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TECHNETIUM-99M TRODAT-1 NEUROMOLECULAR IMAGING FOR PARKINSONIAN SYNDROME: FIRST EXPERIENCE IN INDONESIAN PUBLIC HOSPITAL Aliwarga, Randy; Kusumahstuti, Kharisma Perdani; Nugrahadi, Trias; Kartamihardja, Achmad Hussein Sundawa
MNJ (Malang Neurology Journal) Vol. 12 No. 1 (2026): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2025.012.01.19

Background: Parkinsonian syndromes are characterized by progressive motor impairment resulting from nigrostriatal dopaminergic degeneration. Although diagnosis is primarily clinical, early disease stages often overlap with non-parkinsonian disorders, leading to misclassification. Dopamine transporter (DaT) imaging provides an objective biomarker for confirming presynaptic dopaminergic loss. However, the only internationally approved tracer, Iodine-123 ioflupane (DaTscan™), remains unavailable in Indonesia due to the absence of high-power cyclotron facilities and logistical constraints. Technetium-99m TRODAT-1, a generator-based alternative, offers a practical solution for countries with limited nuclear infrastructure. Objective: Two patients with confirmed Parkinson’s disease (A, B) underwent brain SPECT/CT imaging using 99mTc-TRODAT-1. Radiotracer preparation followed standard reconstitution and autoclaving procedures, achieving >95% radiochemical purity. Images acquired four hours post-injection were evaluated visually using the Fabiani scale to assess DaT binding patterns. Results: Patient A demonstrated asymmetric uptake loss in the posterior putamen consistent with mid-stage PD, while Patient B exhibited near-complete absence of striatal binding with increased extra-striatal activity, typical of advanced PD with cognitive decline. Both cases confirm that TRODAT-1 provides reliable visualization of nigrostriatal degeneration and remains technically feasible for local production and distribution. Conclusion: 99mTc-TRODAT-1 represents a viable and diagnostically robust DaT imaging option for Indonesia, offering both clinical accuracy and logistical practicality. Broader implementation could substantially improve diagnostic precision and disease staging in parkinsonian syndromes nationwide.

Utility of Tc-99m DTPA Hybrid SPECT/CT Cisternography in the Detection of Occult Postoperative CSF Fistula in an Infant with Lipomeningomyelocele: A Diagnostic Challenge and Technical Considerations I Kadek Herry Hermawan; Achmad Hussein Sundawa Kartamihardja; Trias Nugrahadi; Reza Rinaldy Harahap
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1550

Background: Lipomeningomyelocele represents a complex spectrum of closed spinal dysraphism where surgical repair is frequently complicated by cerebrospinal fluid leakage. While overt fistulas are clinically apparent, occult or intermittent leaks in the pediatric population pose a severe diagnostic challenge. Magnetic resonance imaging, despite being the anatomical gold standard, frequently fails to distinguish active extravasation from postoperative seroma or edema due to overlapping signal intensities. This study evaluates the diagnostic superiority of Tc-99m DTPA Hybrid SPECT/CT cisternography in resolving this dilemma. Case presentation: A 5-month-old female underwent resection of a large lumbosacral lipomeningomyelocele. Postoperatively, she developed persistent, clear fluid discharge from the incision, suggestive of a fistula, yet initial surgical re-exploration was inconclusive. The patient underwent radionuclide cisternography using 37 MBq of intrathecal Tc-99m DTPA. Standard planar scintigraphy at 1 hour and 3 hours was equivocal due to background renal activity. However, Hybrid SPECT/CT performed at 3 hours precisely localized an abnormal radiotracer tract extending from the thecal sac at L5 into the right multifidus muscle, a finding invisible on conventional imaging. Conclusion: The integration of physiological flow data from scintigraphy with the anatomical specificity of low-dose CT allows for the detection of slow-flow, occult leaks that evade MRI. In infants with distorted post-surgical anatomy, Hybrid SPECT/CT should be elevated from a problem-solving tool to a primary diagnostic modality when clinical suspicion persists. The technique facilitates targeted repair, minimizing morbidity in this vulnerable population.

Penyerapan I-131 yang Tidak Disengaja pada Karsinoma Ovarium pada Seorang Pasien dengan Karsinoma Tiroid yang Terdiferensiasi: Laporan Kasus: Laporan Kasus Sihombing, Amordekhai Imvan Parlindungan; Nugrahadi, Trias; Kartamihardja, Achmad Hussein Sundawa
Cermin Dunia Kedokteran Vol 53 No 05 (2026): Mei 2026 - CDK 352
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i05.1919

Introduction: Radioactive iodine (I-131) therapy is an essential component in the management of differentiated thyroid carcinoma (DTC) following total thyroidectomy. Post-therapy whole-body scintigraphy (PT-WBS) with I-131 aims to detect residual thyroid tissue, recurrence, or metastatic spread. Radioiodine uptake outside the thyroid region may suggest metastases or false-positive findings, thus requiring careful interpretation. Case: A 47-year-old woman with differentiated thyroid carcinoma (DTC) underwent I-131 therapy. The PT-WBS and single photon emission computed tomography/computed tomography (SPECT/CT) revealed no I-131 uptake in the thyroid bed, but instead showed unexpected I-131 uptake in bilateral ovarian masses. Subsequent histopathological and immunohistochemical evaluation after total hysterectomy with bilateral salpingo-oophorectomy confirmed that the masses were ovarian carcinoma. Discussion: Radioiodine uptake in ovarian carcinoma is extremely rare and may be attributed to the expression of the sodium-iodide symporter (NIS) in the ovarian surface epithelium (OSE). Other contributing factors may include increased tumor vascularity, local inflammation, and enhanced capillary permeability that facilitate iodine retention. Conclusion: This case highlights the importance of considering non-thyroidal malignancies in the interpretation of PT-WBS findings, particularly when atypical uptake is observed.

