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  1. A new upper limit for effective dose in patient administered with 18F-FDG for PET/CT whole-body imaging with diagnostic CT parameters
    Velo P, Ismail MI, Mohandas KK, Kasilingam L
    J Med Imaging Radiat Sci, 2023 Mar;54(1):43-50.
    PMID: 36402716 DOI: 10.1016/j.jmir.2022.09.010
    INTRODUCTION: The aim of present study is to estimate effective dose in patient undergoing 18F-FDG for whole body PET/CT imaging with diagnostic CT parameters and identify the lowest achievable total effective dose.

    METHOD: A total of 2247 PET/CT patients with normal glucose level underwent 18F-FDG-whole body imaging procedures. The 18F-FDG dose of 3.7MBq per kg of patient weight administered via intravenous infusion. For CT parameters, kilovoltage of 140keV and current of 40 mAs were used for all studies. All the acquired images collected retrospectively and the effective dose was calculated for each patient using algorithm adapted from ICRP Publication 106, modified for patient weight and patient blood volume. The estimated effective doses were evaluated for patients' body weight and BMI.

    RESULTS: The mean of total effective dose and standard deviation is approximately 15.08(4.52) mSv using ICRP algorithm. 56% of total patient has normal BMI and their average total effective dose is 13.6mSv. Underweight patients' effective dose can be as low as 9.6mSv even using diagnostic CT protocols.

    CONCLUSION: The effective dose of PET/CT procedure in present study is one of the lowest although using diagnostic parameters for CT acquisition compared to published data worldwide. This is due to the improved sensitivity of PET and complex reconstruction technique that maintains the image quality. A significant association between body weight, BMI and effective dose is reported in present study. Therefore, it is suggested that attention must be given for underweight and ideal BMI patients while prescribing FDG activity and CT imaging parameters in order to minimize the effective dose. The effective dose reported in present study can be considered as an upper limit for effective dose in PET/CT patients with normal BMI. This upper limit can be treated as a standard limit when optimizing imaging parameters, developing algorithm for image reconstruction and prescribing activity for patients. This practice could fulfill ALARA principle that could reduce cancer risk.

    Matched MeSH terms: Whole Body Imaging/methods
  2. Fulltext College of Radiology, Academy of Medicine of Malaysia position on whole body screening CT scans in healthy asymptomatic individuals (2008)
    Ho E, Abdullah B, Tang A, Nordin A, Nair A, Lim G, et al.
    Biomed Imaging Interv J, 2008 Oct;4(4):e44.
    PMID: 21611021 DOI: 10.2349/biij.4.4.e44
    To date, the College of Radiology (CoR) does not see any clear benefit in performing whole body screening computed tomography (CT) examinations in healthy asymptomatic individuals. There are radiation risk issues in CT and principles of screening should be adhered to. There may be a role for targeted cardiac screening CT that derives calcium score, especially for asymptomatic medium-risk individuals and CT colonography when used as part of a strategic programme for colorectal cancer screening in those 50 years and older. However, population based screening CT examinations may become appropriate when evidence emerges regarding a clear benefit for the patient outweighing the associated radiation risks.
    Matched MeSH terms: Whole Body Imaging
  3. Fulltext The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy
    Cheen Hoe AK, Fong LY, Halim FNA, Fatt QK, Hamzah F
    World J Nucl Med, 2018 7 24;17(3):182-187.
    PMID: 30034283 DOI: 10.4103/wjnm.WJNM_59_17
    Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy.

    METHODOLOGY: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours.

    RESULTS: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively.

