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Wickremasinghe A, Ferdinands J, Johari Y, Ho P, Leang Y, Yue H, Laurie C, Beech P, Nadebaum DP, Yap KS, Hebbard G, Brown W, Burton P. The Evaluation of Gastric Emptying Using Nuclear Scintigraphy Compared to Three-Dimensional Multi-detector Computed Tomography (3D-MDCT) Gastric Volumetry in the Assessment of Poor Weight Loss Following Sleeve Gastrectomy. Obes Surg 2024; 34:150-162. [PMID: 37991711 DOI: 10.1007/s11695-023-06951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Poor weight loss and weight regain are principal challenges following laparoscopic sleeve gastrectomy (LSG). There is a lack of standardised assessments and diagnostic tests to stratify the status post-LSG and determine whether anatomical or physiological problem exists. We aimed to compare nuclear scintigraphy gastric emptying with CT volumetric analysis of sleeve anatomy and determine the impact of anatomy on physiological function and its correlation with weight loss. MATERIALS AND METHODS Patients greater than 12 months post-LSG were categorised into optimal weight loss (OWL) (n = 29) and poor weight loss groups (PWL) (n = 50). All patients underwent a protocolised nuclear scintigraphy and three-dimensional multi-detector computed tomography (3D-MDCT) gastric volumetry imaging. RESULTS Post-operative % total weight loss in OWL was 26.2 ± 10.5% vs. 14.2 ± 10.7% in the PWL group (p value < 0.0001). The PWL group had significantly more delayed gastric emptying half-time than OWL (34.1 ± 18.8 vs. 19.5 ± 4.7, p value < 0.0001). Gastric emptying half-time showed statistically significant correlations with weight loss parameters (BMI; r = 0.215, p value 0.048, %EWL; r = - 0.336, p value 0.002 and %TWL; r = - 0.379, p value < 0.001). The median gastric volume on 3D-MDCT did not differ between the OWL (246 (IQR 50) ml) and PWL group (262 (IQR 129.5) ml), p value 0.515. Nuclear scintigraphy gastric emptying half-time was the most highly discriminant measure. A threshold of 21.2 min distinguished OWL from PWL patients with 86.4% sensitivity and 68.4% specificity. CONCLUSION Nuclear scintigraphy is a potentially highly accurate tool in the functional assessment of sleeve gastrectomy physiology. It appears to perform better as a diagnostic test than volumetric assessment. Gastric volume did not correlate with weight loss outcomes. We have established diagnostic criteria of greater than 21 min to assess sleeve failure, which is linked to suboptimal weight loss outcomes.
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Affiliation(s)
- Anagi Wickremasinghe
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia.
| | - Jessica Ferdinands
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
| | - Yazmin Johari
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Patrick Ho
- Department of Radiology, The Avenue Hospital, Melbourne, Australia
| | - Yit Leang
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Helen Yue
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
| | - Cheryl Laurie
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
| | - Paul Beech
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
| | - David P Nadebaum
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
| | - Kenneth S Yap
- Department of Nuclear Medicine and PET, The Alfred Hospital, Melbourne, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, 3004, Australia
| | - Geoffrey Hebbard
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Wendy Brown
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Paul Burton
- Department of Surgery, Central Clinical School, Monash University, Monash University, Melbourne, Australia
- Oesophago-Gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Horne CR, Tufts S. Advances in Imaging Techniques to Guide Therapies and Monitor Response to the Treatment of Musculoskeletal Injuries. Vet Clin North Am Equine Pract 2023; 39:489-501. [PMID: 37482520 DOI: 10.1016/j.cveq.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Continual advancements in diagnostic imaging have allowed for more accurate and complete diagnoses of injuries in the performance horse. The use of several different imaging tools has further allowed the equine sports medicine clinician to more carefully direct treatment options, monitor response to therapy and guide rehabilitation recommendations. The advancements in diagnostic imaging and novel treatment options have led to the improvement in the overall prognosis of many injuries that affect the horse and their performance. The purpose of this section is to review the advancements made in diagnostic imaging of the horse and to aid the practitioner in the selection of the appropriate modality and how best to use them to guide treatment and monitoring decisions.
