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Gastrointestinal neuropathies are frequently found in diabetic patients. The aim of this study was to find out the safety, adverse reactions, and long-term effectiveness of Pistacia lentiscus plant extract (mastic gum) in diabetic gastroparesis (DG) with respect to sustainable improvement in gastroparesis symptoms (Gastrointestinal Cardinal Symptom Index [GCSI] score) by observational follow-up study of a single-centric double-blind noninferiority randomized control trial. Thirty-eight individuals were recruited and equally randomized in two study groups based on GCSI score and TC[sup.99] radionuclide gastric emptying scintigraphy (GES), i.e. the mastic gum group and the levosulpiride group. After 24 weeks, the GCSI score was recalculated in both the groups, and patients were evaluated for the safety, adverse reactions, and long-term effectiveness of mastic gum and the standard drug levosulpiride. In the extended study, mean GCSI score changes at 24 weeks were statistically significant (P < 0.001) (t-test) between the two groups. In the mastic gum arm, the change in mean GCSI score at 24 weeks was statistically nonsignificant mean ± (standard deviation [SD]) 16.7± (3.81) compared to the GCSI score at 2-month postintervention mean (SD) 16.35± (2.27) (intragroup P = 0.89) (repeated measures ANOVA). It strongly indicates that mastic gum provided a sustainable improvement in DG symptoms in comparison to levosulpiride, with excellent subjective well-being postintervention, without any obvious significant adverse effects. Six-month (24-week) interim analysis of patients suggests that mastic gum gives a sustainable improvement in DG symptoms without any obvious adverse effects as compared to levosulpiride.

In 194 cases featuring over 450, high-quality images, Nuclear Medicine and PET/CT Cases provides a succinct review of clinically relevant cases covering the full range of nuclear medicine. Cases are grouped into sections including: Nuclear CNS Imaging, Nuclear Inflammation/Infection Imaging, Ventilation/Perfusion Lung Scintigraphy, Pediatric Nuclear Medicine, Cardiac Imaging, Bone Scintigraphy, PET/CT in Oncology, General Oncologic Imaging, Thyroid and Parathyroid, Radionuclide Therapy and Pre-Therapy Evaluation, Liver, Spleen and Biliary Tract, Gastrointestinal Tract, Renal Scintigraphy. Part of the Cases in Radiology series, this book follows the easy-to-use format of question and answer in which the patient history is provided on the first page of the case, and radiologic findings, differential diagnosis, teaching points, next steps in management, and suggestions for furthering reading are revealed on the following page. This casebook is an essential resource for radiology residents and practicing radiologists alike.

