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Purpose Non-alcoholic fatty liver disease (NAFLD) is the most common chronic hepatic disease worldwide with functional impairment of the mitochondria occurring from early stages. Technetium-99m methoxy-isobutyl-isonitrile (99mTc-MIBI) is a lipophilic agent trapped in the mitochondria. This study aims to evaluate the utility of 99mTc-MIBI heart/liver uptake ratio in screening for NAFLD during myocardial perfusion imaging (MPI). Methods 70eligible patients underwent a two-day rest/stress 99mTc-MIBI scan with a 2-minute planar image acquired in rest phase, at 30, 60 and 120 minutes post radiotracer administration. Heart/liver uptake ratio was calculated by placing identical regions of interest on the heart and liver dome. All patients underwent liver ultrasound and were allocated into groups A, having NAFLD, and B, healthy individuals without NAFLD. Results Mean count per pixel heart/liver ratios gradually increased over time in either groups; nonetheless the values were significantly higher in group A, regardless of acquisition timing; with the P-value equal to 0.007, 0.014 and 0.010 at 30, 60 and 120 minutes, respectively. Conclusions Determining 99mTc-MIBI heart/liver uptake ratio during rest phase in patients undergoing MPI may be a useful, non-invasive screening method for NAFLD; with no additional cost, radiation burden or adverse effects in these patients.

Considering the significant prevalence of silent myocardial ischemia and its related morbidity and mortality in asymptomatic type 2 diabetic patients, it is not well known whether early screening with MPI is cost-effective and predicting factors are not well elucidated. This was a cross-sectional study including 63 asymptomatic patients with type 2 diabetes mellitus (T2DM), with normal ECG and ejection fraction. Patients with any history of documented valvular, congestive or ischemic heart disease, renal or hepatic failure were excluded. At first all patients were interviewed and checked for risk factors and then patients underwent a two-day rest/stress 99mTc-MIBI gated MPI SPECT. Data was assessed by QPS/QGS and 4DM software and evaluated by a nuclear medicine specialist with summed stress score (SSS) of more than 4 defined as CAD. There were 42 females (67%) and 21 males (33%), with a mean age of 61.33 ± 6.98 years and 7.97 ± 4.86 years history of T2DM. CAD was detected in 26 (41.3%) patients and was significantly associated with male gender, smoking and requiring insulin therapy (P-value = 0.019, 0.046, 0.05, respectively). A significant association was found between the duration of diabetes, especially when > 15 years, and the probability of having CAD. Multivariable logistic regression revealed that smoking; male gender and diabetes duration were the strongest independent predictors of abnormal MPI results. We found a high (46%) prevalence of abnormal stress MPI SPECT in patients with type 2 diabetes mellitus, despite being asymptomatic. Asymptomatic patients with a history of smoking, long duration of diabetes, being under insulin treatment and male gender might benefit from MPI for early detection of silent ischemia.

The aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD) in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study which may help prevent diabetic cardiomyopathy. Ninety-three consecutive patients with known type 2 diabetes and 81 age- and gender- matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an possible risk factor for cardiomyopathy- was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups. A total of 174 patients were included in the study. There were no statistically significant difference regarding demographic factors between the two groups (P > 0.05). PBW showed statistically significant differences (increased in diabetics) between the control and diabetic patients (P

Introduction ; An increase in the average volume of platelets has been associated with poor outcomes in patients with acute coronary syndrome. The aim of this study was to assess the use of myocardial perfusion scans to study the association between MPV and myocardial perfusion abnormalities in patients with and without diabetes mellitus (DM). diabetic and non-diabetic patients. Materials and Methods ; This was a cross-sectional study. Forty-nine patients with known type 2 diabetes DM and without obvious cardiovascular symptoms and 49 healthy individuals were included. A myocardial perfusion scan was performed in rest and stress with dipyridamole/dobutamine/exercise testing. Data entered SPSS software and analyzed. A p value below 0.05 was considered as statistically significant. Results; In total, 98 participants including 49 patients with DM and 49 healthy individuals were included. Laboratory variables as well as cardiac scan items including Summed Stress Score (SSS), Summed Rest Score (SRS), Summed Difference Score (SDS), Ejection Fraction (EF) and End Systolic Volume (ESV) were not statistically different in the two groups. Only the average platelet count was higher in controls than diabetics. In regression analysis, by one-unit increase in MPV, the SRS increased by an average of 0.46 (CI; 0.08–0.83 β: 0.46), only in healthy controls. Discussion and Conclusion ; MPV is a predictor of myocardial perfusion defects, which could be measured easily for patients in different clinical scenarios as a herald for coronary artery disease, especially in healthy individuals.

