Diagnostic Imaging

injury and the remaining 38 were operated on at 1 month or later after injury. The Allogeneic bone plug-free tendons such as Achilles, tibialis anterior or posterior tendons were prepared as a single graft of 8 to 10 mm, arthroscopically introduced into the knee joint through a tibial tunnel to a femoral drill hole in the center of the ACL footprint. The graft was fixed using screw posts or buttons via two-incision technique. ROM exercise was started at 2 weeks. Partial weight bearing was allowed at four weeks, followed by full weight bearing at six weeks. Jogging was recommended at 5 months, followed by sports activity at 10 months. At followup, the patients were evaluated subjectively and objectively according to the IKDC evaluation form. Knee stability was measured by KT2000™ knee arthrometer. Osteoarthritic changes were assessed by weight bearing knee flexion X-ray, and thigh muscle strength was analyzed by Cybex II™ or Biodex™.

A 70-year-old woman with a high pretest likelihood of coronary artery disease (CAD) underwent a Tc-99m MIBI SPECT-CT study for myocardial perfusion imaging (MPI), which was complemented by a high-resolution volume CT (VCT) study. After attenuation correction, an MPI pattern of ischemia was detected in the lateral wall of the myocardium. The CT calcium score (CTCS) was above the 75th percentile. The CT angiography (CTA) demonstrated a 70% stenosis at the ostial part of the circumflex artery, and incidentally revealed a saccular aneurysm. In today's nuclear cardiology, low-dose SPECT-CT plus high-resolution VCT allows anatofunctional assessment of suspected CAD.

Lymphatic mapping and sentinel lymphadenectomy (LM/SL) have been successfully used in pre-treatment nodal staging of gynaecological cancers. We hypothesised the added-value of LM/SL plus SPECT/CT in patients with early stage of cervical cancer and vulvar cancer. A prospective, single-center, diagnostic, open label, active control, non-randomized clinical trial has been conducted in 7 patients with FIGO IA-IB1 cervical cancer and 7 patients with FIGO stage I-II-IIIcN0 vulvar cancer. All patients underwent LM/SL plus SPECT/low-dose CT and complete lymph node dissection (CLND) according to the standard of care. In case of negative hematoxylin-eosin staining, serial sections of the SLNs were analysed by immunohistochemistry and high molecular weight cytokeratin. Primary outcome measures were the detection rate, the sensitivity (SV), the negative predictive value (NPV), the diagnostic accuracy (DA) for anatomic localisation of SLNs, and the impact on management of SPECT/CT guided LM/SL versus CLND. The secondary outcome measure was the patient tolerability and operating time of LM/SL guided SPECT/CT versus CLND. http://clinicaltrials.gov/show/NCT00773071 All 14 patients were enrolled into the 1-day research protocol with dual-tracer LM/SL and SPECT/CT. Additional SLNs were detected on SPECT/CT compared to conventional planar imaging. Hot and cold > 1cm SLNs were detected on SPECT/CT. Detection rate, SV, NPV, DA were 100% in both groups; false negative rate was 0%. Rate of SLN metastases was 28.5% in cervical cancer and 42.9% in vulvar cancer. Impact on treatment was 28.5% and 14.3% in cervical cancer and vulvar cancer patients, respectively. SPECT/CT was well tolerated by all patients and operating time for LM/SL was within 30 min. No adverse events were reported with a time frame of 1-to-3 years. In early stage of gynaecological cancers, SPECT/low-dose CT is technically feasible and of clinical added-value for LM/SL.

Diets containing essentially no fat, 1-2 g fat per day, have resulted in cholesterol gallstones. Greater fat may result in less gallbladder stasis. Do gallstones form with greater fat content? We studied 272 moderately obese subjects who had normal gallbladder ultrasonograms. The 900 kcal/day liquid diets contained either 16 g fat (N = 94) or 30 g fat (N = 178) each day for 13 weeks. A second gallbladder ultrasound was performed. Sixteen of 94 (17.0%) of the 16-g fat group developed stones with a weight loss of 18 (+/- 7) kg and a body mass index (BMI) decrease of 6 (+/- 2) kg/m2. Twenty of 178 (11.2%) of the 30-g fat group developed stones (P = 0.18, no difference in stone formation) with similar weight loss of 20 (+/- 7) kg (P = 0.08) and BMI decrease of 7 (+/- 2) kg/m2 (P = 0.04). Substantial fat for rapid weight-reducing diets resulted in gallstone formation. Since experiments have shown that our higher fat diet, containing 10 g fat per meal, results in maximal gallbladder empty...

