This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achi... more This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI)... more There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort. Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportio...
Journal of the American College of Cardiology, 2017
Background: Although increasing attention has been drawn to medical radiation exposure, little is... more Background: Although increasing attention has been drawn to medical radiation exposure, little is reported about worldwide variation in nuclear myocardial perfusion imaging (MPI) techniques that may result in differences in radiation exposure. The IAEA Nuclear Cardiology Protocols Study (INCAPS) was initiated to evaluate such differences. Methods: Observational cross-sectional study of all MPI studies conducted at 308 nuclear cardiology laboratories in 65 countries during a single week in March-April 2013. We evaluated camera technology, reconstruction software and acquisition protocols used and their association with MPI radiation exposure. Results: 7911 studies were included. Stress only protocols (10% of MPI), rest only protocols (4%), multiple position imaging (7%), attenuation correction (26%), avoidance of thallium (95%), advanced software processing (38%), CZT camera (10%), and PET imaging (6%) were associated with significantly lower radiation dose. Of all lab variables evaluated (Table 1), avoidance of thallium, CZT camera, and stress or rest only protocols had the largest effect size for association with radiation exposure. Conclusions: Our findings demonstrate variable and overall low worldwide adoption of IAEA recommended best nuclear Cardiology practices. Nearly all sites have succeeded in avoidance of thallium imaging. Adherence to best practices, even low cost solutions such as multiple position imaging, could reduce worldwide radiation exposure during nuclear MPI.
The aim of this study was to investigate gender-based differences in nuclear cardiology practice ... more The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as c...
reviewed the manuscript. They received no compensation for this role. We thank the INCAPS executi... more reviewed the manuscript. They received no compensation for this role. We thank the INCAPS executive committee, regional coordinators, and investigators group. Investigators group members were compensated for their time and effort involved in data collection.
This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisatio... more This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at ...
The aim of this study was to compare the results obtained using X-ray mammography (MG) and 99mTc-... more The aim of this study was to compare the results obtained using X-ray mammography (MG) and 99mTc-sestamibi scintimammography (SSM) in patients with breast lesions < or = 2 cm. One hundred and thirty-four women (median age 52 years, range 32-78), who had already been selected for open breast biopsy, underwent both MG and SSM prior to surgery. Final pathology showed 27 (20.1%) benign breast lesions and 107 (79.9%) breast cancers (pT1a=5 [4.7%], pT1b=50 [46.7%], pT1c=52 [48.6%]). The sensitivity, positive predictive value, negative predictive value and accuracy were 81.3%, 97.6%, 55.6% and 83.6% for SSM and 83.2%, 89.9%, 48.6% and 79.1% for MG, respectively. The results were similar (p=NS), but patients with breast cancer (BC) undetected by MG were significantly (p<0.05) younger than those in which the tumor was correctly diagnosed, while the age did not affect SSM sensitivity. SSM was more (p<0.05) specific than MG in BC detection both in the overall group of patients (92.6% ...
In patients locally progressing after two lines of chemotherapy, some locoregional approaches sho... more In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan follow...
Thirty-seven non-elderly primary Sjögren's syndrome (I SS) patients, and 27 controls complain... more Thirty-seven non-elderly primary Sjögren's syndrome (I SS) patients, and 27 controls complaining of xerostomia and/or recurrent or persistent swelling of at least one parotid or submandibular gland due to other selected disorders, were studied. A new scintigraphic score (scsc) is proposed for a standardised semiquantitative evaluation of salivary involvement by qualitative sequential salivary scintigraphy (SSS), and is compared with two other well-known methods generally used for this purpose. The scsc proved to be much more suitable for such an evaluation: the other criteria did not allow us either to classify or to score a great number of cases. Furthermore, the scsc allowed us to obtain better SSS sensitivity (89.2%) and specificity (96.3%) values for I.SS (33 of the 37 I SS patients and 26 of the 27 controls were correctly classified by discriminant analysis, for scsc values greater than 8). This was made possible by the different "weights" which we assigned to the...
