Cost-Savings Analysis of Renal Scintigraphy,Stratified by Renal Function Thresholds: Mercaptoacetyltriglycine Versus Diethylene Triamine Penta-Acetic Acid

PurposeTo determine the financial implications of switching technetium (Tc)-99m mercaptoacetyltriglycine (MAG-3) to Tc-99m diethylene triamine penta-acetic acid (DTPA) at certain renal function thresholds before renal scintigraphy.MethodsInstitutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant, retrospective, cohort study. Consecutive adult subjects (27 inpatients; 124 outpatients) who underwent MAG-3 renal scintigraphy, in the period from July 1, 2012 to June 30, 2013, were stratified retrospectively by hypothetical serum creatinine and estimated glomerular filtration rate (eGFR) thresholds, based on pre-procedure renal function. Thresholds were used to estimate the financial effects of using MAG-3 when renal function was at or worse than a given cutoff value, and DTPA otherwise. Cost analysis was performed with consideration of raw material and preparation costs, with radiotracer costs estimated by both vendor list pricing and proprietary institutional pricing. The primary outcome was a comparison of each hypothetical threshold to the clinical reality in which all subjects received MAG-3, and the results were supported by univariate sensitivity analysis.ResultsAnnual cost savings by serum creatinine threshold were as follows (threshold given in mg/dL): $17,319 if ≥1.0; $33,015 if ≥1.5; and $35,180 if ≥2.0. Annual cost savings by eGFR threshold were as follows (threshold given in mL/min/1.73 m²): $21,649 if ≤60; $28,414 if ≤45; and $32,744 if ≤30. Cost-savings inflection points were approximately 1.25 mg/dL (serum creatinine) and 60 mL/min/1.73m² (eGFR). Secondary analysis by proprietary institutional pricing revealed similar trends, and cost savings of similar magnitude. Sensitivity analysis confirmed cost savings at all tested thresholds.ConclusionsReserving MAG-3 utilization for patients who have impaired renal function can impart substantial annual cost savings to a radiology department.     

超声在甲状旁腺功能亢进症诊断及术前定位中应用

目的探讨超声对甲状旁腺功能亢进症的诊断价值。方法对2012年5月至2015年12月重庆医科大学附属第一医院收治的经病理学检查确诊为甲状旁腺功能亢进(HPT)的50例患者的临床资料进行回顾性分析,统计病灶所在部位,所有患者术前血钙、血磷、血清甲状旁腺素(PTH)值,甲状旁腺超声及99m Tc-MIBI显像结果,手术病理结果。并以病理学作为金标准,进一步分析两种影像学检查方法的敏感性及阳性预测值,探讨单发病灶者和多发病灶者的血清学指标有无统计学差异。结果 HPT病灶多位于甲状腺下极,多呈大小不一的低回声病变,内可探及明显血流信号。超声和核素显像对HPT定性诊断的敏感性分别为88.0%、94.0%,差异无统计学意义(P>0.05)。术前定位诊断中,超声和核素显像诊断的敏感性分别为87.8%、76.8%,差异无统计学意义(P>0.05)。阳性预测值分别为97.3%、98.4%,差异无统计学意义(P>0.05)。联合诊断的敏感性为93.9%,与超声比较,差异无统计学意义(P>0.05);与核素比较,差异有统计学意义(P<0.05)。单发患者与多发患者的血钙、血磷、血清PTH值比较,差异均有统计学意义(P<0.05)。结论超声可作为PTH诊断和术前定位的首选方法,敏感度和99mTc-MIBI显像相当,同时行超声和99mTc-MIBI显像可提高检出率。     

Congenital gallbladder duplication: Preoperative diagnosis by ultrasonography

Congenital gallbladder duplication, an uncommon but potentially complicating malformation, is rarely diagnosed preoperatively. A case in which the diagnosis was achieved by real-time ultrasonography is presented and correlated with hepatobiliary scintigraphy. The efficacy of these diagnostic modalities is discussed, and the available literature is reviewed.The opinions expressed herein are the private views of the authors and do not reflect the official policy of the United States Air Force.     

Myocardial perfusion imaging: clinical experience and recent progress in radionuclide scintigraphy and magnetic resonance imaging

In the past 20 years, radionuclide scintigraphy has proven to be a sensitive clinical tool in the assessment of myocardial perfusion abnormalities. Magnetic resonance imaging may also be used to study myocardial perfusion, but its potential value still has to emerge in the clinical setting. This review addresses the potential and achievements of both methods in clinical cardiology.     

Coincidence of infectious osteomyelitis and disseminated neuroblastoma: A diagnostic dilemma solved by scintigraphic imaging

Summary The case of a 41/2-year-old girl with disseminated neuroblastoma and concomitant osteomyelitis is reported. Neuroblastoma was detected in the vertebral column, the right suprarenal fossa, the left side of cranium and in bone marrow aspirates. Osteomyelitis was present in the left femur and was due to Salmonella tennessee. For the first time in the literature the two lesions were demonstrated by means of simultaneous ¹³¹I-MIBG and ^99mTc-DPD scintigraphy. The diagnoses were proved by direct histological and microbiological studies.     

Assessment of myocardial necrosis immediately after intracoronary thrombolysis by intracoronary injection of technetium-99m pyrophosphate

To assess myocardial necrosis immediately after intracoronarythrombolysis, thallium-201 (TL-201) and technetium-99m pyrophosphate(Tc-99m PYP) were injected simultaneously into the coronaryartery in 25 patients with acute transmural myocardial infarction.In 17 of the 25 patients, the occluded coronary artery was reopened.Minutes after the intracoronary injection of Tc-99m PYP intothe reopened coronary artery a localized accumulation was seenwithin the area of the Tl-201 defect in all patients. Controlintravenous scintigraphy, which was performed in 8 of these17 patients 1–6 days later, and in 2 patients 18 and 42days after infarction, revealed a Tc- 99m PYP spot similar tothat of the acute intracoronary Tc-99m PYP scintigram in all10 patients. In the 8 of the 25 patients, in whom intracoronary thrombolysisfailed, no localized Tc-99m PYP accumulation was seen afterinjection into the infarct vessel. In 5 of these patients, acontrol intravenous scintigram, performed 1–8 days later,resulted in a Tc-99m PYP spot in the area of the Tl-201 defect. We conclude that, in the presence of therapeutic or spontaneousreperfusion, Tc-99m PYP scintigraphy may provide a useful methodof assessing myocardial necrosis during the early stage of anacute myocardial infarction.     

Chemokines in pathology and medicine

About 50 human chemokines and nearly 20 receptors have been identified and characterized in little more than a decade since the discovery of interleukin 8 (IL-8), the first chemotactic cytokine. Research in this field has dramatically changed our understanding of leucocyte traffic in inflammation and immunity. This paper has been written for scientists and practitioners in the field of medicine. It reviews in concise and intelligible form information that I consider useful for understanding the role of chemokines in human pathophysiology. The main areas covered are: (i) the basics of chemokine structures, mode of action, activities and selectivity; (ii) newer aspects of the broad involvement of chemokines in the regulation of immune defence and the housekeeping of the immune system; (iii) the role of chemokines in pathology as illustrated by animal models and studies of human diseases; and (iv) novel therapeutic approaches for a variety of inflammatory conditions, which are based on modulation of chemokine activity.