MyMedR

A Rare Case of Isolated Pericardial Effusion Detected by SPECT/CT on a Post-Therapeutic Radioiodine Whole-Body Scan

Tan TH, Hassan SZ

Nucl Med Mol Imaging, 2015 Sep;49(3):246-7.

PMID: 26279701 DOI: 10.1007/s13139-015-0330-8

We reported a rare finding of isolated pericardial uptake detected by SPECT/CT on posttherapeutic radioiodine whole body scan. This case highlights the usefulness of hybrid SPECT/CT, with subsequent correlation with biochemical results, in ruling out metastatic pericardial effusion in the postsurgical radioiodine remnant ablation setting. The effusion was resolved after reinstituted thyroid replacement therapy. Recombinant thyrotropin is recommended to avoid such rare but life-threatening complication.

Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma

Wong TH, Amir Hassan SZ

Med J Malaysia, 2015 Dec;70(6):356-7.

PMID: 26988209

This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Incidental Finding of Endometrioid Adenocarcinoma of the Ovary on 131I Whole-Body Scan

Mohd Rohani MF, Amir Hassan SZ

Clin Nucl Med, 2022 Jan 01;47(1):e20-e22.

PMID: 34028418 DOI: 10.1097/RLU.0000000000003698

A 57-year-old woman was referred for radioactive iodine therapy 12 weeks after completion thyroidectomy and left modified radical neck dissection for pT2N1Mx follicular variant papillary thyroid carcinoma. After 4 weeks of l-thyroxine withdrawal, stimulated serum thyroglobulin level was less than 0.1 ng/mL with positive thyroglobulin antibody. Posttherapy 131I scintigraphy with SPECT/CT of the head and abdominopelvic region showed thyroid residual in the neck, occipital bone metastasis, and heterogenous tracer uptake in a large peritoneal mass, likely arising from the left ovary. Left salpingo-oophorectomy was performed, and histopathologic examination revealed endometrioid carcinoma of left ovary.

Fulltext Diagnostic Value of (68)Ga-DOTATATE PET/CT in Liver Metastases of Neuroendocrine Tumours of Unknown Origin

Tan TH, Lee BN, Hassan SZ

Nucl Med Mol Imaging, 2014 Sep;48(3):212-5.

PMID: 25177378 DOI: 10.1007/s13139-013-0258-9

PURPOSE: In neuroendocrine liver metastases of unknown primary, a multimodality approach is usually adopted and consists of transabdominal ultrasound, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine techniques, endoscopy and exploratory surgery. The purpose of the study is to evaluate the diagnostic value of (68)Ga-DOTATATE positron emission tomography (PET)/CT as part of a multimodality approach in neuroendocrine liver metastases of unknown primary.

MATERIALS AND METHODS: Six patients (M:F = 5:1, age range 28-56 years) with immunohistochemically proven neuroendocrine liver metastases but inconclusive initial CT work-up were retrospectively analysed. Clinical finding, histopathology, comparative imaging and follow-up were used to validate the results when ethically justified.

RESULTS: (68)Ga-DOTATATE PET/CT identified the primary tumour in five out of six (83.3 %) patients: pancreas (n = 4) and stomach (n = 1). Out of three patients with indeterminate primary on initial CT, two patients were confirmed by (68)Ga-DOTATATE PET/CT. Absence of uptake in indeterminate primary of one patient was later confirmed negative by histopathology. In another three patients with undetected primary on initial CT, primary site was demonstrated in all patients with unsuspected metastases in two patients on (68)Ga-DOTATATE PET/ CT. No further work-up was done to confirm the primary in patients with distant metastases. Change of management was observed in three out of six (50 %) patients.

CONCLUSION: Our small study indicates that (68)Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin.

Unusual Bone Superscan, MIBG Superscan, and 68Ga DOTATATE PET/CT in Metastatic Pheochromocytoma

Tan TH, Wong TH, Hassan SZ, Lee BN

Clin Nucl Med, 2015 Nov;40(11):867-8.

PMID: 26252329 DOI: 10.1097/RLU.0000000000000920

A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.

Myocardial Perfusion Scintigraphy in a Patient With Transposition of Great Arteries Post-Atrial Switch Surgery

Mohd Radzi A, Boey CY, Amir Hassan SZ

Clin Nucl Med, 2023 Aug 01;48(8):727-728.

PMID: 37220239 DOI: 10.1097/RLU.0000000000004700

We report a case of a 33-year-old woman who underwent stress and rest myocardial perfusion scintigraphy (MPS) to exclude coronary artery disease. MPS images showed an apparent dextrocardia with a right-sided septal wall uptake. The electrocardiograph showed a right axis deviation with dominant R waves at leads aVR and V1. Upon retrieval of the patient's medical records, she had an underlying transposition of great arteries and underwent a Senning atrial switch surgery. Hence, the MPS images demonstrated a prominent right ventricular wall due to its function as the "systemic" ventricle with minimal uptake in the "pulmonary" left ventricle.

Giant Liver Hemangioma Mimicking a Hydronephrotic Kidney on 99mTc-DTPA Scintigraphy

Boey CY, Mohamed Aslum Khan F, Amir Hassan SZ

Clin Nucl Med, 2021 Jan;46(1):88-89.

PMID: 33181737 DOI: 10.1097/RLU.0000000000003368

We report a case of a 56-year-old woman who underwent Tc-DTPA renal scintigraphy for the evaluation of a right pelviureteric junction calculi, which incidentally showed radiotracer uptake in a giant liver hemangioma. The initial scintigraphic images showed a large lobulated lesion with peripheral uptake of radiotracer at the right abdominal region, resembling a large hydronephrotic kidney. However, the pattern of progression of the radiotracer, coupled with the clinical history and available corresponding radiologic images, confirmed the uptake to be that of a giant liver hemangioma.