Radioactivity in the colon during 131-I-meta-iodobenzylguanidine (MIBG) scintigraphy may obscure ... more Radioactivity in the colon during 131-I-meta-iodobenzylguanidine (MIBG) scintigraphy may obscure or be mistaken for tumor uptake. Fecal excretion of radioactivity was examined in eight patients following therapeutic 131-I-MIBG administration (123-218 mCi, 4.551-8.066 GBq) and was found to be 0.02-1.93% of the administered dose. Semiquantitative grading of colonic activity on scintigraphy was inversely related to fecal excretion. An additional patient with marked colonic activity was studied before and after an enema: all visible gut activity was evacuated. We conclude that radioactivity in the colon seen in 131-I-MIBG scintigraphy is due largely to gut excretion of 131-I and is not due to 131-I-MIBG uptake in the autonomic innervation of the gut. Laxatives and enemas are suggested for patients in which such gut radioactivity may lead to difficulties in interpretation.
The authors describe a 29-year-old man who had a 16-year history of neuroblastoma and uncommon ma... more The authors describe a 29-year-old man who had a 16-year history of neuroblastoma and uncommon manifestations. At age 13, he was diagnosed with stage III retroperitoneal ganglioneuroblastoma that was resected. Ten years later, bilateral testicular enlargement and a pelvic mass from infiltration of the neuroblastoma became palpable. Metastatic involvement was depicted with MIBG, a radiotracer that concentrates in tissues of the sympathetic nervous system. Using I-131 MIBG, the tumors were treated with therapeutic doses of radiation and a partial response was obtained. This case is unique because of the massive degree of bilateral testicular infiltration and its occurrence as a late manifestation of neuroblastoma in early adulthood.
Two patients are described in whom the absorption of l-thyroxine was impaired by non-prescription... more Two patients are described in whom the absorption of l-thyroxine was impaired by non-prescription herbal and nutritional remedies. The absorption of thyroid hormones is discussed and an approach to the problem of patients who appear to be unresponsive to the usual doses of thyroid hormones is suggested.
Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic in... more Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic insulinoma in a patient suffering from intermittent hypoglycemia. This observation widens the range of neuroendocrine tumors that take up to I-131 MIBG and supports the concept that many tumors of the amine precursor uptake and decarboxylation system may be imaged in this way.
Uptake of I-131 in the pericardial area is described in an asymptomatic patient who underwent tot... more Uptake of I-131 in the pericardial area is described in an asymptomatic patient who underwent total body scan for recurrent papillary thyroid cancer. Ultrasonography demonstrated a small pericardial effusion that persisted after I-thyroxine therapy was reinstituted. Two I-131 therapeutic doses were given, and follow-up total body scans were performed during the next 6 years. Although tracer accumulation in the neck was eliminated and the serum thyroglobulin level was not elevated, I-131 uptake persisted in pericardial effusion. Despite diligent study, no neoplastic, infectious, or autoimmune etiology could be demonstrated, and we thus classified it as idiopathic pericardial effusion. This phenomenon should be considered when interpreting I-131 scans that show I-131 uptake in the region of the heart.
When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not ... more When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not be due to concurrent hyperparathyroidism and at times only the control of the hyperthyroidism will resolve the problem. Moreover, the presence of hyperfunctioning thyroid nodules will interfere with Tl-201/Tc-99m pertechnetate parathyroid scintigraphy. Initial treatment of hyperthyroidism with I-131 in this situation controls hyperthyroidism and permits successful localization of parathyroid adenomas, which may then be excised--a result that was achieved in three cases.
This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achi... more This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). BACKGROUND Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. RESULTS The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. CONCLUSIONS This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI)... more There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort. Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportio...
Journal of the American College of Cardiology, 2017
Background: Although increasing attention has been drawn to medical radiation exposure, little is... more Background: Although increasing attention has been drawn to medical radiation exposure, little is reported about worldwide variation in nuclear myocardial perfusion imaging (MPI) techniques that may result in differences in radiation exposure. The IAEA Nuclear Cardiology Protocols Study (INCAPS) was initiated to evaluate such differences. Methods: Observational cross-sectional study of all MPI studies conducted at 308 nuclear cardiology laboratories in 65 countries during a single week in March-April 2013. We evaluated camera technology, reconstruction software and acquisition protocols used and their association with MPI radiation exposure. Results: 7911 studies were included. Stress only protocols (10% of MPI), rest only protocols (4%), multiple position imaging (7%), attenuation correction (26%), avoidance of thallium (95%), advanced software processing (38%), CZT camera (10%), and PET imaging (6%) were associated with significantly lower radiation dose. Of all lab variables evaluated (Table 1), avoidance of thallium, CZT camera, and stress or rest only protocols had the largest effect size for association with radiation exposure. Conclusions: Our findings demonstrate variable and overall low worldwide adoption of IAEA recommended best nuclear Cardiology practices. Nearly all sites have succeeded in avoidance of thallium imaging. Adherence to best practices, even low cost solutions such as multiple position imaging, could reduce worldwide radiation exposure during nuclear MPI.
