Nuclear cardiology has not witnessed development of new tracers or hardware for many years. Hence there is a need for the development of improvised techniques. Dynamic cardiac single photon emission computed tomography (SPECT) is one such technique that has a potential to overcome the limitations of conventional myocardial SPECT including the absolute quantification of blood flow. The main goal of this study is to evaluate the effect of attenuation correction (AC) on estimation of the washout parameters extracted from dynamic SPECT using a conventional protocol. The effect of the postprocessing on quantitative evaluation of dynamic SPECT is also assessed. A physical phantom was employed to physically simulate the dynamic behavior of a heart in the thorax. Using a dual detector SPECT system, 180° tomographic data in every 90 seconds were acquired. The SPECT data were reconstructed using ordered subset expectation maximization (OSEM) method while different iterations and a Butterworth filter with different cut-off frequencies were applied. Estimated washout parameter of the time activity curves (TACs) was compared with applying AC or without it. Results show that AC can improve the bias of computed washout parameter in normal regions (average bias reduction in normal ROI: 7%). Moreover, the postreconstruction filtering and reducing the number of iterations in reconstructing phase can reduce the variance of the computed washout values in normal regions (from 3.99% for cut-off frequency 0.5 cycle/cm and 32 times update in OSEM to 2.05% for cut-off frequency 0.35 cycle/cm and 16 times update in OSEM). They also reduce the actual size of the defect region (13% reduction in defect extent for above change in reconstruction parameters). According to the results, the AC and postprocessing filtration can directly affect the standard deviation of washout value acquired by cardiac dynamic SPECT. These parameters also showed a direct effect on the defect extent in final results. The study showed that the AC may partly improve the bias of calculated normal washout value. The effect of attenuation correction on the defective washout value could not be answered comprehensively in this paper.

Radioiodine therapy is known as the most effective treatment of differentiated thyroid carcinoma (DTC) to ablate remnant thyroid tissue after surgery. In patients with DTC treated with radioiodine, internal radiation dosimetry of radioiodine is useful for radiation risk assessment. The aim of this study is to describe a method to estimate the absorbed dose to the blood using medical internal radiation dosimetry methods. In this study, 23 patients with DTC with different administrated activities, 3.7, 4.62, and 5.55 GBq after thyroidectomy, were randomly selected. Blood dosimetry of treated patients was performed with external whole body counting using a dual-head gamma camera imaging device and also with blood sample activity measurements using a dose calibrator. Absorbed dose to the blood was measured at 2, 6, 12, 24, 48, and 96 hours after the administration of radioiodine with the 2 methods. Based on the results of whole body counting and blood sample activity dose rate measurements, 96 hours after administration of 3.7, 4.62, and 5.55 GBq of radioiodine, absorbed doses to patients’ blood were 0.65 ± 0.20, 0.67 ± 0.18, 0.79 ± 0.51 Gy, respectively. Increasing radioiodine activity from 3.7 to 5.55 GBq increased blood dose significantly, while there was no significant difference in blood dose between radioiodine dosages of 3.7 and 4.62 GBq. Our results revealed a significant correlation between the blood absorbed dose and blood sample activity and between the blood absorbed dose and whole body counts 24 to 48 hours after the administration of radioiodine.

Radioiodine uptake is not commonly seen by the thymus gland. On the contrary, the gland is slowly replaced by fat after puberty. Herein, we present 2 patients with papillary thyroid carcinoma, follicular variant, and cervical lymph node involvement. After total/near-total thyroidectomy, the patients received 131I for ablation therapy. On posttreatment radioiodine scintigraphy, mediastinal 131I uptake was noted that finally was histologically/anatomically diagnosed as thymus gland uptake. It should be borne in mind as a potential cause of false-positive whole-body 131I scintigraphy.

There are a few case reports of hiatal hernia demonstrating thoracic uptake on I-131 scintigraphy. In this case, high thyroglobulin levels in combination with misinterpretation of I-131 uptake in the mediastinum, leaded to mismanagement of the patient. Here we present a case of focal I-131 uptake within a hiatal hernia initially mimicking an isolated mediastinal metastasis. There are many potential causes of false-positive I-131 scan result. In this case, adjunctive chest computed tomography and gastroesophageal barium study helped to elucidate the true nature of this I-131 uptake. False-positive findings may be caused by a wide variety of nonthyroidal carcinomas, which can concentrate radioiodine or from skin contamination. Several organs, such as the gastric, salivary glands, renal cyst, pericardial effusion, and ovarian can accumulate I-131. It should be borne in mind as a potential source of false-positive whole-body I-131 imaging.

Objective Although different methods have been suggested on reducing salivary gland radiation after radioiodine administration, an effective preventive or therapeutic measure is still up for debate. The aim of this study was to evaluate the effect of pilocarpine, as a sialagogue drug on the radioiodine content of the salivary gland, and radioiodine-induced symptoms of salivary gland dysfunction. Patients and methods Patients who were referred for radioiodine therapy were randomized into pilocarpine and placebo groups. The patients as well as the nurse who administered the tablets, and the specialist who analyzed the images, were all unaware of the patients' group. Anterior and posterior planar images including that of both the head and neck were obtained 2, 6, 12, 24, and 48h after the administration of radioiodine in all patients, and round regions of interest were drawn for both left and right parotid glands, with a rectangular region of interest in the region of the cerebrum as background. All patients were interrogated once, 6 months after radioiodine administration, by a phone call for subjective evaluation of symptoms related to salivary gland damage. Results There was no significant difference between the two groups with regard to the mean age, sex, and initial iodine activity. The geometric mean of background-corrected count per administered dose and acquisition time was calculated for the bilateral parotid glands. This normalized parotid count showed a significant reduction in net parotid count in both groups during the first 48h after radioiodine administration. However, no significant difference was found between the groups according to the amount and pattern of dose reduction in this time period. Conclusion This study revealed that pilocarpine had no significant effect on the radioiodine content of parotid glands during the first 48h after radioiodine administration. No significant difference was found in the incidence of symptoms between the two groups treated with placebo and pilocarpine. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.

The 99mTc-MIBI has been used with great value as a diagnostic technique in patients with primary hyperparathyroidism. False-positive scans may occur due to misinterpretation of the physiologic distribution of the 99mTc-MIBI. Reviewing consecutive SPECT scans, we evaluated this possibility and assessed how frequently brown adipose tissue (BAT) is seen on 99mTc-MIBI scintigraphy. Here, we retrospectively reviewed scans of consecutive patients who were evaluated for parathyroid adenomas from March 2015 to June 2015, using dual-phase (early and delayed) planar imaging and SPECT. We identified 60 patients (48 female and 12 male; mean age, 52.25 ± 15.20 years; range, 22-86 years).We detected the presence of 99mTc-MIBI uptake in BAT in 20 of 60 patients (33.33%) in the neck. Although the patients with T99mc-MIBI uptake in BAT were younger (mean age, 48.85 ± 15.27 years, range, 26-73 years) than the patients with no 99mTc-MIBI uptake (mean age, 53.95 ± 15.07 years, range, 22-86 years), this difference was not statistically significant (P = 0.224). The percentage of female patients with BAT detection was higher (17/48 patients; 37.5%) than that of the male population (3/12 patients; 25%), this difference was not also statistically significant (P = 0.85).In patient population referred to 99mTc MIBI scintigraphy of the parathyroid glands, uptake of 99mTc-MIBI in BAT should not be misinterpreted with 99mTc-MIBI-avid-tumors. Fused SPECT/CT images (not SPECT-only) are necessary to distinguish BAT from bone, muscle, thyroid, myocardium, parathyroids, and other structures in the neck and chest.