Tzyy-Ling Chuang

Dialysis-related amyloidosis (DRA) is a recognized complication of long-term dialysis caused by progressive deposition of β2-microglobulin amyloid in osteoarticular and periarticular tissues. Although its musculoskeletal manifestations are well described, bone lesions from DRA may be misidentified as malignant disease on imaging, posing a diagnostic challenge. We describe a 70-year-old woman on long-term dialysis who presented with a pathologic femoral neck fracture and adjacent osteolytic lesions initially suspicious for metastatic disease or brown tumor. Bone SPECT/CT showed uptake only at the fracture site with background activity in the lytic lesions. Histopathological examination confirmed the diagnosis of amyloidosis by Congo red staining. This case illustrates that DRA may present as non-MDP-avid osteolytic lesions on bone scintigraphy, potentially mimicking malignant bone disease. Awareness of this scintigraphic pitfall is essential when evaluating dialysis patients with atypical skeletal lesions.

A 46-year-old woman presented with persistent right knee pain and swelling six months after a fall. MRI initially showed a lateral meniscus tear, leading to meniscus repair and later meniscectomy, but symptoms persisted. Retrospective review of the MRI revealed edema in the tibial plateau and distal femoral condyle. Arthroscopic debridement demonstrated severe synovitis, marked cartilage loss of the lateral femoral condyle with a loose body, and tibial plateau cartilage damage. Bone SPECT/CT showed bony destruction, cleft formation, and focal tracer uptake in the distal femur and proximal tibia. Femoral osteochondritis dissecans and a tibial osteochondral defect were diagnosed based on arthroscopic and imaging findings.

To investigate the association between quantitative sialoscintigraphy parameters and rheumatoid factor (RF) seropositivity in patients with suspected autoimmune salivary gland dysfunction and to evaluate the diagnostic performance of functional imaging in relation to anti-Ro/SSA antibody (SSA) and anti-La/SSB antibody (SSB) profiles. We retrospectively reviewed the records of 100 patients who underwent sialoscintigraphy for sicca symptoms or suspected Sjögren’s syndrome from April 2020 to May 2022. Quantitative parameters including time to maximum uptake(T_max)and time to onset of secretion(T_min)were extracted from time-activity curves. Serologic data for RF, SSA, and SSB antibodies were analyzed. Logistic regression and receiver operating characteristic (ROC) analyses were performed to assess associations and diagnostic performance. Of the 100 included patients, 22% were RF-positive, 52% were SSA positive, and 22% were SSB positive. Logistic regression analysis identified younger age (OR [odds ratio] = 0.955; 95% CI [confidence interval], 0.922–0.989;p = 0.009), prolonged submandibular gland T_min(OR = 1.309; 95% CI, 1.026–1.672;p= 0.031); and reduced T_maxin both the parotid (OR = 0.904; 95% CI, 0.820–0.997;p = 0.043) and submandibular glands (OR = 0.941; 95% CI, 0.891–0.993;p= 0.028) as significantly associated with RF seropositivity. Although group-wise comparisons showed no statistically significant differences, borderline trends were observed in submandibularT_maxand T_min.Taken together, these findings suggest that although the individual diagnostic performance of T_maxand T_minmay be limited, their combined assessment offers clinically meaningful insights into autoimmune-related salivary gland dysfunction. Quantitative sialoscintigraphy parameters, particularly prolonged submandibular T_minand reduced T_maxin submandibular and parotid glands, are associated with RF seropositivity and likely reflect early immune-mediated glandular dysfunction. Although their individual diagnostic performance is modest, these scintigraphic parameters may contribute valuable information when integrated with serologic markers and visual interpretation in assessing autoimmune salivary gland disease.

A 43-year-old man with a 1-year history of bilateral hip pain, worsened by standing and walking, presented with a limping gait. x-rays showed diffuse osteoporosis (osteoblastic-lytic), and a bone scan revealed symmetric uptake in the costochondral junctions (rosary beads), femoral neck, proximal tibia, and feet, with no visualization of the kidneys, suggesting a metabolic disorder or neoplasm. Computed tomography revealed osteolytic lesions in multiple bones. Suspecting metabolic bone disease or metastasis, laboratory tests were conducted. Magnetic resonance imaging confirmed bilateral femoral neck fractures. He underwent open reduction internal fixation for the hip fractures. The imaging and laboratory findings suggest osteomalacia.

Purpose: This study analyzed the association between anti-Ro/SSA and anti-La/SSB antibody levels with quantitative and visual sialoscintigraphy patterns in patients suspected of having Sjögren or sicca syndrome. Patients and Methods: Medical records of patients who underwent sialoscintigraphy between April 2020 and May 2022 were reviewed. Associations between antibody levels and sialoscintigraphy parameters were evaluated using linear regression. Receiver operating characteristic curve analysis was used to identify antibody cutoff values for predicting flat-type patterns and the risk of Sjögren or sicca syndrome. Results: Of the 170 patients (mean age, 56.6 years; 78.8% female), 95.3% had dry mouth and eyes, 30% experienced polyarthralgia, and 66.5% were prescribed hydroxychloroquine. The most common sialoscintigraphy finding was the median-type time-activity curve (TAC) pattern. Anti-Ro/SSA and anti-La/SSB levels were significantly correlated with maximum accumulation or maximum secretion in the salivary glands. Receiver operating characteristic analysis for anti-Ro/SSA predicting a flat-type TAC pattern showed an area under the curve (AUC) of 0.659 to 0.780, with specificity between 82.1% and 86.3% for antibody levels greater than 85.2 units. Anti-Ro/SSA levels greater than 49.75 units predicted a higher risk of Sjögren or sicca syndrome, with an AUC of 0.622 and 83.9% specificity. Anti-La/SSB levels had no significant predictive value, with an AUC of 0.554. Conclusions: Anti-Ro/SSA levels greater than 85.2 units were strong predictors of flat-type TAC patterns, indicating near-total salivary gland dysfunction and supporting their diagnostic utility in Sjögren or sicca syndrome.