Fulltext Dual thyroid ectopia with graves' disease: a case report and a review of the literature

Tan TH, Lee BN, Amir Hassan SZ, Ch'ng ES, Hussein Z

Nucl Med Mol Imaging, 2012 Dec;46(4):300-3.

PMID: 24900078 DOI: 10.1007/s13139-012-0160-x

Ectopic thyroid or thyroid ectopia is a rare developmental anomaly with the prevalence of 1 per 100,000-300,000 population. Even rarer, such an anomaly manifests as dual thyroid ectopia. To our best knowledge, only one case has been reported on dual thyroid ectopia with Graves' disease in the English literature. We present here a case of dual thyroid ectopia complicated by Graves' disease, whereby the diagnosis was rendered through judicious use of various diagnostic modalities coupled with a close clinical follow-up. In this case, therapeutic consideration should be personalized with proper informed consent of the patient.

Value of Baseline Post-Transplant MAG3 Renal Scintigraphy in the Evaluation of Graft Function

Boey CY, Yee SY, Amir Hassan SZ, Yahya R, Hashim H

Transplant Proc, 2022 Jan 24.

PMID: 35086676 DOI: 10.1016/j.transproceed.2021.12.016

INTRODUCTION: Accurate assessment of renal graft function in the early post-transplant period is crucial, as it influences clinical management and graft prognostication. However, there are limitations in current available modalities. MAG3 scintigraphy could contribute vital information on graft function.

OBJECTIVES: This study aimed to determine the predictive value of parameters derived from MAG3 performed within 72 hours post transplant in detecting graft function. Delayed graft function (DGF), which is defined as dialysis requirement within the first week post transplant, is chosen as a surrogate measure of graft function.

METHODOLOGY: All renal transplant recipients who underwent MAG3 within 72 hours post transplant from 2017 to 2019 were enrolled. Three MAG3 parameters, renogram grade, tubular injury severity score, and R20:3, were evaluated.

RESULTS: A total of 117 patients were enrolled. The overall incidence of DGF was 16.2% with a significantly higher incidence amongst cadaveric graft recipients (53.6%) compared with living graft recipients (4.5%). Renogram grade ≥2, tubular injury severity score ≥4, and R20:3 > 1.31 significantly predicted DGF, P < .05 with high area under the curve for R20:3 of 0.97. Grafts with parameters above the cutoffs also showed significantly worse GFR at 1- and 3-months post-transplant. On multivariate analysis, prolonged cold ischemia time was associated with a higher risk of DGF, odds ratio 1.005 (95% confidence interval 1.003-1.007), P < .05.

CONCLUSION: Baseline MAG3 accurately depicts early graft function and was also predictive of GFR at 1- and 3- months post-transplant. These baseline MAG3 scans could be particularly useful amongst deceased donor graft recipients owing to the higher risk of poor graft function.

Concurrent Benign Iodine-Avid Thymic and Liver Cysts Mimicking Metastatic Disease on 131I Whole-Body Scintigraphy

Kamarulzaman K, Mohd Rohani MF, Mat Nawi N, Amir Hassan SZ

Clin Nucl Med, 2024 Mar 01;49(3):250-252.

PMID: 38306377 DOI: 10.1097/RLU.0000000000005037

A 57-year-old woman received radioiodine therapy post total thyroidectomy for pT3aNxMx follicular thyroid carcinoma. Posttherapy 131I whole-body scan showed 131I concentration in the chest, mediastinum, and left upper thigh with stimulated thyroglobulin (Tg) of 89 μg/L. Subsequent radioiodine therapies showed persistent 131I accumulation in the anterior mediastinal soft tissue lesions and a hypodense segment VII liver lesion visualized on SPECT/CT, suggestive of iodine-avid metastatic disease despite the undetectable serum Tg (<1.0 μg/L) with no Tg antibody interference. Biopsy of the liver lesion revealed liver cyst, and consequent removal of the mediastinal lesions showed benign thymic cysts.

Metabolic Superscan on 18 F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

Mohd Rohani MF, Bujang NL, Rosdi AH, Amir Hassan SZ

Clin Nucl Med, 2024 Jan 01;49(1):e19-e21.

PMID: 37883221 DOI: 10.1097/RLU.0000000000004941

Superscan on PET/CT has been reported in the literature and mainly involved metastatic diseases. We report an uncommon case of a metabolic superscan on 18 F-FDG PET/CT in a 56-year-old man with end-stage renal disease on hemodialysis who presented with secondary hyperparathyroidism. Parathyroid scintigraphy showed 2 lesions posteroinferior to both thyroid lobes, suggestive of parathyroid adenoma/hyperplasia. FDG PET/CT performed to assess for pulmonary nodules revealed diffuse FDG hypermetabolism involving the visualized skull, mandible, spine, sternum, ribs, and appendicular skeleton without corresponding CT lesion with no urinary radiotracer excretion, consistent with metabolic superscan secondary to renal osteodystrophy.

Bone single-photon emission computed tomography/computed tomography in cancer care in the past decade: a systematic review and meta-analysis as well as recommendations for further work

Mohd Rohani MF, Zanial AZ, Suppiah S, Phay Phay K, Mohamed Aslum Khan F, Mohamad Najib FH, et al.

Nucl Med Commun, 2021 Jan;42(1):9-20.

PMID: 33165258 DOI: 10.1097/MNM.0000000000001306

Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91-0.95] and 96.0% (95% CI 0.94-0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works.

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