The aim of this study was to investigate gender-based differences in nuclear cardiology practice ... more The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as c...
reviewed the manuscript. They received no compensation for this role. We thank the INCAPS executi... more reviewed the manuscript. They received no compensation for this role. We thank the INCAPS executive committee, regional coordinators, and investigators group. Investigators group members were compensated for their time and effort involved in data collection.
This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisatio... more This multi-centre phase II clinical trial is the first prospective evaluation of radioembolisation of patients with colorectal liver metastases (mCRC) who failed previous oxaliplatin- and irinotecan-based systemic chemotherapy regimens. Eligible patients had adequate hepatic, haemopoietic and renal function, and an absence of major hepatic vascular anomalies and hepato-pulmonary shunting. Gastroduodenal and right gastric arteries were embolised before hepatic arterial administration of yttrium-90 resin microspheres (median activity, 1.7 GBq; range, 0.9-2.2). Of 50 eligible patients, 38 (76%) had received > or =4 lines of chemotherapy. Most presented with synchronous disease (72%), >4 hepatic metastases (58%), 25-50% replacement of total liver volume (60%) and bilateral spread (70%). Early and intermediate (>48 h) WHO G1-2 adverse events (mostly fever and pain) were observed in 16 and 22% of patients respectively. Two died due to renal failure at 40 days or liver failure at ...
The aim of this study was to compare the results obtained using X-ray mammography (MG) and 99mTc-... more The aim of this study was to compare the results obtained using X-ray mammography (MG) and 99mTc-sestamibi scintimammography (SSM) in patients with breast lesions < or = 2 cm. One hundred and thirty-four women (median age 52 years, range 32-78), who had already been selected for open breast biopsy, underwent both MG and SSM prior to surgery. Final pathology showed 27 (20.1%) benign breast lesions and 107 (79.9%) breast cancers (pT1a=5 [4.7%], pT1b=50 [46.7%], pT1c=52 [48.6%]). The sensitivity, positive predictive value, negative predictive value and accuracy were 81.3%, 97.6%, 55.6% and 83.6% for SSM and 83.2%, 89.9%, 48.6% and 79.1% for MG, respectively. The results were similar (p=NS), but patients with breast cancer (BC) undetected by MG were significantly (p<0.05) younger than those in which the tumor was correctly diagnosed, while the age did not affect SSM sensitivity. SSM was more (p<0.05) specific than MG in BC detection both in the overall group of patients (92.6% ...
In patients locally progressing after two lines of chemotherapy, some locoregional approaches sho... more In patients locally progressing after two lines of chemotherapy, some locoregional approaches showed encouraging results in terms of local control of disease. The aim of our study was to evaluate toxicity, clinical response and quality of life in 48 patients with unresectable colorectal liver metastases submitted to selective internal radiotherapy (SIRT). Up to now 35 patients with unresectable colorectal liver metastases, refractory to two lines of chemotherapy, underwent intra-arterial infusion of resin microspheres with yttrium-90 (SIR-spheres). Pre-treatment evaluation included a CT scan, blood tests, a PET scan and arteriography of celiac trunk, hepatic and superior mesenteric artery; extrahepatic uptakes and pulmonary shunts more than 10% were excluded by a Scinti-scan. The gastroduodenal artery was embolized before the SIR-spheres injection. Other exclusion criteria were liver dysfunction and anatomical vascular anomalies. The clinical response was evaluated by CT-scan follow...