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Affiliation(s)
- Caitlyn R Horne
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
| | - Sara Tufts
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA
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Wickremasinghe AC, Johari Y, Yue H, Laurie C, Shaw K, Playfair J, Beech P, Hebbard G, Yap KS, Brown W, Burton P. Changes in Oesophageal Transit, Macro-Reflux Events, and Gastric Emptying Correlate with Improvements in Gastro-Intestinal Symptoms and Food Tolerance Early Post Sleeve Gastrectomy. Obes Surg 2023; 33:2384-2395. [PMID: 37349670 PMCID: PMC10345052 DOI: 10.1007/s11695-023-06695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE There are significant alterations in gastro-intestinal function, food tolerance, and symptoms following sleeve gastrectomy (SG). These substantially change over the first year, but it is unclear what the underlying physiological basis for these changes is. We examined changes in oesophageal transit and gastric emptying and how these correlate with changes in gastro-intestinal symptoms and food tolerance. MATERIAL AND METHODS Post-SG patients undertook protocolised nuclear scintigraphy imaging along with a clinical questionnaire at 6 weeks, 6 months, and 12 months. RESULTS Thirteen patients were studied: mean age (44.8 ± 8.5 years), 76.9% females, pre-operative BMI (46.9 ± 6.7 kg/m2). Post-operative %TWL was 11.9 ± 5.1% (6 weeks) and 32.2 ± 10.1% (12 months), p-value < 0.0001. There was a substantial increase of meal within the proximal stomach; 22.3% (IQR 12%) (6 weeks) vs. 34.2% (IQR 19.7%) (12 months), p = 0.038. Hyper-accelerated transit into the small bowel decreased from 6 weeks 49.6% (IQR 10.8%) to 42.7% (IQR 20.5%) 12 months, p = 0.022. Gastric emptying half-time increased from 6 weeks 19 (IQR 8.5) to 12 months 27 (IQR 11.5) min, p = 0.027. The incidence of deglutitive reflux of semi-solids decreased over time; 46.2% (6 weeks) vs. 18.2% (12 months), p-value < 0.0001. Reflux score of 10.6 ± 7.6 at 6 weeks vs. 3.5 ± 4.4 at 12 months, (p = 0.049) and regurgitation score of 9.9 ± 3.3 at 6 weeks vs. 6.5 ± 1.7, p = 0.021 significantly reduced. CONCLUSIONS These data demonstrate that there is an increase in the capacity of the proximal gastric sleeve to accommodate substrate over the first year. Gastric emptying remains rapid but reduce over time, correlating with improved food tolerance and reduced reflux symptoms. This is likely the physiological basis for the changes in symptoms and food tolerance observed early post-SG.
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Affiliation(s)
- Anagi C Wickremasinghe
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Yazmin Johari
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Helen Yue
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
| | - Cheryl Laurie
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Kalai Shaw
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Julie Playfair
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul Beech
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
| | - Geoffrey Hebbard
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia
| | - Kenneth S Yap
- Department of Nuclear Medicine, The Alfred Hospital, Melbourne, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, 3004, Australia
| | - Wendy Brown
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Paul Burton
- Monash University Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Choen S, Kent MS, Chaudhari AJ, Cherry SR, Krtolica A, Zwingenberger AL. Kinetic Evaluation of the Hypoxia Radiotracers [ 18F]FMISO and [ 18F]FAZA in Dogs with Spontaneous Tumors Using Dynamic PET/CT Imaging. Nucl Med Mol Imaging 2023; 57:16-25. [PMID: 36643946 PMCID: PMC9832187 DOI: 10.1007/s13139-022-00780-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/12/2022] [Accepted: 09/28/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose We evaluated the kinetics of the hypoxia PET radiotracers, [18F]fluoromisonidazole ([18F]FMISO) and [18F]fluoroazomycin-arabinoside ([18F]FAZA), for tumor hypoxia detection and to assess the correlation of hypoxic kinetic parameters with static imaging measures in canine spontaneous tumors. Methods Sixteen dogs with spontaneous tumors underwent a 150-min dynamic PET scan using either [18F]FMISO or [18F]FAZA. The maximum tumor-to-muscle ratio (TMRmax) > 1.4 on the last image frame was used as the standard threshold to determine tumor hypoxia. The tumor time-activity curves were analyzed using irreversible and reversible two-tissue compartment models and graphical methods. TMRmax was compared with radiotracer trapping rate (k 3), influx rate (K i), and distribution volume (V T). Results Tumor hypoxia was detected in 7/8 tumors in the [18F]FMISO group and 4/8 tumors in the [18F]FAZA