Abstract: Hybrid imaging is becoming a popular technology in nuclear medicine. We have evaluated the added value of an integrated SPECT/low-dose multislice CT over conventional planar/SPECT nuclear imaging. Phantom and clinical studies were performed on the Infinia ™ Hawkeye ™ 4 slice (HWK-4) with an upgraded software package (Xeleris 2.05v) from GE Heatlthcare to assess 1) the benefit of CT for contrast-resolution, attenuation correction, and anatomic localisation; 2) the impact of hybrid imaging in 456 consecutive patients in a clinical setting. SPECT/CT data were compared to conventional planar/SPECT data and correlated to clinical, biochemical, morphological imaging, angiography, and pathology findings. SPECT/CT was well tolerated by the patients with minimal CT irradiation dose (< 2mSv). HWK-4 provided useful attenuation correction for its routine use in MPI and accurate anatomic localisation of physiological and pathological foci in

Purpose: To assess the advantages and limitations of a low-dose CT (max current = 2.5mA, max voltage = 140kV) incorporated into a dual-head gamma-camera. Method: We evaluated the usefulness of an integrated SPECT-CT (Infinia-Hawkeye-4, GE Healthcare) for clinical and research purposes. Accordingly, phantom experiments and clinical studies were conducted in various clinical routine indications. The CT performances were evaluated in terms of image quality and clinical impact. SPECT-CT data were correlated to diagnostic CT, and MRI. Results: In cardiac studies (n=140), attenuation maps generated by a lowcurrent CT (2.5 mA) allowed an effective attenuation correction. Moreover, a minimal current of 1.0 mA was found feasible for a reliable attenuation correction. In non-cardiac studies (n=400), the low-dose CT was found primarily useful for anatomic localization of equivocal or ill-defined hot spots, especially in parathyroid studies, posttherapy 131I survey, 99mTc-labelled white or red ...

Background: The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery. Methods: We reviewed the pre-and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH. Results: We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre-and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P<0.0001. The diameter of pre-existing HH 2.8 (±1.8) cm was significantly greater after surgery 3.9 (±2.5) cm, P<0.0001. As well the volume of the pre-existing HH 5.8 (4.4-9.2) mL (quartile) was significantly greater after surgery 14.1 (7.2-64.9) mL, P<0.0001. 20/155 (12.9%) had a newly developed HH after RA-CABG. A binary multivariate regression including HH risk factors showed that male gender is a predictor of developing a HH after RA-CABG with Hazard Ratio of 3.038, confidence interval (1.10-8.43), P=0.033. Conclusions: RA-CABG is associated with an increased risk of developing HH and increases the size of pre-existing HH.

ObjectivesAccelerated atherosclerosis is a well-established phenomenon after coronary artery bypass grafting surgery (CABG). In this study, we analysed coronary artery calcium (CCS) progression after CABG.MethodsWe retrospectively measured the CCS Agatston score (AS), volume score (VS) and mass score (MS) of 39 patients before and after CABG. The annualised CCS change and annualised CCS percent change of each coronary artery, coronary artery segments proximal and distal to anastomosis were analysed.ResultsMean age at the time of the surgery was 59.8±8.5 years. Follow-up period between the first and second CT scans was 6.7±2.8 (range, 1.1–12.8) years. Annualised CCS percent change (AS, VS and MS) of the coronary segments proximal-to-anastomosis did not differ from that of the non-grafted coronary arteries as follow: segments proximal-to-anastomosis: median (Q1–Q3) 12.8 (5.0–37.4), 13.7 (6.1–41.1) and 14.9 (5.4–53.7), left main coronary artery 12.6 (7.4–43.8), 22.0 (8.1–44.4) and 18.2...

We present this case series exploring the complementary role of coronary computed tomography angiography (CCTA) to SPECT myocardial perfusion imaging (MPI) in the detection of myocardial necrosis. Methods: A cardiac hybrid imaging database search identified 144 patients with a previous history of ST-segment elevation myocardial infarction treated with coronary revascularization. CCTA and MPI scans were evaluated to determine whether CCTA had an added value to MPI in detecting myocardial necrosis. Results: Five patients with patent stents and/or bypass grafts and both fixed perfusion defects on MPI and sub-endocardial hypo-perfusion on CCTA were identified. The extent and location of the perfusion defects were closely correlated between the CCTA and SPECT MPI images. Conclusion: In this series, CCTA and SPECT MPI were found to play a complementary role in the assessment of fixed perfusion defect, with CCTA adding specificity to the diagnosis of myocardial necrosis.