A 46-year-old man has a history of right eye vision loss from childhood due to an injury, right hypopharyngeal cancer with metastasis to right neck lymph nodes treated with concurrent chemoradiotherapy, and left tonsillar cancer after resection and adjuvant chemotherapy. Whole-body bone scan showed abnormal uptake to the right eye region, whereas SPECT/CT imaging localized this uptake to sharply defined, round to oval bone density foci of calcium scattered in the sclera and surrounding tissues, indicative of phthisis bulbi with posttraumatic calcification. Phthisis bulbi represents a shrunken ocular globe with calcification or ossification, typically as a sequela of trauma.

Purpose: Pulmonary function analysis is essential for implementing functional avoidance in modern radiotherapy treatment planning. The gold standard for pulmonary function analysis is the SPECT V-Q scan. However, additional radiation exposure introduced and dynamic image fusion remains obstacles in treatment planning. Methods and Materials: This study proposes a hybrid deformable image registration method for pulmonary ventilation functional analysis. The proposed method separates the deformation of the human lung into two parts, deformation of the outer boundaries and the inner lung tissue. In reality, the deformation of the lung boundaries is constrained by adjacent organs such as the heart, parietal pleura, and diaphragm, where the lung boundaries exhibit non-linear, anisotropic deformation behavior, especially near the diaphragm; the inner lung tissue exhibit a more fluid-like, viscous deformation behavior. Therefore, in this study, the lung boundaries are modeled using the coherent point drift (CPD) registration method, while the inner lung tissue is registered using the Demons registration method. The proposed hybrid DIR method establishes the correspondence between exhalation and inhalation 3D-CT images of a 4D-CT data set. Finally, a ventilation functional map is then constructed based on the difference in Hounsfield Units (HU) and compared to the ventilation of SPECT. Results: For all 4D-CT SPECT data sets, the ventilation of the corresponding functional maps was found to deviate by no more than 7.92%. In addition, the lowest correlation between the corresponding functional maps is found to be 0.68, and the highest is 0.87. Conclusion: With the results of this study, the basic feasibility of the proposed DIR for pulmonary functional analysis is confirmed. Furthermore, the 4D-CT-based ventilation functional maps have higher resolution compared to SPECT ventilation maps and give evidence of the former as a replacement for the latter.

A 55-year-old man consumed approximately 10 units of alcohol daily for 25 years, developing social withdrawal after retiring. For 2 months, he walked diagonally to the right, with a right shoulder droop. He spoke and walked slowly, but his speech was clear. After 20 days of abstinence, his symptoms improved, and his walk became more steady. Brain MRI revealed no specific finding. Brain perfusion scintigraphy with ^99mTc-ECD on 2-tailed view display in eZIS showed hypoperfusion in the prefrontal, frontal, and left anterior temporal lobes and left thalamus and hyperperfusion in the posterior white matter, parietal-occipital cortical regions, pons, and cerebellum.

Background and Objectives: The burden of osteoporosis is projected to increase. Identification and prompt intervention for osteoporotic fractures are important. Adjusting the Fracture Risk Assessment (FRAX^®) tool with trabecular bone score (TBS) could improve risk prediction. However, little is known about whether TBS-adjusted FRAX^® would change the proportion of individuals qualified for osteoporosis intervention. Therefore, the aim of the present study was to compare the proportions of Taiwanese adults who qualified for intervention, according to the FRAX^® and TBS-adjusted FRAX^®, with stratification by sex, age group, and glucose regulation status. Materials and Methods: A medical record review on adults 50–90 years who had undergone a general health examination in a regional hospital in Taiwan was conducted. FRAX^® and TBS-adjusted FRAX^® were calculated. FRAX^® cut-points of ≥ 20% for major osteoporotic fracture and ≥3% for hip fracture were adopted to identify individuals qualified for osteoporosis intervention. Individuals were classified as prediabetes and diabetes if their HbA1c was 5.7–6.4% and >6.4%, respectively. Results: A total of 8098 individuals with a mean age of 61.0 years were included. The proportion of men qualified for intervention for hip fracture was significantly lower according to TBS-adjusted FRAX^® (17.2%) compared with FRAX^® (20.7%) (p < 0.001), with a similar pattern across all three age groups and in those with prediabetes. In contrast, the proportion of women qualified for intervention for major osteoporotic fracture was significantly higher according to TBS-adjusted FRAX^® (4.6%) compared with FRAX^® (3.7%) (p < 0.001), particularly among those with prediabetes 60–69 years. Conclusions: TBS-adjusted FRAX^® led to small but significant changes in the proportions of individuals qualified for intervention in specific age groups and glucose regulation status.

An 80-year-old man was treated with rituximab for active rheumatoid arthritis until 2019, now controlled with Salazopyrin, prednisolone, methotrexate, and folic acid. However, laboratory data showed elevated C-reactive protein and erythrocyte sedimentation rate. Whole-body bone scan showed bony and joint destruction to the upper cervical vertebra (C spine), bilateral shoulders, wrists, finger joints, ankles, and left knee. SPECT/CT localized the upper C spine uptake to the C1/C2 joint and adjacent C1 and C2 with C1/C2 subluxation. C spine CT showed vertical atlantoaxial subluxation and bony erosions.