group. All hypoxic tumors were detected at > 120 min with [18F]FMISO and at > 60 min with [18F]FAZA. [18F]FAZA showed better fit with the reversible model. TMRmax was strongly correlated with the irreversible parameters (k 3 and K i) for [18F]FMISO at > 90 min and with the reversible parameter (V T) for [18F]FAZA at > 120 min. Conclusions Our results showed that [18F]FAZA provided a promising alternative radiotracer to [18F]FMISO with detecting the presence of tumor hypoxia at an earlier time (60 min), consistent with its favorable faster kinetics. The strong correlation between TMRmax over the 90-150 min and 120-150 min timeframes with [18F]FMISO and [18F]FAZA, respectively, with kinetic parameters associated with tumor hypoxia for each radiotracer, suggests that a static scan measurement (TMRmax) is a good alternative to quantify tumor hypoxia. Supplementary Information The online version contains supplementary material available at 10.1007/s13139-022-00780-4.
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Affiliation(s)
- Sangkyung Choen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA USA
| | - Michael S. Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA USA
| | - Abhijit J. Chaudhari
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA USA ,Department of Radiology, School of Medicine, University of California, CA Sacramento, USA
| | - Simon R. Cherry
- Department of Biomedical Engineering, College of Engineering, University of California, Davis, CA USA
| | | | - Allison L. Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA USA
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Kyrouac D, Schiffer W, Lennep B, Fergestrom N, Zhang KW, Gorcsan J, Lenihan DJ, Mitchell JD. Echocardiographic and clinical predictors of cardiac amyloidosis: limitations of apical sparing. ESC Heart Fail 2021; 9:385-397. [PMID: 34877800 PMCID: PMC8788049 DOI: 10.1002/ehf2.13738] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 01/15/2023] Open
Abstract
Aims The accuracy of an apical‐sparing strain pattern on transthoracic echocardiography (TTE) for predicting cardiac amyloidosis (CA) has varied in prior studies depending on the underlying cohort. We sought to evaluate the performance of apical sparing and other TTE strain findings to screen for CA in an unselected population and determine the frequency that patients with echocardiographic concern for CA undergo evaluation for amyloidosis in clinical practice. Methods and results As strain is routinely performed at our institution on all clinical TTEs, we identified all TTEs performed from 2016 through 2019 with reported concern for CA or apical sparing. We determined the performance characteristics for echocardiographic strain findings in discriminating CA including apical sparing, the ejection fraction to global longitudinal strain ratio (EF/GLS), and the septal apical–septal basal ratio (SA/SB); other clinical predictors of confirmed CA; and predictors of patients who underwent complete evaluation for CA. CA was confirmed by endomyocardial biopsy or diagnostic cardiac imaging. A total of 547 TTEs, representing 451 patients, reported concern for CA and had adequate strain for analysis. A total of 111 patients underwent complete evaluation for amyloidosis with 100 patients undergoing complete cardiac evaluation for CA. In those 100 patients, multivariable predictors of confirmed CA were age [odds ratio (OR) 3.37 per 5 years], a visual apical‐sparing pattern (OR 10.85), and left ventricular ejection fraction (LVEF)/GLS > 4.1 (OR 35.37). CA was less likely in those with coronary artery disease (OR 0.04), hypertension (OR 0.18), and increased systolic blood pressure (OR 0.60 per 5 mm Hg increase). SA/SB [area under the curve (AUC) 0.72, 95% confidence interval (CI) 0.60–0.84] and LVEF/GLS (AUC 0.72, 95% CI 0.60–0.84) both had improved discrimination for CA compared with the apical‐sparing ratio (AUC 0.66, 95% CI 0.54–0.79). Many patients with suggestive TTE findings did not receive an evaluation for amyloidosis. Complete evaluation was more likely with Caucasian race (OR 2.1), increased septal thickness (OR 1.4), increased body mass index (OR 1.2), and if the report specifically stated ‘amyloid’ (OR 1.9). Evaluations were less likely in patients with comorbidities. While hypertension reduced the likelihood of evaluating for CA, 34% of patients with CA had hypertension (>130/80 mm Hg) at time of diagnosis. Conclusions In a broad population of patients undergoing TTE, apical sparing on strain imaging increased the likelihood of CA diagnosis but with modest sensitivity and specificity. GLS/EF ratio may be a more reliable tool to screen for CA. The low rate of complete evaluation in patients with concerning TTE findings indicates a strong need for practice improvement and enhanced disease awareness.
