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author:("mirza, sirofs")
1.  Radiological diagnosis of dialysis-associated complications 
Insights into Imaging  2014;5(5):603-617.
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients.
Teaching Points
• The occurrence of venous stenosis in haemodialysis patients is up to 41 %.
• Catheters usually have a fibrin sheath that can be rinsed but not aspirated.
• The steal phenomenon occurs in 75–90 % of patients with a shunt system.
• Arterial pseudoaneurysms can cause a number of complications.
PMCID: PMC4195842  PMID: 25095722
Dialysis; Complications; Infections; Shunt stenosis; Catheter dysfunction; Cardiovascular diseases
2.  Improvement of Cerebral Hypoperfusion with Levothyroxine Therapy in Hashimoto's Encephalopathy Demonstrated by 99mTc-HMPAO-SPECT 
European Thyroid Journal  2013;2(2):116-119.
Hashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy associated with autoimmune Hashimoto's thyroiditis.
Objectives and Methods
We report on a patient with HE and significant clinical improvement correlating with an increase in cerebral blood flow demonstrated by hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). HMPAO-SPECT was performed with 740 MBq of technetium-99m-HMPAO. To demonstrate the improvement in regional cerebral blood flow, individual regions of interest were drawn around visually diminished HMPAO uptake, the lesion to reference region ratio was calculated and transverse section images and semi-quantitative measurements were performed.
We show a 5-year follow-up with significant clinical improvement, a 10-fold reduction in autoantibodies to thyroid peroxidase and an approximately 20% improvement in cerebral blood flow with HMPAO-SPECT.
Adequate levothyroxine treatment achieving and maintaining euthyroidism should be considered as therapy to lower autoantibodies and improve clinical outcome in patients with Hashimoto's thyroiditis and encephalopathy.
PMCID: PMC3821506  PMID: 24783049
Hashimoto's encephalopathy; Hashimoto's thyroiditis; Hypothyroidism; Levothyroxine; 
Hexa­methyl­pro­pylene­amine oxime single-photon emission computed tomography

3.  Use of segmented CT transmission map to avoid metal artifacts in PET images by a PET-CT device 
Background: Attenuation correction is generally used to PET images to achieve count rate values independent from tissue densities. The goal of this study was to provide a qualitative comparison of attenuation corrected PET images produced by a PET-CT device (CT, 120 kV, 40 mAs, FOV 600 mm) with and without segmentation of transmission data (ACseg+ and ACseg-respectively). Methods: The reconstructed images were compared to attenuation corrected images obtained with a high-energy transmission source (Cs-137 – 662 keV).
Thirty oncologic patients were studied using CT and 137Cs for attenuation correction. All image data were acquired using the Gemini PET-CT scanner (Philips Medical Systems). It is an open PET-CT system that consists of the MX8000 multislice CT and the Allegro PET scanner arranged in a separable configuration. Images with ACseg+ and ACseg- were analyzed simultaneously in coronal, sagittal and transaxial planes. Two nuclear medicine physicians reviewed the image sets. Results: The image quality in the area of metal implants was better with ACseg+ than ACseg-, without metal induced artifacts generally observed in CT corrected images. Further the images with ACseg+ were qualitatively comparable to those obtained with 137Cs attenuation correction. Conclusions: In case of metal implants, PET studies corrected by CT should preferably use the ACseg+ method to avoid the image artifacts.
PMCID: PMC1164418  PMID: 15953395
4.  Comparison of Technetium-99m-MIBI imaging with MRI for detection of spine involvement in patients with multiple myeloma 
Recently, radiopharmaceutical scanning with Tc-99m-MIBI was reported to depict areas with active bone disease in multiple myeloma (MM) with both high sensitivity and specificity. This observation was explained by the uptake of Tc-99m-MIBI by neoplastic cells. The present investigation evaluates whether Tc-99m-MIBI imaging and magnetic resonance imaging (MRI) perform equally well in detecting myelomatous bone marrow lesions.
In 21 patients with MM, MRIs of the vertebral region TH12 to S1 and whole body scans with Tc-99m-MIBI were done.
Tc-99m-MIBI scanning missed bone marrow infiltration in 43 of 87 vertebrae (50.5%) in which MRI showed neoplastic bone marrow involvement. In patients with disease stage I+II, Tc-99m-MIBI scanning was negative in all of 24 vertebrae infiltrated according to MRI. In patients with disease stage III, Tc-99m-MIBI scanning detected 44 of 63 (70%) vertebrae involved by neoplastic disease.
Tc-99m-MIBI scanning underestimated the extent of myelomatous bone marrow infiltration in the spine, especially in patients with low disease stage.
PMCID: PMC317308  PMID: 14670090
7.  Assessment of diffuse Lewy body disease by 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) 
Lewy body disease is, after Alzheimer's disease, the second most common cause of senile degenerative dementia with progressive cognitive deterioration, fluctuation of cognitive and motoric functions and psychotic symptoms. It is characterized histologically by the occurrence of Lewy bodies in allocortical, neocortical and subcortical structures. The aim of this study was to measure the cortical glucose metabolism using FDG PET (2-[18F]fluoro-2-deoxy-D-glucose position emission tomography) compared to normal subjects.
Patients and Methods
Five patients (5 m, mean age 75 y) with clinically suspected diffuse Lewy body disease (DLB) were studied with FDG PET. PET studies of the head were performed with a Siemens ECAT-ART PET-scanner with attenuation correction using 137-Cs point sources.
We found the same distribution pattern of diffuse glucose hypometabolism in the entire cortical region with relative sparing of the primary sensory-motor cortex in all the patients. The few cases reported in the literature so far describe findings similar to ours.
The pattern of diffuse glucose hypometabolism in the entire cortex including the occipital region seems to be a typical feature of DLB that is distinctive from dementia of Alzheimer's disease.
PMCID: PMC151666  PMID: 12625839
Dementia; FDG PET; Lewy body disease

Results 1-9 (9)