Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography.
Gastrointestinal: the role of multidetector computer tomography in diagnosis of pneumatosis cystoides intestinalisA 46-year old woman presented to our hospital with abdominal pain, diarrhea and bloody stools. She had no previous clinical history of asthma, diabetes, connective tissue diseases, endoscopic examinations and surgery. Laboratory and abdominal ultrasound examination revealed no abnormalities. Barium enema disclosed multiple round filling defects with smooth margins in the sigmoid and descending colon. Further colonoscopy evaluation showed multiple sessile soft, polypoid lesions with normal overlying mucosa. The results of histopathological examination were nonspecific and inconclusive. The patient underwent multidetector computer tomography (MDCT) examination in order to determine the nature and extent of detected polypoid lesions. Multiplanar reformation images with a lung window setting (Figure 1) showed numerous air filled cysts within the wall of sigmoid and ascending colon. Virtual CT colonoscopy (Figure 2) also revealed multiple gas cysts. MDCT findings were consistent with the diagnosis of pneumatosis cystoides intestinalis (PCI).Pneumatosis cystoides intestinalis is a rare condition characterized by multiple air filled cysts within submucosa or subserosa of the intestinal wall. The etiology of PCI is still unclear although many theories have been proposed. PCI can develop as a primary idiopathic condition, or secondary to different bronchopulmonary and gastrointestinal diseases. Association of PCI with raised intraabdominal pressure has already been reported. PCI is usually benign condition, but can present with serious complications such as obstruction, intussusception and intestinal perforation. Different diagnostic modalities are used in the diagnosis of PCI. Colonoscopy findings of multiple, round submucosal protrusions usually with normal overlying mucosa are not conclusive and include lymphoid hyperplasia, hyperplastic polyposis or colitis cystica profunda in differential diagnosis. Barium enema reveals smooth protrusions but can not exclude multiple polypoid lesions. MDCT evaluation with multiplanar reformations and virtual colonoscopy resolves the diagnostic problem, revealing gas filled cysts in colonic wall. Moreover, MDCT can exclude or detect complications and other pathological conditions such as polyposis, diverticulosis, and tumors.
This study aimed to estimate the relationship between the single kidney glomerular filtration rate (SKGFR) of a planned kidney transplant and the subsequent graft function and survival of living related kidney recipients (LKRs). Of 180 LKRs with the graft functioning for more than a year, 70 patients without delayed graft function (DGF) or acute rejection (AR) were selected for the study. According to SKGFR, assessed by 99m TcDTPA, the patients were allocated into Group 1, receiving kidney with SKGFR < 50 mL/min (32 patients), and Group 2, with SKGFR > 50 mL/min (38 patients). The database included donor, recipient and transplant variables. No significant difference was found between the patient and graft survival rate, creatinine clearance (CCr) and the rate of CCr change between the groups. Additional evaluation revealed no significant influence of the ratio of SKGFR and the recipient's body weight/size on patient and graft outcome. The analysis of factors of influence on patient and graft survival and function revealed the major influence of nonimmunological factors but not of SKGFR of the transplanted kidney. Our study did not confirm the influence of SKGFR on graft function and survival in the LKRs without DGF and AR but the limited number of patients must not be disregarded.
Our aim was to assess clinical utility of 99m Tc-EDDA/HYNIC-TOC scintigraphy for evaluation of lung lesions in patients with neuroendocrine tumors (NETs). Single photon emission computed tomography (SPECT) of the thorax and whole body scintigraphy were performed in 34 patients using Tc-EDDA/HYNIC-TOC. Visual assessment was complemented by semiquantitative evaluation based on tumor to non-tumor (T/NT) ratio. Clinical, laboratory, and histological findings served as the standard for comparison. Enhanced tracer uptake was observed on both SPECT and whole body scintigraphy in 29 of 34 patients (88% sensitivity). T/NT ratios were significantly higher on SPECT than whole body images (2.96±1.07 vs.1.70±0.43, p<0.01) and did not correlate with NET proliferation index p=0.27). Conclusion: 99m Tc-EDDA/ HYNIC-TOC scintigraphy is useful for evaluation of NET tissue in the lungs. SPECT provides better visualization of lung lesions than whole body scintigraphy. The intensity of tracer uptake, however, does not relate to the proliferation rate of NETs. Tc-EDDA/HYNIC-TOC scintigraphy may be helpful for selecting and monitoring treatment options, particularly when radiolabeled somatostatin analogue therapy becomes available.
Insignificant degree of accordance, especially in the assessment of scars necessitates the standardization of criteria and terminology in order to interprete the renal scintigraphy with more accuracy and objectivity.
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