Background: Joint replacement is a procedure with a major impact on the quality of life of patients with joint degenerative disease or traumatic injuries. However, some patients develop symptoms after the intervention caused by mechanical loosening or infection. Metabolic imaging by 18F-FDG-PET investigated in these patients isoften hampered by low specificity for diagnosis of possible septic vs. mechanical loosening. The reason for this shortcoming is to our opinion the unawareness of physiological remodeling processes that could be seen in asymptomatic patients. Objectives: In order to overcome this drawback, we aimed to find out the physiological metabolic functional pattern in asymptomatic patients with implanted hip prosthesis Patients and Methods: Twelve patients (6 males, 6 females); mean age 73 ± 7 (range 58 - 91) years were prospectively enrolled in the study. The patients were admitted to our department for oncological referral with implanted hip prostheses. All patients explained no symptoms with regard to their implanted prosthesis. The attenuation corrected images were used for analysis. Results: Fourteen hip prostheses in 12 patients were visually analyzed. Seven out of 14 prostheses among 12 patients showed focal periprosthetic enhanced metabolism, two of which showed two sites of enhanced uptake; whereas, the remaining five prostheses showed singular hypermetabolic areas within the periprosthetic site. The remaining seven prostheses in the other five patients showed no periprosthetic-enhanced uptake. Conclusion: Of the asymptomatic patients investigated, 58% showed focal enhanced periprosthetic glucose metabolism. This finding should be taken into consideration as a more probable unspecific metabolic pattern for correct interpretation of 18F-FDG-PET studies in patients with suspected septic loosening of the hip prosthesis.

Serum thyreoglobulin (Tg) and whole body scintigraphy (I-131 WBS) have been used to detect recurrent and metastatic thyroid cancers postoperatively. However, discordant results of Tg measurement and 131I WBS have been reported. Negative 131I WBS and a positive Tg test are usually found, but less common occurrence of positive 131I WBS and a negative Tg test has also been demonstrated in a small but significant number of cases. Therefore, the aim of the study was to retrospectively analyse patients with positive 131I WBS after total thyreoidectomy and again 1 year after the radioactive iodine. There were 52 patients included in the study. Four weeks after surgery, during which thyroid hormone treatment was not introduced, each patient received an ablative dose of 131I. The evaluation of the WBS was qualitative and considered positive if thyroid remnant, lymphatic node or metastasis were detected. WBS and serum Tg was measured 12 months after 131I ablation with thyroid hormone suppression. We considered positive any Tg level above the sensitivity values and negative if lower than this level. Tg levels were related to the existence of a positive scan or a negative one. In our 52 WBS positive patients concordant positive Tg levels were observed in 42 patients while in 10 patients we found a negative Tg levels after the surgery. After 1-year follow-up, out of initially 42 concordant patients 8 patients showed remaining concordant positive Tg and WBS values. Discordant results were observed in 13 patients (4 patients were Tg- and WBS+ while 9 patients were Tg+ and WBS-). In the majority of patients (50%) remained with concordant results but changed from Tg+ and WBS+ to Tg- and WBS-. Diagnostic WBS is an additional valuable tool, besides Tg levels, in the follow up of patients after total thyreoidectomy.

Early detection of coronary artery disease is one of the prerequisites for adequate and successful treatment of patients and because of that it is important to assess which diagnostic method in a certain time gives the most reliable data to define the optimal medical treatment. The study included 100 subjects. All subjects underwent the electrocardiogram, electrocardiographic stress test, ultrasound examination of the heart without a load, SPECT stress/rest myocardial perfusion scintigraphy and coronary angiography. Coronary angiography as an invasive method has been used as a gold standard with which are compared the results of conducted diagnostic noninvasive examinations, and determined their specificity and sensitivity. The results were statistically analyzed using the recipient operating curve-ROC. Discussed are the diagnostic features of each method and conclusions that brought complementary radiological and nuclear medical imaging can provide very important information about coronary heart disease before making a decision on coronary angiography.

