Should early venous oximetry be indicated in suspected cases of fulminant myocarditis?
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Adult↗
Biomedical subjects
Sukanta Barai
Publications and source records attributed to Sukanta Barai.
Left ventricular ejection fraction and volumes on rest gated 201Tl perfusion SPECT: comparison with two-dimensional echocardiography.
BACKGROUND: Rest gated 201Tl images are considered to be of poor count statistics due to lower energy and low photon flux of 201Tl in addition to increased attenuation and low dose that can be administered. We compared the left ventricular ejection fraction (LVEF), end diastolic (EDV) and end systolic volume (ESV) obtained on 4 h gated rest 201Tl myocardial perfusion single photon emission computed tomography (SPECT) with those obtained by two-dimensional echocardiography (2-D ECHO) in patients with known or suspected coronary artery disease (CAD). METHODS: Eighty-two consecutive patients who underwent gated 201Tl stress-rest myocardial perfusion SPECT and 2-D ECHO were studied. The gated thallium images were processed with Siemens e-soft autocardiac processor and LVEF, EDV and ESV were evaluated using Emory Cardiac Toolbox. The same parameters were also assessed on the 2-D ECHO using the modified Simpson method for comparison. RESULTS: Out of 82 rest gated images, one study was excluded because of poor count statistics. In 81 (99%) patients there was good linear correlation with 2-D ECHO values and rest gated 201Tl SPECT images for EDV, ESV and LVEF. Pearson's correlation co-efficient (r value) for EDV, ESV and LVEF between the two methods was 0.78, 0.79 and 0.88, respectively. A Bland-Altman plot showed close agreement with LVEF but not for EDV and ESV. CONCLUSION: These results suggest that the 4 h rest gated 201Tl study gives a reliable value for the LVEF compared to 2-D ECHO and can be used in routine clinical practice.
Adult↗
Do healthy potential kidney donors in india have an average glomerular filtration rate of 81.4 ml/min?
BACKGROUND: Until now, a normal reference range for glomerular filtration rate (GFR) in adult Indian potential kidney donors has not been determined and values from a western population are being used as reference. AIM: To determine the reference range of GFR in healthy adult Indian potential kidney donors. BASIC PROCEDURES: GFR was measured in 610 (250 male, 360 female, average age 35.16 years) healthy potential kidney donors using the 99mTc-DTPA (diethylenetriamine pentaacetic acid) two-plasma sample method of Russell. RESULTS: The mean body surface area (BSA)-normalized GFR value of a young healthy Indian adult potential kidney donor was calculated as 81.4 +/- 19.4 ml/min/1.73 m2 BSA--for males it was 82.3 +/- 21.3 ml/min/1.73 m2 BSA and for females 80.8 +/- 18.1 ml/min/1.73 m2 BSA. There was no significant difference between derived mean GFR values in males and females with a p value of 0.37. CONCLUSIONS: The normal GFR value for the healthy Indian adult potential kidney donor appears to be much lower than the accepted value for a western population. The mean GFR value of a young healthy Indian adult potential kidney donor is 81.4 +/- 19.4 ml/min/1.73 m2 BSA, which is significantly different from the normal value of 109-125 ml/min derived from a western population. These findings might be useful in deciding on a suitable kidney donor in an Indian context.
Adult↗
Magnetic resonance imaging as a sole method for the morphological and functional evaluation of live kidney donors.
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Donor Selection↗
Multiple ectopic thyroid masses in a hypothyroid child.
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Child↗
Prevalence of vesicoureteral reflux in patients with incidentally diagnosed adult hypertension.
OBJECTIVES: To evaluate the prevalence of vesicoureteral reflux (VUR) in hypertensive patients without any other evidence of renal involvement. Reflux nephropathy may be clinically latent and present in early adulthood as hypertension when superimposed confounding factors are added. METHODS: The medical records of 157 adult hypertensive patients with normal renal parameters and low-probability, captopril-enhanced renal dynamic scan findings who underwent direct radionuclide voiding cystoscintigraphy between June 1998 and May 2003 were retrospectively analyzed. RESULTS: VUR was documented in 30 patients (19.1%). In those 30 patients, VUR was mild in 8 (26.6%), moderate in 6 (20%), and severe in 16 (53.3%) patients. Bilateral VUR was seen in 7 patients, graded as severe in all cases. The prevalence by age was 20% in the 18 to 30-year-old group, 16.6% in the 31 to 45-year-old group, and 20% in the older than 45-year-old group. CONCLUSIONS: The results of this study have shown that VUR is present in a significantly large proportion of adult patients with hypertension without any apparent renal parenchymal or renovascular involvement.
Adult↗
Bone scan demonstrating metastasis to the breast from an ovarian carcinoma and a review of the literature.
Breast metastasis from a primary ovarian neoplasm is very rare. We report a case of breast metastasis along with involvement of the liver, spleen, and pelvis from ovarian carcinoma in a 54-year-old woman demonstrated by whole-body bone scanning. Ovarian metastatic deposits frequently show calcification, and a Tc-99m MDP bone scan could be useful in determining the extent of calcified soft tissue metastatic spread in these patients. A review of the literature of breast metastases form ovarian carcinoma is discussed.
