The management protocol for differentiated thyroid cancer includes whole body iodine-131 imaging, to detect residual thyroid tissue and distant metastasis, after thyroidectomy. However, the diagnostic dose of radioiodine may fail to detect the non-functioning or poorly functioning metastasis. We present a case where hybrid single photon-emission computed tomographic and computed tomographic (SPECT-CT) fusion imaging, using a diagnostic dose of iodine-131, was able to detect both functioning as well as non-functioning pulmonary metastases, prior to high-dose radioiodine therapy.

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Background The proper localization of a hypersecreting parathyroid gland is of vital importance for successful unilateral neck exploration (UNE) and parathyroidectomy. Aim: In this study we aim to evaluate the (99mTc) sestamibi parathyroid scan as a single localizing modality, and we also assess its relation to the weight of the gland and to the preoperative parathyroid hormone (PTH) levels. Patients and Methods: We reviewed 170 patients from our hospital (Notre-Dame hospital) from 2005 to 2008, with a mean age of 56.6 years and a female to male ratio of 3.3:1. With primary hyperparathyroidism, all of them had (99mTc) sestamibi parathyroid scan for the localization of the parathyroid adenoma. Preoperative and postoperative PTH levels were recorded. The histopathology reports confirmed the diagnosis and weight of the diseased gland, which were recorded every time. The results were analyzed and correlated with the sestamibi results, to evaluate its accuracy. Results: Seventy-eight patients (41%) of the 170 had an exact match (EM) sestamibi results,81 (51.6%) had a partial match, and only 11 patients were reported as mismatch. Analyzing the mean weight of the gland in each group between matching (EM, PM) versus mismatch resulted in a mean difference of 0.823 g (1.05 and 0.247 g, respectively) P = 0.045. Hyperplasia to adenoma ratio was more in the partial matching group (18.5%) versus the exact matching group (7.6%). Finally the mean PTH level was higher in the EM group (28.8 pmol/L) compared to the mismatch group (10.1 pmol/L) P = 0.02. Overall sensitivity and specificity for the (99 mTc) sestamibi in our data was 98.1 and 97%, respectively. Conclusion: (99mTc) sestamibi is a highly accurate test that can be employed as a single localizing modality for identifying a hypersecreting parathyroid, a UNE, or a parathyroidectomy.The weight of the gland plays an important role in the accuracy of the test, as also the preoperative PTH levels.

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Gorham's (vanishing bone) disease is an extremely rare condition of the bone. The diagnosis is usually made on the basis of the characteristic history of osteolysis and failure of bone healing in conjunction with the histological findings of marrow fibrosis and increased vascularity. When the disease is established, an X-ray and magnetic resonance imaging show complete loss of affected bone. There are very few reports found in literature on bone scan appearance of the disease. A bone scan of a 24-year-old female patient with known Gorham's disease revealed absence of tracer uptake in the right iliac bone, right sacroiliac joint, and part of the right ischial pubic rami, which matched the radiographic abnormalities. Consequently this disease should be added to the gamut of cold defects seen on bone scan.

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A seven-year-old male child presented with swelling at the left temporal region. His skull X-ray was normal. A three-phase bone scan showed increased blood flow, soft tissue activity, and increased tracer concentration in the left temporal region. Single photon emission computed tomography (SPECT) imaging of the skull revealed full thickness involvement of the left temporal bone. Our case report shows that, in osteomyelitis of the skull, SPECT imaging provides significantly more information for identifying the extent and thickness of bone involvement.

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Objectives : This paper addresses a comparison between physical dosimetry and mathematical dose calculation in nuclear medicine. Materials and Methods: Dose rate was calculated by mathematical external dose calculation formula and by physical dosimetry from the surface of 38 adult patients' body referred to nuclear medicine department. Results of the methods were compared and correlation and regression tests were also performed. Results: Although the physical dosimetry data in this study are in good consistency with other researches, they are much lower than the results of mathematical dose calculation formula. The correlation coefficient between measured dose rate with calculated values derived by mathematical formula was found to be 0.852 (P value=0.148). Conclusion: It seems that physical dosimetry data are more accurate than the results of mathematical dose calculation. In case of using mathematical dose calculation formula, other correction factors should be considered and applied for getting reliable data.

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Caffey's disease is not a common clinical occurrence; it often poses problems in diagnosis due to its close resemblance to osteomyelitis. Initial plain radiographic diagnosis is sometimes fraught with the limitation of not being able to differentiate it from chronic osteomyelitis. Skeletal scintigraphy is sensitive in localizing the disease activity to the radiological features of the affected regions and the characteristic location of the lesions helps make the diagnosis without resorting to biopsy and further workup.

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Tumoral calcinosis is an uncommon and benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing tumoral calcinosis. A 28-year-old female patient with a history of operation due to tumoral calcinosis located bilateral hips, referred to our department. She had a tender palpable mass in the right knee and a fistulized incisional scar overlying the bilateral hip joints. A sporadic case of tumoral calcinosis with relapses was presented.

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Osteod osteoma, although not a common clinical occurrence, does pose problems both in diagnosis and surgical management. Initial plain radiographic diagnosis is sometimes fraught with the limitation of not being able to differentiate from chronic osteomyelitis and stress fracture. CT-aided localization of the nidus is also often inconclusive. Radionuclide single photon emission computed tomography (SPECT) scintigraphy is highly sensitive in localizing the active nidus and also orients the lesion in a three-dimensional plane well, for effective surgical removal

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Authors describe the incremental value of hybrid SPECT-CT in upstaging disease and changing the management strategy of a case of renal cell carcinoma

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Background : The purpose of this study is to investigate whether or not radio-guided surgery has any beneficial effects on completion thyroidectomy (CT) and the associated complication rates. Patients and Methods: Twenty-seven patients were scheduled for CT, for thyroid carcinoma, from December 2004 to June 2005, and were included in the study. All the patients had had initial thyroid surgery in other centers and been referred to our clinic for CT. Operation findings and the effectiveness of Tc-99m radio-guided CT were analyzed. Results: The intraoperative mean ratio of thyroid activity to background activity counted with a gamma probe was 1.3 ± 0.3. Average operation timing was 74 ± 9 minutes. Postoperatively, no residual tissue was detected in any of the patients with ultrasonography and thyroid scintigraphy. In the first postoperative month, serum TSH level was 61 ± 16.4 mIU / L, when preoperatively it was 7.3 ± 3.1 mIU / L (P < 0.001). In the postoperative period, one patient experienced temporary hypoparathyroidism (3.9%). Permanent hypoparathyroidism or recurrent laryngeal nerve damage was not detected in any patient. Conclusion: Tc-99 radio-guided CT is a reliable surgical method, which provides the detection and removal of residual thyroid tissues with minimal complications.

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