    CONCLUSION: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

    Matched MeSH terms: Whole Body Imaging
  4. Fulltext Dose optimisation of 18f-flurodeoxyglucose for whole body PET oncology examination in CDNI of UPM
    Hishar, H., Salasiah, M., Fathinul Fikri, A. S., Nordin, A. J.
    Pertanika Journal of Science & Technology, 2015;23(2):187-192.
    MyJurnal
    A shift to administration of optimal dose of 18F-FDG between 4 and 5 MBq/kg from the current practice of higher doses potentially yields a reasonable-to-excellent PET image. For this purpose, whole-body MIP images of 32 patients (23 men, 9 women, age 51.9 ± 13.7 years), administered with 18F-FDG (activity 5.3 ± 0.5 MBq/kg, 45 minutes uptake time) for whole-body PET/CT examinations, were evaluated. Image quality was assessed visually by two radiologists using a three-point scoring scale: poor, reasonable and excellent. The interobserver agreement revealed a kappa value higher than 0.7. Therefore, the utilisation of 18F-FDG dose between 4 and 5MBq/kg is considered an optimum dose for whole-body PET/CT examination.
    Matched MeSH terms: Whole Body Imaging
  5. Fulltext Tissue Diagnosis for Musculoskeletal Tumours
    Saw, A.
    Malays Orthop J, 2007;1(2):1-2.
    MyJurnal
    Musculoskeletal tumour is much less common compared to tumours of epithelial origin. Most of these tumours are benign, with only about 1% malignant in nature. A general orthopaedic surgeon may only come across a malignant primary bone or soft tissue tumour a few times in his entire medical career. The current recommendation is for these conditions to be investigated and treated in centres with musculoskeletal oncology service. Careful clinical evaluation with appropriate plain radiography can provide adequate information for definitive diagnosis and treatment for most cases, especially the benign tumours. For some other cases, further investigations will be necessary. Magnetic resonance imaging (MRI) can provide excellent details on anatomical location of a tumour and delineate vital structures that may have been distorted by the lesion. For primary malignant tumours, computerized tomography scanning is still the gold standard for evaluation of pulmonary metastasis, and bone scan can allow early detection of distant metastasis to other bones. Whole body MRI has recently been recommended for tumour staging but the potential benefit for musculoskeletal tumour is not that convincing. PET may be very helpful for follow up detection of tumour recurrence but its role in diagnosis and staging of musculoskeletal tumours is still being evaluated...
    Matched MeSH terms: Whole Body Imaging
  6. Fulltext Clinical use of PET/CT in thyroid cancer diagnosis and management
    Sundram F
    Biomed Imaging Interv J, 2006 Oct;2(4):e56.
    PMID: 21614336 MyJurnal DOI: 10.2349/biij.2.4.e56
    The incidence of thyroid cancer is low, but when it occurs, it is mainly of the papillary histopathological type. Although PET/CT has a limited role in the diagnosis, it plays a significant role in the overall post-surgery management of a patient with thyroid cancer. This follow-up role is important, especially in patients with elevated serum thyroglobulin, but negative radioiodine whole body scans. There is increasing evidence that PET/CT should be a part of routine care in the Tg positive Radioiodine scan negative patient.
    Matched MeSH terms: Whole Body Imaging
  7. Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma
    Wong TH, Amir Hassan SZ
    Med J Malaysia, 2015 Dec;70(6):356-7.
    PMID: 26988209
    This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.
    Matched MeSH terms: Whole Body Imaging
  8. Fulltext Incremental Value of Single-photon Emission Computed Tomography-computed Tomography for Characterization of Skeletal Lesions in Breast Cancer Patients
    Mahaletchumy T, AbAziz A
    World J Nucl Med, 2017 Oct-Dec;16(4):303-310.
    PMID: 29033679 DOI: 10.4103/1450-1147.215496
    The incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar bone scintigraphy and SPECT in detecting skeletal lesions in breast cancer patients and its effect on patient management is assessed in this study. This is a prospective study which was conducted over 1-year duration. Whole-body planar scintigraphy, SPECT, and SPECT-CT were performed in 85 breast cancer patients with total of 128 lesions. Correlative imaging and clinical follow-up was used as the reference standard. McNemar's multistep analysis was performed for each patient and each lesion. On patient-wise analysis, 47 patients had equivocal diagnosis on planar bone scintigraphy, 28 on SPECT, and eight on SPECT-CT. On lesion-wise analysis, there were 72 equivocal lesions on planar bone scintigraphy, 48 on SPECT, and 15 on SPECT-CT. Overall, SPECT-CT resulted in a significant reduction in the proportion of equivocal diagnosis on both patient-wise (P < 0.004) and lesion-wise basis (P < 0.004), irrespective of the skeletal region involved. The sensitivity on a per-patient basis was 43%, 58%, and 78% for planar bone scintigraphy, SPECT, and SPECT-CT, respectively. Similarly, the specificity was 85%, 92%, and 94% for planar bone scintigraphy, SPECT, and SPECT-CT, respectively. Patient management was correctly altered in 32% of the patients based on SPECT-CT interpretation. Our data suggest that adding SPECT-CT to whole-body imaging significantly improves sensitivity and specificity in diagnosing bone metastases and significantly reduces the proportion of equivocal diagnosis in all regions of the skeleton. The most important outcome is derived from the accurate alteration in patient management clinically by down- and up-staging of patients and a more precise identification of metastatic extent.
    Matched MeSH terms: Whole Body Imaging
  9. A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases
    Khoo ACH, Chen SL
    World J Nucl Med, 2019 9 14;18(3):301-303.
    PMID: 31516376 DOI: 10.4103/wjnm.WJNM_43_18
    Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (131I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.
    Matched MeSH terms: Whole Body Imaging
  10. Fulltext Estimation of kidneys and urinary bladder doses based on the region of interest in (18)fluorine-fluorodeoxyglucose positron emission tomography/computed tomography examination: a preliminary study
    Mustapha FA, Bashah FAA, Yassin IM, Fathinul Fikri AS, Nordin AJ, Abdul Razak HR
    Quant Imaging Med Surg, 2017 Jun;7(3):310-317.
    PMID: 28811997 DOI: 10.21037/qims.2017.05.03
    BACKGROUND: Kidneys and urinary bladder are common physiologic uptake sites of 18fluorine-fluorodeoxyglucose ((18)F-FDG) causing increased exposure of low energy ionizing radiation to these organs. Accurate measurement of organ dose is vital as (18)F-FDG is directly exposed to the organs. Organ dose from (18)F-FDG PET is calculated according to the injected (18)F-FDG activity with the application of dose coefficients established by International Commission on Radiological Protection (ICRP). But this dose calculation technique is not directly measured from these organs; rather it is calculated based on total injected activity of radiotracer prior to scanning. This study estimated the (18)F-FDG dose to the kidneys and urinary bladder in whole body positron emission tomography/computed tomography (PET/CT) examination by comparing dose from total injected activity of (18)F-FDG (calculated dose) and dose from organs activity based on the region of interest (ROI) (measured dose).