Diagnostic imaging of traumatic pseudoaneurysm of the thoracic aorta Background. The purpose of the study was the presentation of findings and diagnostic imaging in patients with traumatic pseudoaneurysms of the thoracic aorta, as a rare consequence of road traffic accidents. Patients and methods. In 22 years we have found 8 traumatic pseudoaneurysms of the thoracic aorta, out of which 7 (87.5%) in male and 1 (12.5%) in female patients. At the time of accidents the youngest patient was 21 and the oldest was 55 (mean age 33.8 years), and at the moment of diagnosing a pseudoaneurysm they were 26 and 55 years old, respectively (mean age 38.7 years). In all patients chest radiography was performed as well as CT scan, in 6 (75%) patients intra-venous digital subtraction angiography was performed (i.v. DSA) and in 1 (12.5%) MRI. CT was performed with the application of 120 ml, and i.v. DSA with 60 ml of contrast medium, respectively. Results. In 8 (100%) patients, who suffered a road traffic accident, and whose chest radiograph showed the enlargement of the aortic knob and widening of the mediastinum, CT, i.v. DSA and MRI revealed a traumatic pseudoaneurysm of the thoracic aorta. Periods of time between the accidents and the initial diagnosis of the pseudoaneurysm varied from 7 days to 18 years (median 2.0 years). The diameter of the pseudoaneurysm was from 4.5 to 9.2 cm (median 5.5 cm). In 7 (87.5%) isthmus was involved, and in 1 (12.5%) descending thoracic aorta, respectively. The chest radiograph revealed marginal calcifications in 4 (50%), and on the CT in 5 (62.5%) patients. Intraluminal thrombosis was found by CT in 2(25%) traumatized patients. Conclusions. Traumatic pseudoaneurysm should be taken into consideration in blunt chest trauma, where a chest radiograph shows suspicious regions. A multislice CT is a diagnostic method of choice.

One of the possible ways breast cancer can spread is by lymphatic system. The first lymph node to be affected is called sentinel node (SLN) and can be identified by injecting radioactive tracer. During sentinel lymph node biopsy, the node is located by hand held probe. The result of frozen section analysis is important for surgical decision and oncological treatment.

Significant multi-vessel stenoses of the coronary arteries are definitely treated with aorto-coronary by-pass grafting. Most often, the procedure is complicated with acute and subacute occlusion of the graft. Diabetics are high-risk patients, requiring more complex pre- and postoperative diagnostic work-up. Percutaneous transluminal coronary dilatation with stenting (PTCA) has been a well-established procedure of choice for the resolution of the occlussion over the last few years. The aim is to present a case of a diabetic patient, whose work-up and follow-up included all parts of the diagnostic-therapeutic pyramid in the treatment of the coronary disease. Given its characteristics, sensitivity, specificity and reproducibility, myocardial perfusion scintigraphy (MPS) should be an unavoidable step in the post-operative follow-up of diabetics with coronary disease. Myocardial perfusion scintigraphy proved highly efficient in assessing the grafts, as it renders morphological and functional data on the myocardial status that is directly proportional to the coronary arteries status.

Ionizing radiation has many practical applications, but it is also, as it is well known, dangerous to human health. The purpose of this study was to estimate the dose and exposure for medical staff involved in sentinel node assay and to determine how safe this assay really is. The theoretical method was used for calculation. Three groups of medical staff were selected: nuclear medicine specialist, nuclear medicine technologist and a surgeon. The results obtained show that the most exposed staff member is nuclear medicine specialist and that dose received by the surgeon is smaller then the dose limit.

Left ventricular function is an important prognostic indicator in patients with coronary artery disease. The electrocardiogram gated, myocardial, single photon emission tomography (SPECT) program is coming into wide use. This program permits measurement of end diastolic volume, end systolic volume, and ejection fraction. This study was designed to show whether the measurement of ejection fraction by using 99mTc tetrofosmin gated SPECT at rest could give additional information to the interpretation of perfusion. Exercise 99mTc tetrofosmin SPECT and gated 99mTc tetrofosmin SPECT at rest were performed in 33 patients with or suspected of having coronary artery disease. Left ventricular ejection fraction was calculated from reconstructed gated SPECT at rest with a software quantitative gated SPECT. The results showed a poor correlation between segmental ejection fraction and segmental perfusion in stress and rest. There was an increasing probability of reversibility as the ejection fraction increased, while there was a greater chance of a fixed defect as the ejection fraction decreased. It is concluded that gated SPECT using 99mTc tetrofosmin provides clinically satisfactory functional data that, in combination with the perfusion information, will improve diagnostic and prognostic accuracy without an increase in cost or radiation dose to patients.