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Affiliation(s)
- Douglas Kyrouac
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Walter Schiffer
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Brandon Lennep
- Cardiovascular Division, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Nicole Fergestrom
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathleen W Zhang
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - John Gorcsan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel J Lenihan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA
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Giblin GT, Cuddy SAM. Multimodality Imaging in Cardiac Amyloidosis. Curr Cardiol Rep 2021; 23:134. [PMID: 34410523 DOI: 10.1007/s11886-021-01564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Cardiac amyloidosis is an increasingly recognized condition with a growing range of targeted therapies, but diagnosis requires a high index of suspicion and multimodality imaging expertise. Early diagnosis remains key to improving quality of life and survival. This article reviews the multimodality imaging approach to the diagnosis, differentiation, and prognosis of cardiac amyloidosis. RECENT FINDINGS Recent advances in multimodality cardiac imaging have allowed for earlier diagnosis of cardiac amyloidosis resulting in earlier initiation of life-saving therapy in cases of light chain amyloidosis and life-prolonging therapy in transthyretin amyloidosis. With these advances in multimodality imaging, it is important for cardiologists and cardiac imagers to be aware of the subtleties of early disease, the appropriate diagnostic approach as well as understanding the practicalities and pitfalls that are encountered with each modality.
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Affiliation(s)
- Gerard T Giblin
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Heart & Vascular Centre, Brigham and Women's Hospital and Harvard Medical School, 15 Francis St, Boston, MA, 02115, USA
| | - Sarah A M Cuddy
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Heart & Vascular Centre, Brigham and Women's Hospital and Harvard Medical School, 15 Francis St, Boston, MA, 02115, USA. .,CV Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, USA.
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Johari Y, Yue H, Laurie C, Hebbard G, Beech P, Yap KS, Brown W, Burton P. Expected Values of Esophageal Transit and Gastric Emptying Scintigraphy Post-uncomplicated Sleeve Gastrectomy. Obes Surg 2021; 31:3727-3737. [PMID: 34091832 DOI: 10.1007/s11695-021-05487-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) results in significant anatomical and physiological alterations of the esophagus and stomach, including food tolerance. Currently, there is no consensus on the parameters of abnormal esophageal transit and gastric emptying in this population. We describe standardized esophageal transit and gastric emptying protocols, and define expected values following an uncomplicated SG. MATERIALS AND METHODS In 43 asymptomatic post-SG patients with optimal weight loss, a standardized liquid and semi-solid (oatmeal) esophageal transit study, plus a 90-min semi-solid gastric emptying study with dynamic 5-s image acquisition to assess gastroesophageal reflux, was performed. Gastric emptying half-time and retention rate was calculated. Esophageal transit and reflux were graded by visual inspection of images. RESULTS Thirty-one female and 12 male patients participated: mean age 49.0±10.7 years, pre-operative BMI 47.6±7.0 kg/m2, excess weight loss 58.8±26.0% at median follow-up of 7.4 months. The standardized semi-solid meal and liquid preparations were well tolerated. Delays in esophageal transit of liquid and semi-solid boluses were infrequent (7.0% and 16.3% respectively). Deglutitive reflux of both semi-solids and liquids was common (48.8% and 32.6%). The median semi-solid gastric emptying half-time was 21.0 min. A large proportion of substrate transited into the small bowel on initial image acquisition (median 39.1%). Reflux events during gastric emptying were common (median 5.0 events, 12.7% of image acquisition time). CONCLUSIONS Rapid gastric emptying with asymptomatic deglutitive and post-prandial gastroesophageal reflux events are common following SG. We have defined the expected values of standardized esophageal transit and gastric emptying scintigraphy specifically tailored to SG patients.