Antineoplastic Agents↗
Is brain SPECT a suitable modality for evaluation of postradiotherapy posterior fossa brain tumours? A comparative evaluation with contrast enhanced computed tomography.
Single photon emission computed tomography (SPECT) of the brain is exquisitely sensitive in detecting viable tumour tissue in the supratentorial region, but its efficacy has not been properly evaluated till date in case of infratentorial posterior fossa tumours. Twenty-four patients with primary posterior fossa brain tumour were included in this study. In each case brain SPECT with 99mTc-glucoheptonate (GHA) was performed for the evaluation of disease status. Contrast enhanced computerised tomography of brain was also performed in all the patients. Brain SPECT was positive in four patients with recurrence of tumour as compared to fifteen cases with computed tomography with a mean GHA retention index 5.26 +/- 1.64. Patients with postradiation gliosis (n=9) showed lower GHA retention index of 1.24 +/- 0.27. This study demonstrates that brain SPECT is not sensitive in detecting recurrence of tumour tissue in infratentorial region, as it is in the supratentorial region, with a sensitivity of 20%, accuracy of 45.83% and negative predictive value of 40% and the chance of any single study coming as false negative is about 80%.
Adolescent↗
Diagnostic significance of semiquantitative and quantitative parameters of Tc99m-Ethylenedicystine renal allograft scintigraphy.
OBJECTIVES: No objective parameters for renal allograft evaluation have yet been described for Tc99m-Ethylenedicystine. This study evaluates the diagnostic significance of different quantitative and semi-quantitative parameters of renal allograft scintigraphy using Tc99m-Ethylenedicystine. METHODS: A total of 72 renal dynamic scintigraphic studies were performed within 2-weeks of renal transplantation in 42 patients. The graft perfusion, kidney/aorta ratio, washout index and retention index were derived from all studies. All these parameters were evaluated for their ability to distinguish between a normal graft, a graft with acute rejection (AR), and a graft with acute tubular necrosis (ATN). Histopathological verification of diagnosis was obtained in all cases. RESULTS: Studies were subdivided into 3 groups according to histopathological findings: acute rejection (n = 42), normal (n = 18) and acute tubular necrosis (n = 12). Normal allografts were visualized with in 2.66 +/- 0.59 seconds of visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 15.22 +/- 6.86, 1.67 +/- 0.45, and 5.48 +/- 0.98 respectively. Allografts with ATN were visualized with in 3.36 +/- 0.80 seconds of visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 12.73 +/- 6.74, 0.60 +/- 0.14, and 9.18 +/- 1.48 respectively. In AR, allografts were visualized 15.18 +/- 9.48 seconds after visualization of abdominal aorta. The K/A ratio, wash out index and retention index was 7.07 +/- 2.15, 0.63 +/- 0.11, and 2.26 +/- 1.28 respectively. CONCLUSIONS: Retention index can separate all the three condition of normal, acute rejection and acute tubular necrosis from each other. Retention index of < 4 suggests acute rejection, a value between 4 and 7 suggests normal allograft and a value of > or = 7 is suggestive of acute tubular necrosis. However, perfusion, K/A ratio and washout index can not segregate all the three groups.
Adolescent↗
Imaging using Tc99m-tetrofosmin for the detection of the recurrence of brain tumour: a comparative study with Tc99m-glucoheptonate.
BACKGROUND: In the past "blood-brain barrier" agents such as Tc99m-glucoheptonate were routinely used for the diagnosis of brain tumours. Of late, agents used for studying myocardial perfusion namely, Tc99m-tetrofosmin, Thallium-201, and Tc99m-sestamibi have replaced the "blood-brain barrier agents " when imaging is undertaken for the detection of the recurrence of brain tumours. However, the incremental diagnostic information provided by Tc99m-tetrofosmin when compared with a blood brain barrier agent in the diagnosis of recurrent brain tumour has not been evaluated till date. AIMS: The study was carried out to substantiate whether Tc99m-tetrofosmin provides any incremental diagnostic information not provided by the blood brain barrier agent Tc99m-glucoheptonate. MATERIAL AND METHODS: Brain SPECT scans were performed using Tc99m-tetrofosmin and Tc99m-glucoheptonate in 126 patients of recurrent brain tumour. Bio-distribution and uptake properties of both the tracers were analysed by measuring relative uptake of both the tracers in tumour compared to background (T/B ratio), nasopharynx (T/N ratio) and scalp (T/S ratio). STATISTICAL ANALYSIS: Descriptive statistics were calculated for each variable. Pearson's correlation coefficient was applied to see agreement of the continuous variables. Paired t test was used to evaluate the difference between two means. RESULTS: Uptake properties of both the tracers were analysed in 105 patients in whom both Tc99m-tetrofosmin and Tc99m-glucoheptonate showed concentration. The remaining 21 patients in whom the tumour mass did not show Tc99m-tetrofosmin concentration were excluded from the study. Mean T/B ratio, T/N ratio and T/S ratio was 5.83 + 2.09 and 5.99 + 2.26, 0.53 + 0.21 and 0.55 + 0.22 and 1.11 + 0.60 and 1.26 + 0.52 for Tc99m-tetrofosmin and Tc99m-glucoheptonate respectively. No statistically significant difference between T/B ratio and T/N ratio of Tc99m-tetrofosmin and Tc99m-glucoheptonate was found; p values were 0.25 and 0.83 respectively. However there was significant difference (P=0.006) between the T/S ratio of Tc99m-tetrofosmin and that of Tc99m-glucoheptonate. CONCLUSION: Tc99m-tetrofosmin does not provide any incremental diagnostic information not provided by the blood brain barrier agent Tc99m-glucoheptonate.