Proton pump inhibitors (PPIs) have been speculated to cause gastric wall uptake (GWU) in MPI scans. However, the uptake mechanism and prevention methods are less studied. In this prospective trial we aimed to evaluate the impact of gastroprotective medications on GWU and its solutions. 351 consecutive patients, scheduled for 2-day rest/stress 99mTc-MIBI scan, were distributed into 5 groups. 3-7 days following the baseline rest scan, the stress scan was acquired after intervention in the trial group, consisting of patients with history of PPI intake, randomly assigned to 3 subgroups: discontinuing PPIs(A), replacement with H2 blockers (B), and continuing PPIs (C). Patients receiving H2 blockers, continued it as before (D) and the remaining patients were the control group (E). GWU was graded compared to the myocardial uptake. In the rest phase, all groups had significantly higher GWU compared to the control group. In the stress phase, group A had less GWU than group B (P-value < 0.05) and both of them had significantly less GWU compared to group C (P-value < 0.001). There was no significant difference between PPI discontinuation periods of 3-5 days versus 5-7 days. There was a significant association between duration of oral PPI intake, but not IV PPIs, and GWU. GWU was significantly lower with oral compared to IV PPI administration. PPIs significantly increase GWU and discontinuing them for at least 3-5 days significantly reduces GWU. H2 antagonists are a good alternative in patients who cannot tolerate dyspepsia symptoms.

Radioiodine ablation following surgery is the accepted treatment for patients with differentiated thyroid cancer (DTC). Since that surgical volume and radioiodine dose can have impact on treatment outcome, we aimed to evaluate them on the treatment outcome of low-risk DTC patients. Low-risk DTC patients were classified into four groups, including (1) thyroidectomy was performed by thyroid surgeon and low-dose (1850 MBq [30 mCi]) radioiodine was administered (n = 17), (2) thyroidectomy was performed by thyroid surgeon and high-dose (3700 MBq [100 mCi]) radioiodine was administered (n = 10), (3) thyroidectomy was performed by general surgeon and low-dose radioiodine was administered (n = 22), and (4) thyroidectomy was performed by general surgeon and high-dose radioiodine was administered (n = 29). All patients were followed at least for 6 months and also for evaluation of treatment success, neck sonography, thyroid-stimulating hormone-off, thyroglobulin (Tg)-off, and anti-Tg-off tests were performed. Furthermore, two common radioiodine treatment-associated side effects, including dry mouth, and nausea/vomiting were assessed for all patients. Seventy-eight low-risk DTC patients (female: 70 [89.7%]; male: 8 [10.3%]) aged from 18 to 78 years old with mean of 41.96 ± 13.42 years were enrolled in this study. In total, the treatment was successful in 96.2% of patients. There was no significant difference in treatment success among groups (P > 0.05), while there was a significant association among administered activity and side effects. In low dose patients, only one patient complained from dry mouth; however, 11/39 patients who received high dose of iodine complained from dry mouth (P = 0.002). In addition, 9/39 high dose patients suffered from vomiting/nausea, while none of low-dose patients suffered from vomiting/nausea (P = 0.001). In low-risk DTC patients, surgical volume and amounts of radioiodine had no significant impact on treatment results; therefore, low dose radioiodine following thyroidectomy may be preferable to low-risk DTC patients to avoid side effects.

Introduction; An increase in the average volume of platelets has been associated with poor outcomes in patients with acute coronary syndrome. The aim of this study was to assess the use of myocardial perfusion scans to study the association between MPV and myocardial perfusion abnormalities in patients with and without diabetes mellitus (DM). diabetic and non-diabetic patients.Materials and Methods; This was a cross-sectional study. Forty-nine patients with known type 2 diabetes DM and without obvious cardiovascular symptoms and 49 healthy individuals were included. A myocardial perfusion scan was performed in rest and stress with dipyridamole/dobutamine/exercise testing. Data entered SPSS software and analyzed. A p value below 0.05 was considered as statistically significant.Results; In total, 98 participants including 49 patients with DM and 49 healthy individuals were included. Laboratory variables as well as cardiac scan items including Summed Stress Score (SSS), Summed Rest Score (SRS), Summed Difference Score (SDS), Ejection Fraction (EF) and End Systolic Volume (ESV) were not statistically different in the two groups. Only the average platelet count was higher in controls than diabetics. In regression analysis, by one-unit increase in MPV, the SRS increased by an average of 0.46 (CI; 0.08-0.83 β: 0.46), only in healthy controls.Discussion and Conclusion; MPV is a predictor of myocardial perfusion defects, which could be measured easily for patients in different clinical scenarios as a herald for coronary artery disease, especially in healthy individuals.