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Affiliation(s)
- Yazmin Johari
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia. .,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | - Helen Yue
- Department of Nuclear Medicine & PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Cheryl Laurie
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Geoffrey Hebbard
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, 3050, Australia
| | - Paul Beech
- Department of Nuclear Medicine & PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Kenneth Sk Yap
- Department of Nuclear Medicine & PET, The Alfred Hospital, Melbourne, VIC, 3004, Australia.,Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, 3004, Australia
| | - Wendy Brown
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Paul Burton
- Monash University Department of Surgery, Central Clinical School, Monash University, Level 6, Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.,Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, VIC, 3004, Australia
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Afsharfarnia S, Mohseni M, Fartashvand M, Assadnassab G, Mahmoudian B. Effects of parenteral administration of tylosin and ivermectin on abomasal emptying rate in healthy suckling lambs by use of nuclear scintigraphy. Res Vet Sci 2020; 134:181-185. [PMID: 33388615 DOI: 10.1016/j.rvsc.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
Abomasal hypomotility is one of the important causes of neonatal mortality in small ruminants. Various pharmaceutical agents have been studied to address this problem in large ruminants. The aim of this study was to determine the effect of parenteral administration of tylosin and ivermectin on abomasal emptying rate in neonatal suckling lambs. Abomasal emptying rate was assessed using nuclear scintigraphic method in 10 healthy female Iranian fat tailed Ghezel lambs. Each lamb was tested three times, once as a control (1 ml of saline 0.9%, IM) and twice after the injection of tylosin (17.6 mg/kg, IM) and ivermectin (200 μg/kg, SC) in a crossover study. Based on radiopharmaceutical counts, remnant activity in abomasums at 90 min were 48.3 ± 3.5, 45.6 ± 7.5 and 41.6 ± 2.9% in control, tylosin and ivermectin groups, respectively. Administration of tylosin (p = 0.049) and ivermectin (p = 0.045) to lambs, significantly caused faster abomasal emptying rate compared to control. Evaluating the ROIs revealed that the half emptying time (T1/2) in control, tylosin and ivermectin groups were 67.1 ± 8.6, 62.6 ± 14.2 and 54.3 ± 9.9 min, respectively. These difference between all groups, statistically were significant (p = 0.026). However, the clinical efficacy of abomasal emptying rate facilitating by tylosin or ivermectin administration in lambs remains to be determined.
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Affiliation(s)
- Sajjad Afsharfarnia
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Mojtaba Mohseni
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Majid Fartashvand
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran.
| | - Gholamreza Assadnassab
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Babak Mahmoudian
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Brownrigg J, Lorenzini M, Lumley M, Elliott P. Diagnostic performance of imaging investigations in detecting and differentiating cardiac amyloidosis: a systematic review and meta-analysis. ESC Heart Fail 2019; 6:1041-1051. [PMID: 31487121 PMCID: PMC6816075 DOI: 10.1002/ehf2.12511] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/10/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022] Open
Abstract
Aims The study aims to systematically assess the diagnostic performance of cardiac magnetic resonance (CMR) and nuclear scintigraphy (index tests) for the diagnosis and differentiation of subtypes of cardiac amyloidosis. Methods and results MEDLINE and Embase electronic databases were searched for studies evaluating the diagnostic performance of CMR or nuclear scintigraphy in detecting cardiac amyloidosis and subsequently in differentiating transthyretin amyloidosis (ATTR) from immunoglobulin light‐chain (AL) amyloidosis. In this meta‐analysis, histopathological examination of tissue from endomyocardial biopsy (EMB) or extra‐cardiac organs were reference standards. Pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated, and a random effects meta‐analysis was used to estimate diagnostic odds ratios. Methodological quality was assessed using a validated instrument. Of the 2947 studies identified, 27 met the criteria for inclusion. Sensitivity and specificity of CMR in diagnosing cardiac amyloidosis was 85.7% and 92.0% against EMB reference and 78.9% and 93.9% with any organ histology reference. Corresponding sensitivity and specificity of nuclear scintigraphy was 88.4% and 87.2% against EMB reference and 82.0% and 98.8% with histology from any organ. CMR was unable to reliably differentiate ATTR from AL amyloidosis (sensitivity 28.1–99.0% and specificity 11.0–60.0%). Sensitivity and specificity of nuclear scintigraphy in the differentiation of ATTR from AL amyloidosis ranged from 90.9% to 91.5% and from 88.6% to 97.1%. Pooled negative likelihood ratio and positive likelihood ratio for scintigraphy in this setting were 0.1 and 8, with EMB reference standard. Study quality assessed by QUADAS‐2 was generally poor with evidence of bias. Conclusions Cardiac magnetic resonance is a useful test for diagnosing cardiac amyloidosis but is not reliable in further classifying the disease. Nuclear scintigraphy offers strong diagnostic performance in both the detection of cardiac amyloidosis and differentiating ATTR from AL amyloidosis. Our findings support the use of both imaging modalities in a non‐invasive diagnostic algorithm that also tests for the presence of monoclonal protein.