Utility of Tc-99m DTPA Hybrid SPECT/CT Cisternography in the Detection of Occult Postoperative CSF Fistula in an Infant with Lipomeningomyelocele: A Diagnostic Challenge and Technical Considerations I Kadek Herry Hermawan; Achmad Hussein Sundawa Kartamihardja; Trias Nugrahadi; Reza Rinaldy Harahap
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1550

Background: Lipomeningomyelocele represents a complex spectrum of closed spinal dysraphism where surgical repair is frequently complicated by cerebrospinal fluid leakage. While overt fistulas are clinically apparent, occult or intermittent leaks in the pediatric population pose a severe diagnostic challenge. Magnetic resonance imaging, despite being the anatomical gold standard, frequently fails to distinguish active extravasation from postoperative seroma or edema due to overlapping signal intensities. This study evaluates the diagnostic superiority of Tc-99m DTPA Hybrid SPECT/CT cisternography in resolving this dilemma. Case presentation: A 5-month-old female underwent resection of a large lumbosacral lipomeningomyelocele. Postoperatively, she developed persistent, clear fluid discharge from the incision, suggestive of a fistula, yet initial surgical re-exploration was inconclusive. The patient underwent radionuclide cisternography using 37 MBq of intrathecal Tc-99m DTPA. Standard planar scintigraphy at 1 hour and 3 hours was equivocal due to background renal activity. However, Hybrid SPECT/CT performed at 3 hours precisely localized an abnormal radiotracer tract extending from the thecal sac at L5 into the right multifidus muscle, a finding invisible on conventional imaging. Conclusion: The integration of physiological flow data from scintigraphy with the anatomical specificity of low-dose CT allows for the detection of slow-flow, occult leaks that evade MRI. In infants with distorted post-surgical anatomy, Hybrid SPECT/CT should be elevated from a problem-solving tool to a primary diagnostic modality when clinical suspicion persists. The technique facilitates targeted repair, minimizing morbidity in this vulnerable population.

Diagnostic Challenges in Detecting Thyroid Microcarcinoma Using [99mTc]Tc-Sestamibi WashOut Index (WOIND) in Toxic Intrathoracic Multinodular Goiter: A Case Report: Case Report Indiarti, Nitami Oktavia; Hidayat, Basuki; Nugrahadi, Trias; Kartamihardja, Achmad Hussein Sundawa
Cermin Dunia Kedokteran Vol 53 No 09 (2026): September 2026 - CDK 356
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i09.2299

Introduction: Intrathoracic multinodular goiter is a type of goiter that extends partially or completely into the thoracic cavity. Hyperthyroidism is uncommon in this condition, and the incidence of malignancy is also low (approximately 5.9%). [99mTc]Tc-Sestamibi washout index (WOind), with a cutoff of −19%, is used as an additional modality to assess the malignancy risk of hypofunction thyroid nodules, with a high negative predictive value of 100%. However, cancer detection is decreased in microcarcinomas, resulting in false-negative results. Case: A 54-yearold female with hyperthyroidism and intrathoracic multinodular goiter complained of a goiter and palpitations for one year. Fine-needle aspiration (FNA) cytology showed bilateral adenomatous goiter (Bethesda II). The patient was treated with propylthiouracil for one month, resulting in subclinical hyperthyroidism. A [99mTc]Tc-Pertechnetate uptake test was normal and showed predominant cold and warm nodules in multinodular goiter. The [99mTc]Tc-Sestamibi WOind ranged from -30% to -52% in all nodules (indicating benign). SPECT/CT showed tracheal deviation due to the large goiter, with a recommendation for resection. Postoperative histopathological results showed a focus of micropapillary thyroid carcinoma follicular variant in ƒthe left lobe, and adenomatous goiter in the right lobe and isthmus. The small size of the microcarcinoma in large adenomatous goiters makes it difficult to detect with FNA cytology and [99mTc] Tc-Sestamibi WOind. A focus of microcarcinoma is very unlikely to show malignant imaging characteristics, including on [99mTc] Tc-Sestamibi WOind. Discussion: Despite benign FNAB findings and a negative [99mTc]Tc-Sestamibi WOind scan, postoperative histopathology revealed micropapillary thyroid carcinoma, representing a false-negative result likely related to the small tumor size and limited detectability within a large, heterogeneous goiter. Conclusion: The [99mTc]Tc-Sestamibi WOind is a useful adjunct in diagnosing malignancy in thyroid nodules. However, clinicians must be aware of the possibility of false negatives, especially in cases of microcarcinoma within large adenomatous goiters.

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