattern, genes, and syndromes of NSC. FGFR2 IIIa, IIIb, IIIc has given 80% (120). However FGFR1, FGFR3 has observed lesser than the correlation with NSC. According to previous scientific literature, study, observation and older hypothesis we first reported and given our results to public health and justified that FGFR2 gene and its isomers FGFR2IIIa, FGFR2IIIb, FGFR2IIIc genes may be reliable for prognostic marker as well as 99m Tc ECD brain SPECT before,after the surgery and follow up of the patients used as diagnostic marker is more helpful for NSC in management, counselling, screening and better treatment for future.

Indian J Nucl Med. 2013 Dec;28(Suppl 1):S16–S20.

SC-NO-14: Utility of single-photon emission computed tomography/computed tomography in extraosseous uptake of 99mTc MDP on bone scan for primary bone sarcoma

Satyawati Deswal, Dhananjay Kumar Singh, Himanshu, Gaurav Sinha

Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Objective: We present two cases to emphasis the use of hybrid imaging single-photon emission computed tomography/computed tomography (SPECT-CT) to improve the accuracy and specificity of abnormalities detected on planar bone scan.

Materials and Methods: Bone scan is performed routinely in patients with primary malignant bone tumors for staging. We present 2 cases of primary bone sarcomas (a osteosarcoma and a Ewings sarcoma). A whole body bone scan was performed in both anterior and posterior projection on a 16 slice SPECT CT (Discovery NM 670). Subsequently a plain CT of thorax was also performed.

Results: On planar bone scan, there was increased uptake of 99mTc-MDP (99mTc-methylene diphosphonate) at the primary site. Multiple focal scattered abnormal increased tracer uptake were also noted in the thoracic cage, initially assumed to be localized in the ribs. SPECT/CT correctly identified them as pulmonary metastases.

Conclusions: The use of hybrid SPECT-CT combines the strength of anatomical and functional imaging, both of which help in the proper anatomical localization of focal uptake, and improves the overall diagnostic accuracy of bone scintigraphy. Additionally, exclusion of disease by identification of physiological uptake and accurate identification of anatomical sites of extraosseous focus increases the specificity of bone scintigraphy.

Articles from Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India are provided here courtesy of Wolters Kluwer -- Medknow Publications

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