Objectives: This study aims to evaluate the effectiveness and role of telomere length measurements in leukocytes, plasma free cell DNA (cfDNA), and biopsy cells, along with technetium-99m (Tc-99m) methoxyisobutylisonitrile (MIBI) scintigraphy, as non-invasive methods for diagnosing malignant thyroid lesions. Methods: Data from 128 patients, who underwent ultrasound, Tc-99m MIBI scintigraphy, and fine-needle biopsy with a preliminary diagnosis of malignant thyroid nodules, were analyzed. In 98 patients, telomere lengths in leukocytes (from blood), cfDNA (from plasma), and biopsy cells were measured using the quantitative polymerase chain reaction method, and the relative telomere/single copy gene (T/S) ratio was calculated. Based on cytological examination results, patients were categorized into three groups: malignant, benign, and suspicious. Group differences were analyzed using the Kruskal-Wallis and Chi-square tests, and correlations between variables were examined with Spearman correlation analysis. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tc-99m MIBI scintigraphy for diagnosing malignant thyroid nodules were 64.70%, 79.16%, 29.72%, 83.51%, and 67.96%, respectively. While these results align with the literature, the positive predictive value was notably lower. No significant differences were observed in telomere lengths (T/S ratios) in leukocytes, plasma, or tissue between the groups. Conclusion: Tc-99m MIBI scintigraphy demonstrates reasonable diagnostic accuracy for identifying malignancy in thyroid nodules. Contrary to limited reports, telomere length measurements may not be a reliable method for predicting thyroid malignancy. Larger studies are needed to further explore these findings. Keywords: Thyroid cancer, technetium-99m methoxyisobutylisonitrile scintigraphy, cell DNA, liquid biopsy, circulating tumor DNA, telomere Ama : Bu alisma, l kositlerde, plazma serbest h cre DNA'sinda (cfDNA) ve biyopsi h crelerinde telomer uzunlugu l mleri ile teknesyum-99m (Tc-99m) metoksiizob tilizonitril (MIBI) sintigrafisinin, k t huylu tiroid lezyonlarinin teshisinde non-invaziv y ntemler olarak etkinligini ve rol n degerlendirmeyi ama lamaktadir. Y ntem: Malign tiroid nod lleri n tanisi konulan ve ultrason, Tc-99m MIBI sintigrafisi ve ince igne biyopsisi uygulanan 128 hastanin verileri analiz edilmistir. Doksan sekiz hastada, l kositlerde (kandan), cfDNA'da (plazmadan) ve biyopsi h crelerinde telomer uzunluklari kantitatif polimeraz zincir reaksiyonu y ntemiyle l lm s ve g receli telomer/tek kopya gen (T/S) orani hesaplanmistir. Sitolojik inceleme sonu larina g re hastalar; k t huylu, iyi huylu ve s pheli olmak zere gruba ayrilmistir. Gruplar arasi farklar Kruskal-Wallis ve ki-kare testleriyle analiz edilmis, degiskenler arasindaki korelasyonlar Spearman korelasyon analizi ile degerlendirilmistir. Bulgular: Tc-99m MIBI sintigrafisinin k t huylu tiroid nod llerini teshis etmedeki duyarlilik, zg ll k, pozitif ng r degeri, negatif ng r degeri ve dogruluk oranlari sirasiyla %64,70, %79,16, %29,72, %83,51 ve %67,96 olarak bulunmustur. Bu sonu lar literat rle uyumlu olmakla birlikte, pozitif ng r degerinin belirgin sekilde d s k oldugu g zlemlenmistir. L kosit, plazma veya doku rneklerindeki telomer uzunluklari (T/S oranlari) a isindan gruplar arasinda anlamli bir fark bulunmamistir. Sonu : Tc-99m MIBI sintigrafisi, tiroid nod llerinde malignitenin tespitinde makul bir tanisal dogruluk sunmaktadir. Ancak sinirli raporlara ragmen, telomer uzunlugu l mlerinin tiroid malignitesini ng rmede g venilir bir y ntem olmayabilecegi anlasilmaktadir. Bu bulgularin daha kapsamli alismalarla arastirilmasi gerekmektedir. Anahtar kelimeler: Tiroid kanseri, teknesyum-99m metoksi izob tilizonitril sintigrafi, h cre DNA'si, sivi biyopsi, dolasan t m r DNA'si, telomer

Shedding light on Hidradenitis Suppurativa activity: a pilot study to evaluate the potential of [[sup.99m] Tc]Tc-anti-TNF-alpha scintigraphy. Background/Objectives : Hidradenitis suppurativa (HS), also known as acne inversa and Verneuil’s disease, is a chronic and non-contagious auto-inflammatory disease of pilo-sebaceous units that can lead to severe complications and sequelae. The actual prevalence of HS is unknown due to diagnostic delay and/or misdiagnosis, but it is estimated to affect 0.00033–4.1% of the general population worldwide. Only severe cases are referred for imaging assessment, and the final diagnosis is mostly established on a clinical basis. Here, we present a pilot study aiming to evaluate clinically active inflammatory disease in patients with HS using [[sup.99m] Tc]Tc-anti-TNF-alpha scintigraphy. Methods : Four patients (2 male, 2 female) had their HS clinical features measured through the HS-PGA and Hurley Score and compared to [[sup.99m] Tc]Tc-anti-TNF-alpha scintigraphy findings. Results : Scintigraphy with [[sup.99m] Tc]Tc-anti-TNF-alpha showed abnormal uptake in clinically active lesions of HS and also detected some clinically unknown potential active lesions, later confirmed by clinical reassessment after the imaging. Conclusions : Our results suggest that scintigraphy with [[sup.99m] Tc]Tc-anti-TNF-alpha may be able to detect increased radiotracer uptake in most clinically identified active lesions in this pilot cohort. While promising, due to the inherent limitations of this pilot study, more studies need to be carried out to arrive at a definitive diagnostic assessment of active inflammatory disease using this method.

Cardiac amyloidosis, once considered untreatable, is now gaining well-deserved attention due to advances in imaging and the recent approval of targeted breakthrough therapies. In this paper, we discuss the role of radionuclide imaging in the evaluation and management of patients with the most common form of amyloidosis—cardiac transthyretin amyloidosis (ATTR). We provide a comprehensive summary of the literature interspersed with our institutional experience as appropriate, to deliver our perspective.