Thirty-seven non-elderly primary Sjögren's syndrome (I SS) patients, and 27 controls complain... more Thirty-seven non-elderly primary Sjögren's syndrome (I SS) patients, and 27 controls complaining of xerostomia and/or recurrent or persistent swelling of at least one parotid or submandibular gland due to other selected disorders, were studied. A new scintigraphic score (scsc) is proposed for a standardised semiquantitative evaluation of salivary involvement by qualitative sequential salivary scintigraphy (SSS), and is compared with two other well-known methods generally used for this purpose. The scsc proved to be much more suitable for such an evaluation: the other criteria did not allow us either to classify or to score a great number of cases. Furthermore, the scsc allowed us to obtain better SSS sensitivity (89.2%) and specificity (96.3%) values for I.SS (33 of the 37 I SS patients and 26 of the 27 controls were correctly classified by discriminant analysis, for scsc values greater than 8). This was made possible by the different "weights" which we assigned to the...
Radioactivity in the colon during 131-I-meta-iodobenzylguanidine (MIBG) scintigraphy may obscure ... more Radioactivity in the colon during 131-I-meta-iodobenzylguanidine (MIBG) scintigraphy may obscure or be mistaken for tumor uptake. Fecal excretion of radioactivity was examined in eight patients following therapeutic 131-I-MIBG administration (123-218 mCi, 4.551-8.066 GBq) and was found to be 0.02-1.93% of the administered dose. Semiquantitative grading of colonic activity on scintigraphy was inversely related to fecal excretion. An additional patient with marked colonic activity was studied before and after an enema: all visible gut activity was evacuated. We conclude that radioactivity in the colon seen in 131-I-MIBG scintigraphy is due largely to gut excretion of 131-I and is not due to 131-I-MIBG uptake in the autonomic innervation of the gut. Laxatives and enemas are suggested for patients in which such gut radioactivity may lead to difficulties in interpretation.
The authors describe a 29-year-old man who had a 16-year history of neuroblastoma and uncommon ma... more The authors describe a 29-year-old man who had a 16-year history of neuroblastoma and uncommon manifestations. At age 13, he was diagnosed with stage III retroperitoneal ganglioneuroblastoma that was resected. Ten years later, bilateral testicular enlargement and a pelvic mass from infiltration of the neuroblastoma became palpable. Metastatic involvement was depicted with MIBG, a radiotracer that concentrates in tissues of the sympathetic nervous system. Using I-131 MIBG, the tumors were treated with therapeutic doses of radiation and a partial response was obtained. This case is unique because of the massive degree of bilateral testicular infiltration and its occurrence as a late manifestation of neuroblastoma in early adulthood.
Two patients are described in whom the absorption of l-thyroxine was impaired by non-prescription... more Two patients are described in whom the absorption of l-thyroxine was impaired by non-prescription herbal and nutritional remedies. The absorption of thyroid hormones is discussed and an approach to the problem of patients who appear to be unresponsive to the usual doses of thyroid hormones is suggested.
Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic in... more Scintigraphy with I-131 metaiodobenzylguanidine (MIBG) was effective in depicting a pancreatic insulinoma in a patient suffering from intermittent hypoglycemia. This observation widens the range of neuroendocrine tumors that take up to I-131 MIBG and supports the concept that many tumors of the amine precursor uptake and decarboxylation system may be imaged in this way.
Uptake of I-131 in the pericardial area is described in an asymptomatic patient who underwent tot... more Uptake of I-131 in the pericardial area is described in an asymptomatic patient who underwent total body scan for recurrent papillary thyroid cancer. Ultrasonography demonstrated a small pericardial effusion that persisted after I-thyroxine therapy was reinstituted. Two I-131 therapeutic doses were given, and follow-up total body scans were performed during the next 6 years. Although tracer accumulation in the neck was eliminated and the serum thyroglobulin level was not elevated, I-131 uptake persisted in pericardial effusion. Despite diligent study, no neoplastic, infectious, or autoimmune etiology could be demonstrated, and we thus classified it as idiopathic pericardial effusion. This phenomenon should be considered when interpreting I-131 scans that show I-131 uptake in the region of the heart.
When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not ... more When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not be due to concurrent hyperparathyroidism and at times only the control of the hyperthyroidism will resolve the problem. Moreover, the presence of hyperfunctioning thyroid nodules will interfere with Tl-201/Tc-99m pertechnetate parathyroid scintigraphy. Initial treatment of hyperthyroidism with I-131 in this situation controls hyperthyroidism and permits successful localization of parathyroid adenomas, which may then be excised--a result that was achieved in three cases.
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