The whole-body postablation scan of a 38-year-old man, with history of papillary thyroid cancer, revealed a focus of intense 131I accumulation about the lower thoracic vertebrae. SPECT/CT revealing a soft tissue lesion adjacent the T9 to T10 vertebrae, which was reported as neurofibroma on the subsequently performed MRI. However, the lesion was confirmed as a bronchogenic cyst on biopsy. Respecting that unlike neurofibroma, immunohistochemistry studies have confirmed Na-I symporter expression in bronchogenic epithelium; our case highlights that, although rare, paravertebral bronchogenic cysts should be considered in differential diagnosis of radioiodine-avid paravertebral lesions.

Physicians should be alert about the possibility of subacute thyroiditis (SAT) being induced by COVID‐19 vaccination. SAT may present with anterior neck pain, extended fever or palpitation in recently vaccinated patients, which should not be easily dismissed as expected post‐vaccination flu‐like symptoms, thereby, facilitating in time diagnosis and treatment.

A 59-year-old prostate cancer patient, status post radical prostatectomy, was referred to our department for restaging with 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scan. Aside multiple metastatic lesions involving pelvic lymph nodes as well as the right femoral trochanter, a PSMA-positive rectal wall thickening was detected. Colonoscopy correlation and tissue diagnosis, recommended to rule out accompanying primary malignancy, confirmed the presence of rectal adenocarcinoma. This case signifies the importance of requesting pathological correlation for unexplained PSMA-positive lesions, emphasizing the potential role PSMA ligands may play in detecting occult second primary malignancies, especially synchronous/metachronous colorectal cancers.

Introduction; the aim of this study was to employ phase analysis to diagnose left ventricular mechanical dyssynchrony (LVMD)in asymptomatic patients with diabetes mellitus type 2 and normal perfusion study to prevent diabetic cardiomyopathy.Methods & materials; Ninety-three consecutive patients with known type 2 diabetes and 81 age- and gender- matched patients without diabetes who were candidates for SPECT-MPI were considered as the control group. The presence of LVMD as an indicator of cardiomyopathy- was determined using phase analysis for each scan with quantitative gated SPECT (QGS) and corridor4DM (4DM) software. All outcomes such as phase bandwidth (PBW) and phase standard deviation (PSD) were compared between the two groups. Results; A total of 174 patients were included in the study. There were no statistically significant difference regarding demographic factors between the two groups (P>0.05). PBW showed statistically significant differences (increased in diabetics) between the control and diabetic patients (P < 0.05). Kruskal Wallis analysis revealed that as the duration of diabetes is prolonged, especially more than 15 years, the probability of LVMD is increased as well (p=0.021). Discussion; Fraction of asymptomatic diabetic patients with normal ejection fraction and gated SPECT MPI-especially those with prolonged diabetes- might have some degrees of LVMD. Phase analysis can detect this which in turn would prevent progress into heart failure.

A 63-year-old woman with neuroendocrine carcinoma of the colon was referred to our department for staging with Tc-octreotide scan. Two focal, highly intense, superficial lesions were detected in patient's scalp and paralumbar region, medial to the right kidney. Pathology correlation was recommended, revealing them both to be benign trichilemmal cysts. This unexpected finding strengthens the hypothesis of Merkel cell carcinoma and trichilemmal cysts originating from pluripotent stem cells of adnexal epithelium, making a neuroendocrine differentiation for the latter plausible.

A 68-year-old man with metastatic castration-resistant prostate cancer and widespread bone metastases as well as a history of kidney transplant, underwent 5 cycles of Lu-prostate-specific membrane antigen 617 therapies in our department. Being more cautious of the radiation burden imposed on the transplanted kidney, a lower average dose of 4 GBq per cycle was administered (instead of the more routine 6.0-7.4 GBq per cycle). However, excellent response was noted and serum creatinine level of 0.8 mg/dL remained stable.