Adolescent↗
Cerebellar medulloblastoma presenting with skeletal metastasis.
Medulloblastomas are highly malignant brain tumours, but only rarely produce skeletal metastases. No case of medulloblastoma has been documented to have produced skeletal metastases prior to craniotomy or shunt surgery. A 21-year-old male presented with pain in the hip and lower back with difficulty in walking of 3 months' duration. Signs of cerebellar dysfunction were present hence a diagnosis of cerebellar neoplasm or skeletal tuberculosis with cerebellar abscess formation was considered. MRI of brain revealed a lesion in the cerebellum suggestive of medulloblastoma. Bone scan revealed multiple sites of skeletal metastases excluding the lumbar vertebrae. MRI of lumbar spine and hip revealed metastases to all lumbar vertebrae and both hips. Computed tomography-guided biopsy was obtained from the L3 vertebra, which revealed metastatic deposits from medulloblastoma. Cerebrospinal fluid cytology showed the presence of medulloblastoma cells. A final diagnosis of cerebellar medulloblastoma with skeletal metastases was made. He underwent craniotomy and histopathology confirmed medulloblastoma.
Adult↗
Imaging of recurrent brain tumors with trivalent (99m)Tc-dimercaptosuccinic acid - initial results.
There is considerable chemical and structural similarity between the widely used oncophilic substance pentavalent dimercaptosuccinic acid labeled with (99m)Tc [(99m)Tc-DMSA(V)] and the renal imaging agent trivalent [(99m)Tc-DMSA(III)]. Other renal imaging agents like diethyltriamine penta acetic acid (DTPA) and glucoheptonate labeled with (99m)Tc have been used for imaging brain lesions, mainly for brain tumor imaging. The aim of this study was to evaluate technetium labeled (99m)Tc-DMSA(III) for brain tumor imaging. Single photon emission computed tomography (SPECT) of the brain with (99m)Tc-DMSA(III) was performed in twenty-three patients with brain tumors in recurrence and the results were correlated with contrast enhanced magnetic resonance imaging (MRI) findings. Ten patients had multiform blioblastoma, 7 patients had anaplastic astocystoma, 5 patients low grade glioma and 1 patient menengioma. Our results show that brain SPECT was able to detect 20 of the 21 tumors detected by the contrast enhanced MRI of the brain. The brain scan was false positive in one patient. In two other patients two sites of radiation necrosis showed no tracer concentration. We conclude that (99m)Tc-DMSA(III) concentrates in recurrent brain tumors and can be used for the imaging of these tumors.
Journal Article↗
Sequential brain perfusion abnormalities in various stages of Japanese encephalitis.
There is a paucity of regional cerebral blood flow studies on Japanese encephalitis (JE) with none of these studies describing brain perfusion abnormalities in all three stages of the disease. In this communication we report the changes noted in brain perfusion as detected by single photon emission tomography (SPET), in the acute, subacute and chronic stages of JE. Between December 2000 and March 2006, 31 patients, 19 men and 12 women, mean age 49 y, range 6-64 y of various stages of JE underwent brain perfusion SPET. Tauhese patients were at the following stages of the disease: acute stage, five patients, subacute stage 17 and chronic stage nine . The acute stage was considered as up to seven days from the onset of symptoms, the subacute, from seven to 56 days and any duration beyond 56 days was considered as the chronic stage. In the acute stage all five patients demonstrated focal areas of hyperperfusion involving mainly the thalamus. Additionally, bilateral thalami involvement was noted in three, frontal lobe involvement in four and parietotemporal hyperperfusion in three of these patients. In the subacute stage group, hypoperfusion of the thalamus was noted in all patients while frontoparietal hypoperfusion in seven patients. In the chronic stage group, hypoperfusion of thalamus was noted in four, one patient demonstrated additional occipital lobe hypoperfuion whereas normal perfusion was noted in the remaining five patients. In conclusion, the brain perfusion abnormalities observed depended on the stage of the disease. In the acute stage there was focal hyperperfusion to sites of the brain where JE virus is considered to replicate. In the subacute stage focal hypoperfusion was found to be possibly due to virus induced damage of cellular protein synthesis and in the chronic stage perfusion returns to normal due to regeneration of cellular organelles. Our results also confirm the high frequency of thalamic involvement in JE.
Adolescent↗