Spondyloepiphyseal dysplasia tarda (SEDT) is a rare X-linked skeletal disorder affecting the spine and long bones, leading to short stature, spinal deformities, and joint stiffness. It is caused by genetic mutations, and primarily affects males. Diagnosis is confirmed by imaging and genetic testing. We report the case of a 33 years old patient with a history of X-linked SEDT, who presented with pain in the lower limbs and pelvis, accompanied by limited mobility. Bone scan with [.sup.99m]Tc-methylene diphosphonate (MDP) revealed a polyostotic SEDT involvement, periarticular ossifications, and bony bridges in the active phase. The authors highlight the role of bone scan with [.sup.99m]Tc-MDP in diagnosing this rare disease.

There is no gold standard indicator that is currently used to predict posthepatectomy liver failure (PHLF). A novel indicator of liver function, the LU15 index of .sup.99m Tc-galactosyl serum albumin (GSA) scintigraphy, refers to the liver uptake ratio over a 15-min interval. We aimed to evaluate the usefulness of the future liver remnant (FLR)-LU15 in predicting PHLF. The clinical data of 102 patients (70 males and 32 females; median age, 70 years) who underwent liver resection between January 2011 and August 2019 were analyzed. The FLR-LU15 was calculated by a fusion of simulated 3-dimensional images and .sup.99m Tc-GSA scintigraphy. PHLF was determined according to the definition of the International Study Group of Liver Surgery. The FLR-LU15 was an independent risk factor for PHLF [greater than or equal to] Grade B according to multivariate analysis, and its value correlated with the PHLF grade. The area under the receiver operating characteristic curve of the FLR-LU15 for PHLF [greater than or equal to] Grade B was 0.816 (95% confidence interval, 0.704-0.929), which was better than that of other indicators. When the cut-off value of FLR-LU15 was set at 16.7, the sensitivity was 86.7%, specificity was 74.7%, and odds ratio was 19.2 (95% confidence interval, 4.0-90.9), all of which were superior to other indicators. If the cut-off value was 13, the positive predictive value was 57.1%. The FLR-LU15 is a useful predictor of PHLF and may be more reliable than other predictors.

Although extrapulmonary Coccidioides infection is rare, it has been shown to disseminate to the skin and musculoskeletal system, with a strong affinity for bone. We present a case of disseminated Coccidioides infection with bone scintigraphy indicating diffuse fungemia despite equivocal serum assay, leading to appropriate antifungal therapy and a full recovery.

A 62-year-old male patient, with bladder carcinoma, was referred to our institution for Technetium-99m methylene diphosphonate bone scintigraphy to assess for bone metastasis. While the bone scan showed no abnormal uptake, extraosseous uptake was detected in the left perirenal and pelvic regions on the whole body scan. Computed tomography showed fornix rupture and demonstrated tracer pooling in the perirenal collection. Our diagnosis was very consistent, and oriented the therapeutic attitude towards a percutaneous drainage for the perinephric urinary leak.

Background Split kidney function (SKF) is critical for treatment decision in pediatric patients with hydronephrosis and is commonly measured using renal scintigraphy (RS). Non-contrast-enhanced magnetic resonance urography (NCE-MRU) is increasingly used in clinical practice. This study aimed to investigate the feasibility of using NCE-MRU as an alternative to estimate SKF in pediatric patients with hydronephrosis, compared to RS. Methods Seventy-five pediatric patients with hydronephrosis were included in this retrospective study. All patients underwent NCE-MRU and RS within 2 weeks. Kidney parenchyma volume (KPV) and texture analysis parameters were obtained from T2-weighted (T2WI) in NCE-MRU. The calculated split KPV (SKPV) percent and texture analysis parameters percent of left kidney were compared with the RS-determined SKF. Results SKPV showed a significant positive correlation with SKF ( r  = 0.88, p  < 0.001), while inhomogeneity was negatively correlated with SKF ( r  =  − 0.68, p  < 0.001). The uncorrected and corrected prediction models of SKF were established using simple and multiple linear regression. Bland–Altman plots demonstrated good agreement of both predictive models. The residual sum of squares of the corrected prediction model was lower than that of the uncorrected model (0.283 vs. 0.314) but not statistically significant ( p  = 0.662). Subgroup analysis based on different MR machines showed correlation coefficients of 0.85, 0.95, and 0.94 between SKF and SKPV for three different scanners, respectively ( p  < 0.05 for all). Conclusions NCE-MRU can be used as an alternative method for estimating SKF in pediatric patients with hydronephrosis when comparing with RS. Specifically, SKPV proves to be a simple and universally applicable indicator for predicting SKF. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information