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Affiliation(s)
- Jack Brownrigg
- Pfizer Limited, Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, KT20 7NS, UK
| | | | - Matthew Lumley
- Pfizer Limited, Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, KT20 7NS, UK
| | - Perry Elliott
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Shibata N, Takagi K, Morishima I, Yoshioka N, Furui K, Nagai H, Kanzaki Y, Yoshida R, Morita Y, Tsuboi H, Murohara T. The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy. Int J Cardiovasc Imaging 2020; 36:161-70. [PMID: 31451993 DOI: 10.1007/s10554-019-01690-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/19/2019] [Indexed: 02/05/2023]
Abstract
Data on the efficacy of excimer laser coronary atherectomy (ELCA) for patients with ST-elevation myocardial infarction (STEMI) are limited. Therefore, we sought to evaluate the impact of ELCA on myocardial salvage using nuclear scintigraphy in patients with STEMI. Between September 2014 and April 2017, we retrospectively enrolled 316 consecutive patients undergoing primary PCI (p-PCI) after their first STEMI in our institute. Of those, 72 patients with STEMI, an initial thrombolysis in myocardial infarction (TIMI) flow-0/1, and an onset to balloon time (OBT) < 6 h were included (ELCA, n = 32; non-ELCA, n = 40). The endpoint was the myocardial salvage index (MSI) based on a 17-segment model with a 5-point scoring system. MSI was calculated as: MSI = (∑123I-BMIPP defect score at 3-7 days after p-PCI - ∑99mTc-tetrofosmin defect score at 3-6 months after p-PCI)/∑123I-BMIPP defect score × 100 (%) at 3-7 days after p-PCI. The groups were compatible except in age (ELCA: 62.9 ± 12.4 years vs. non-ELCA: 69.8 ± 11.0 years) and loading antiplatelet drug (prasugrel: 100% vs. 40.0%). Direct implantation of shorter stents more frequently occurred in the ELCA group than in the non-ELCA group. MSI seemed to be better in the ELCA group compared with the non-ELCA group (57.6% vs. 45.6%, p = 0.09). This trend was emphasized when the final TIMI-3 flow was achieved (67.1% vs. 45.7%, p = 0.01). The nuclear scintigraphy results showed that ELCA can potentially improve myocardial salvage in patients with STEMI with OBT < 6 h and initial TIMI flow-0/1.
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Bhogal RH, Wotherspoon A, Zerizer I, Khan AZ. Pancreatic tail splenunculus: Case report and review of the literature. Int J Surg Case Rep 2019; 57:36-38. [PMID: 30884375 PMCID: PMC6424060 DOI: 10.1016/j.ijscr.2019.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Abstract
Solitary pancreatic tail lesion should undergo nuclear scintigraphy to assess whether the lesion is compatible with a splenunculus.
Introduction Mass lesions in the pancreatic tail are increasingly identified upon radiological imaging. However the diagnosis of these lesions can be challenging and impact significantly upon patient management. Presentation of case We report a case of an intrapancreatic accessory spleen initially diagnosed as a neuroendocrine tumour of the pancreas tail following nuclear scintigraphy. Discussion The investigation of solitary pancreatic tail lesions and the potential management paradigms are discussed. Conclusion Solitary lesions within the pancreatic tail should have splenunculus included in the differential diagnosis.