Purpose: To determine the prevalence of color vision deficiency (CVD) and its correlation with amblyopia and refractive errors among primary school children. Methods: In this population-based cross-sectional study, 2160 children were selected from 36 primary schools; 60 students were from each school (10 students in each grade), with equal sex distribution. A complete eye examination including refraction using a photorefractometer, determination of visual acuity (VA) and color vision using a Yang vision tester, and evaluation of ocular media opacity using a direct ophthalmoscope was performed. Children who could not answer at least 4 plates of the Ishihara color test were considered as color vision deficient subjects. Amblyopia was determined if pinhole VA was worse than 0.3 LogMAR (equal to 20/40). Results: The prevalence of CVD was 2.2% (95% CI: 1.5% to 3%) which was higher in male subjects (37 [3.5%] boys vs. 11 [1.0%] girls, P < 0.001). Mean VA was lower among students with CVD as compared to normal color vision children (P = 0.035) and amblyopia was observed in 8.3% (95% CI: 0.2% to 16.4%) of patients with CVD versus 2.1% (95% CI: 1.5% to 2.08%) of children with normal color vision perception (P = 0.005). A statistically significant correlation between lower VA and CVD was observed (P = 0.023). Conclusion: Although CVD was correlated with lower VA and amblyopia, there was no relationship between CVD and the type of amblyopia, refractive error, anisometropia or strabismus.

Purpose: To determine the accuracy of photorefraction and autorefraction as compared to cycloautorefraction and to detect the repeatability of photorefraction. Methods: This diagnostic study included the right eyes of 86 children aged 7?12 years. Refractive status was measured using photorefraction (PlusoptiX SO4, GmbH, Nurnberg, Germany) and autorefraction (Topcon RM800, USA) with and without cycloplegia. Photorefraction for each eye was performed three times to assess repeatability. Results: The overall agreement between photorefraction and cycloautorefraction was over 81% for all refractive errors. Photorefractometry had acceptable sensitivity and specificity for myopia and astigmatism. There was no statistically significant difference considering myopia and astigmatism in all comparisons, while the difference was significant for hyperopia using both amblyogenic (P = 0.006) and nonamblyogenic criteria (P = 0.001). A myopic shift of 1.21 diopter (D) and 1.58 D occurred with photorefraction in nonamblyogenic and amblyogenic hyperopia, respectively. Using revised cut?off points of + 1.12 D and + 2.6 D instead of + 2.00 D and + 3.50 D improved the sensitivity of photorefractometry to 84.62% and 69.23%, respectively. The repeatability of photorefraction for measurement of myopia, astigmatism and hyperopia was acceptable (intra?cluster correlation [ICC]: 0.98, 0.94 and 0.77, respectively). Autorefraction results were significantly different from cycloautorefraction in hyperopia (P < 0.0001), but comparable in myopia and astigmatism. Also, noncycloglegic autorefraction results were similar to photorefraction in this study. Conclusion: Although photorefraction was accurate for measurement of myopia and astigmatism, its sensitivity for hyperopia was low which could be improved by considering revised cut?off points. Considering cut?off points, photorefraction can be used as a screening method.

Purpose: To compare macular thickness in children with functional amblyopia and those without amblyopia using optical coherence tomography (OCT). Methods: This case-control study was conducted on 93 children aged 3-10 years including 44 cases with unilateral amblyopia and 49 subjects without amblyopia. Amblyopic eyes were considered as the case group and their fellow eyes as internal controls; eyes of non-amblyopic children served as the external control. Macular thickness of all eyes were measured by optical coherence tomography in the center (foveola), 1 mm ring (fovea), and 3 and 6 mm rings and compared. Results: Although macular thickness was generally not different between the study groups, there was a significant difference in central macular thickness between eyes with moderate to severe amblyopia and the external controls (P = 0.037). Foveal thickness difference exceeding 10 microns between fellow eyes was detected in a larger number of amblyopic children as compared to non-amblyopic controls (P = 0.002). Mean foveal thickness was greater in boys (P = 0.037) but there was no significant difference in foveal thickness among various types of refractive errors. Conclusion: Although there was no significant relationship between macular thickness and amblyopia, foveolar thickness in eyes with moderate to severe amblyopia was significantly greater than the external controls. Further studies with more cases of moderate to severe amblyopia are recommended.