Bone scintigraphy is used to detect radiographically silent fractures. Magnetic resonance imaging (MRI) is currently used to screen knee injuries for cartilage and ligament damage. MRI also delineates bone marrow and fractures. We investigated the bone scintigraphic findings in patients who had subchondral bone injuries demonstrated on MRI. Thirteen patients underwent MRI, three-phase bone scintigraphy with SPECT, and arthroscopic surgery after sustaining acute traumatic hemarthrosis of a knee. They all had clinically unsuspected subchondral bone injuries demonstrated on MRI with normal radiographs and normal overlying articular cartilage at arthroscopy, consistent with occult fractures. All showed focal bone repair on scintigraphy. Two of the 13 patients showed additional bone injuries only on bone scan. Two other patients scintigraphically showed focal bone repair at the medial femoral condyle due to avulsion of the medial collateral ligament. SPECT was easier to interpret than multi-view planar imaging. Bone scintigraphy confirms subchondral fractures demonstrated on MRI but also demonstrates ligament avulsion injuries and additional more subtle bone injuries.

(US), the incidence is of approximately 6/100,000 patients per year, translating to about 17,000 new cases destined to meet criteria of intractability annually. 2 This group accounts for over 50% of the total cost of epilepsy. 3 For many of these patients, epilepsy surgery offers the only opportunity to become completely or nearly free of seizures. The role of surgery for intractable epilepsy is rapidly changing. No longer an intervention of last resort, surgical therapy is often an earlier option to be considered because it may achieve seizure-free outcomes in patients otherwise intractable. 4 A standard presurgical evaluation of a patient with intractable epilepsy consists of a video-EEG study performed in an epilepsy ABSTRACT: Background: Functional neuroimaging can address some challenges of seizure localization, and sometimes preclude the need for EEG recording using intracranial electrodes. Ictal Single Photon Emission Computed Tomography (SPECT) has developed into an important tool in the presurgical evaluation of patients with medically-intractable localization-related epilepsy. The purpose of the study was to determine whether the development of a programme using trained nurses to perform ictal injections enabled a more efficient delivery of radiopharmaceuticals and therefore a greater sensitivity and specificity of outcome. Methods: In our epilepsy unit, nursing staff inject 99m Tc-HMPAO at bedside, during or at seizure onset. Brain SPECT is performed later on a gamma camera. Results: Since the implementation of the new protocol (February 2005), 57 scans have been performed: 22 ictal and 35 interictal. Latency of ictal injection was found to be 5-40 seconds (mean 19.7 sec, standard deviation (SD) 10.4). Only 20% of reconstituted radiopharmaceutical vials were not used. Contamination rate was nil. Sixty three percent of SPECT studies were concordant with standard presurgical evaluation. Conclusion: The latency of injections and the percentage of unused vials indicated an efficient and effective protocol compared to the literature. Our results show that ictal SPECT can be a safe, noninvasive procedure performed on a routine basis in the epilepsy unit when appropriately trained support staff are incorporated into a structured multidisciplinary programme. RÉSUMÉ: Évaluation du développement d'un protocole de TEMP dans une unité d'épilepsie au Canada. Contexte : La neuroimagerie fonctionnelle peut permettre de relever certains défis que pose la localisation des crises convulsives et obvier à la nécessité de recourir à l'enregistrement ÉEG effectué au moyen d'électrodes intracrâniennes. La TEMP ictale est devenue un outil important dans l'évaluation préchirurgicale de patients ayant une épilepsie localisée, réfractaire au traitement médical. Le but de cette étude était de déterminer si le développement d'un programme d'injection ictale par des infirmières ayant reçu une formation pertinente permettrait d'optimiser l'administration des substances radiopharmaceutiques et donc d'améliorer la sensibilité et la spécificité des résultats. Méthodes : Le personnel infirmier de notre unité d'épilepsie injecte le 99mTc-HMPAO au chevet du malade pendant ou au début de la crise convulsive. La TEMP du cerveau est ensuite réalisée par une caméra à rayons gamma. Résultats : Depuis l'implantation du nouveau protocole en février 2005, cinquante-sept scintigraphies ont été effectuées, soit 22 scintigraphies ictales et 35 interictales. La latence de l'injection ictale était de 5 à 40 secondes (moyenne 19,7 secondes, écart type 10,4 secondes). Seulement 20% des flacons de substance radiopharmaceutique reconstituée n'ont pas été utilisés. Le taux de contamination a été nul. Les résultats de soixante-trois pour cent des études TEMP concordaient avec ceux de l'évaluation préchirurgicale standard. Conclusion : Le temps de latence des injections et le pourcentage de flacons inutilisés indiquent qu'il s'agit d'un protocole efficace, ayant un bon rendement, comparé à ce qui est rapporté dans la littérature. Nos résultats démontrent que la TEMP ictale peut être une intervention sûre, non effractive, pratiquée de routine dans l'unité d'épilepsie quand un personnel de soutien formé est incorporé à un programme multidisciplinaire structuré.