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There was a strong association between ischemia on MPI and CAC seen on CTAC (P less then 0.01), dyslipidemia (P less then 0.01), family history of CAD (P less then 0.05), smoking (P less then 0.01), and type of malignancy (P less then 0.01). Conclusion A strong association exists between visual estimation of CAC on CTAC and MPI. Zero is highly associated with normal MPI, but moderate-to-severe CAC is associated with abnormal MPI, in addition smoking, dyslipidemia, and certain cancer are associated with ischemic MPI; subsequently, preoperative cardiac testing is warranted in these subsets of patients. Saracatinib Copyright © 2020 Indian Journal of Nuclear Medicine.Background/Aims Esophageal transit scintigraphy (ETS) is a useful tool for evaluating esophageal motility disorders, although conflicting results are seen due to lack of ideal bolus. Semisolid/solid boluses have shown superiority over liquid boluses, and the present study aims to establish the utility of in-house-prepared bolus in normal volunteers and its comparison with liquid bolus. Materials and Methods Thirty-three healthy volunteers were selected for ETS with in-house-prepared semisolid bolus jelly containing 99mTc-sulfur colloid. Dynamic studies were acquired in anterior projection with single swallow for both supine and sitting positions. T90% esophageal emptying time (EET) was calculated for whole and three equally divided segments of esophagus and also done with liquid bolus on different day. Results The median value of EET for semisolid bolus for whole esophagus in sitting and supine positions was 11.7 s (interquartile range [IQR] 8.0-16.7) and 17.7 s (IQR 12.0-33.0). EET of liquid bolus for whole esophagus in sitting and supine positions was 9.3 s (IQR 8.0-13.3) and 13.0 s (IQR 9.7-25.0), respectively. Significantly different EET for whole esophagus and lower one-third esophagus between sitting and supine positions was seen for semisolid (whole esophagus;P = 0.003, lower one-third esophagus; P = 0.025) and liquid boluses (whole esophagus; P = 0.032, lower one-third esophagus; P = 0.016). Comparing EET using semisolid and liquid boluses, only lower one-third esophagus in supine position showed significant difference (P = 0.033). Conclusions In-house-prepared semisolid radiolabeled jelly is inexpensive, easy to prepare with good radiolabeling. Condensed dynamic images from semisolid bolus were better, sharper, and reproducible in comparison to liquid bolus without fragmentation. This study standardized semisolid bolus and verified its suitability for clinical use. Copyright © 2020 Indian Journal of Nuclear Medicine.Purpose Graves' disease (GD) is the most common cause of hyperthyroidism. It was reported that the right thyroid lobe is generally larger, and it is more likely to be affected by thyroid disorders. The aim of the current study is to verify preferential affection of one of the thyroid lobes and incidence of higher activity of either thyroid lobe in patients with GD through analysis of quantitative data of Tc-99m thyroid scan and possible relation of different thyroid lobar activity to gender, age, and total thyroid uptake (TTU) level. Materials and Methods Retrospective analysis of quantitative data of Tc-99m thyroid scan in patients with GD was done. Total and lobar thyroid uptake levels were analyzed and correlated with age, gender, and TTU. Results GD was reported in 222 patients, representing 76.6% of those with hyperthyroidism, women represent 70.3% of patients. The right thyroid lobe uptake (RLU) figures were significantly higher compared to the left in the whole group as well as in women and in young patients (30% had higher RLU figures. Conclusion There is significant preferential thyroid lobar affection in favor of the right thyroid lobe in patients with GD, with significantly higher RLU figures and significantly more incidence of patients with higher right lobar activity. This significance is maintained in women and in young patients and lost in men and old patients. The incidence of higher right thyroid lobe activity also increases in association with increase in TTU. Our results emphasize the value of Tc99m thyroid scan in patients with GD, especially when surgery is the treatment of choice, helping to tailor suitable surgical procedure for each individual patient. Copyright © 2020 Indian Journal of Nuclear Medicine.Purpose of the Study Well-differentiated thyroid carcinomas have good prognosis, but as it de-differentiates, the survival rates go down. Early identification of such patients needs a marker which indicates the dedifferentiation process. CYFRA 21.1 has also shown to be increased in patients with 131I refractory thyroid cancer. We tested whether CYFRA 21.1 can differentiate between 131I avid and refractory tumors. Methodology Well-differentiated thyroid cancer patients with known distant metastases were accrued and tested for stimulated and unstimulated thyroglobulin and CYFRA 21.1. All patients underwent 131I whole-body scan, 131I post therapy scan, and 18F-Fluorodeoxyglucose positron emission tomography-computed tomography. Those with even a single 131I nonavid lesion were considered 131I refractory disease. CYFRA 21.1 of both 131I avid and nonavid was compared, and CYFRA 21.1 levels against disease extent were analyzed. Results CYFRA 21.1 levels were significantly elevated in 131I refractory group. A cutoff value of 2.07 ng/ml distinguished between 131I avid and refractory disease with high sensitivity and specificity (88% and 89. 7%, respectively). However, CYFRA 21.1 levels were similar in patients when analyzed based on disease sites. Conclusion CYFRA 21.1 can be utilized to differentiate between 131I avid and refractory diseases. Further long-term studies are required to use it as a predictive and prognostic marker. Copyright © 2020 Indian Journal of Nuclear Medicine.Background In diabetic (DM) patients, hyperglycemia degrades image quality in F-18 FDG PET CT by altering bio-distribution of FDG in the body and augmenting soft tissue and muscular uptake. We intend to evaluate the use of short acting I.V insulin in minimising the rescheduling of patients detected with FBG>160 mg/dL on the day of scan. Aim and Objectives To show the utility of short acting IV insulin therapy in preparation of cancer patients incidentally detected with high blood glucose levels for F-18 FDG PET CT scan, (>160mg/dL) and to compare the obtained image quality with patients detected with fasting blood glucose level (FBG) 160 mg/dL, Group II (n=349) DM patients with FBG less then 160 mg/dL (100-160mg/dL), Group III (n=234) Non DM patients FBG less then 100mg/dL. In Group I short acting insulin was given intravenously using a sliding scale, post insulin after 90 minutes F-18 FDG (radiotracer) injection was given and PETCT scan was obtained 60 mins post radiotracer injection. Qualitative image analysis was done using biodistribution score and quantitative analysis was done by chi square test, ANOVA (analysis of variance) and paired t-test.
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