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Affiliation(s)
- Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom.
| | - Andrew Wotherspoon
- Department of Histopathology, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
| | - I Zerizer
- Department of Nuclear Medicine and Radiology, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
| | - Aamir Z Khan
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, Chelsea, London, SW3 6JJ, United Kingdom
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Beck KR, Shergill AK. Colonoscopy in Acute Lower Gastrointestinal Bleeding: Diagnosis, Timing, and Bowel Preparation. Gastrointest Endosc Clin N Am 2018; 28:379-90. [PMID: 29933782 DOI: 10.1016/j.giec.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lower gastrointestinal bleeding is bleeding from a colonic source. Rapid colon purge using 4 to 6 L of polyethylene glycol followed by early colonoscopy, within 24 hours of presentation, is recommended to optimize the detection and management of bleeding sources. Although the data are mixed, early colonoscopy seems to be associated with higher detection of bleeding lesions and therapeutic interventions. There is no clear benefit for early colonoscopy in terms of reduced duration of stay, rebleeding, transfusion requirement, or surgery compared with patients undergoing elective colonoscopy. Further studies are needed to determine the effect of early colonoscopy on clinically important outcomes.
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Xiao SM, Xu R, Tang XL, Ding Z, Li JM, Zhou X. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour. World J Surg Oncol 2017; 15:78. [PMID: 28399879 PMCID: PMC5387232 DOI: 10.1186/s12957-017-1153-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. Case presentation We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. Conclusions An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Xiao-Li Tang
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Ji-Man Li
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, China
| | - Xiang Zhou
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China.
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Scott-Moncrieff JC, Heng HG, Weng HY, Dimeo D, Jones MD. Effect of a Limited Iodine Diet on Iodine Uptake by Thyroid Glands in Hyperthyroid Cats. J Vet Intern Med 2015; 29:1322-6. [PMID: 26306818 PMCID: PMC4858048 DOI: 10.1111/jvim.13577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 03/03/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The effect of feeding a limited iodine diet on radioactive iodine uptake in the thyroid glands of hyperthyroid cats is unknown. OBJECTIVES To determine how feeding limited dietary iodine affects radioactive iodine uptake by the thyroid glands of hyperthyroid cats. ANIMALS Eight geriatric cats with spontaneous hyperthyroidism. METHODS Prospective study of eight client owned hyperthyroid cats fed a commercially available iodine limited diet for 6 months. Clinical signs were evaluated and TT4 and fT4 were measured during consumption of the diet. Uptake of (123)I was determined before and 8-16 weeks after exclusive consumption of the diet. RESULTS Clinical signs of hyperthyroidism resolved in all cats, but there was no significant increase in body weight. TT4 and fT4 decreased into the reference range by 8-16 weeks in all cats. Mean TT4 before consumption of the diet was 9.7 μg/dL (SD 5.2) and after consumption of the diet was 3.1 μg/dL (SD 0.9). Scintigraphy revealed unilateral uptake of isotope in 5 cats and bilateral uptake in 3 cats. Mean percentage uptake of (123)I by the thyroid gland at 8 hours after isotope administration was 16.2 (SD 11.8) before diet consumption and 34.6 (SD 11.7) 8-16 weeks after exclusive consumption of the diet. The percentage increase was variable between cats (38-639%). CONCLUSIONS AND CLINICAL IMPORTANCE Limited iodine diets increase iodine uptake in the autonomous thyroid glands of hyperthyroid cats. Further studies are necessary to determine if consumption of a limited iodine diet changes sensitivity of the thyroid gland to (131)I treatment.
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Affiliation(s)
- J C Scott-Moncrieff
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - H G Heng
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - H Y Weng
- Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - D Dimeo
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN
| | - M D Jones
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN
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Tomlinson JE, Johnson AL, Ross MW, Engiles JB, Levine DG, Wisner WA, Sweeney RW. Successful detection and removal of a functional parathyroid adenoma in a pony using technetium Tc 99m sestamibi scintigraphy. J Vet Intern Med 2014; 28:687-92. [PMID: 24417704 PMCID: PMC4858011 DOI: 10.1111/jvim.12285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/20/2013] [Accepted: 11/20/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- J E Tomlinson
- New Bolton Center, University of Pennsylvania, Kennett Square, PA
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