    METHODS: Nine subjects were injected intravenously with the mean (18)F-FDG dose of 292.42 MBq prior to whole body PET/CT scanning. Kidneys and urinary bladder doses were estimated by using two approaches which are the total injected activity of (18)F-FDG and organs activity concentration of (18)F-FDG based on drawn ROI with the application of recommended dose coefficients for (18)F-FDG described in the ICRP 80 and ICRP 106.

    RESULTS: The mean percentage difference between calculated dose and measured dose ranged from 98.95% to 99.29% for the kidneys based on ICRP 80 and 98.96% to 99.32% based on ICRP 106. Whilst, the mean percentage difference between calculated dose and measured dose was 97.08% and 97.27% for urinary bladder based on ICRP 80 while 96.99% and 97.28% based on ICRP 106. Whereas, the range of mean percentage difference between calculated and measured organ doses derived from ICRP 106 and ICRP 80 for kidney doses were from 17.00% to 40.00% and for urinary bladder dose was 18.46% to 18.75%.

    CONCLUSIONS: There is a significant difference between calculated dose and measured dose. The use of organ activity estimation based on drawn ROI and the latest version of ICRP 106 dose coefficient should be explored deeper to obtain accurate radiation dose to patients.

    Matched MeSH terms: Whole Body Imaging
  11. Fulltext SPECT-CT in differentiating metastatic and degenerative lesions of the spine
    Khadijah Abdul Hamid, Sazilah Ahmad Sarji, Mohammad Nazri Md Shah, Ibrahim Lutfi Shuaib
    Malaysian Journal of Medicine and Health Sciences, 2020;16(102):31-37.
    MyJurnal
    Introduction: The purpose of this study was to determine the usefulness of SPECT-CT in differentiating metastatic and degenerative disease of the spine. Methods: Twenty-eight patients aged 50 years and above diagnosed with various cancers were referred for whole body (WB) planar bone scintigraphy. Those with a maximum three foci of tracer up- take in the spine were selected for the study. SPECT-CT of these areas of uptake was performed and the lesions were classified as degenerative, indeterminate or metastasis. A repeat study (WB planar bone scintigraphy and SPECT-CT) was performed between 3 to 12 months later. These areas of uptake were reassessed and compared with the first WB planar bone scintigraphy and SPECT-CT. The second SPECT-CT was used as the standard for the diagnosis. Results: Thirty-seven lesions in 28 patients were assessed. The sensitivity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 75%, 62.5% and 75% respectively. The specificity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 86%, 93%, 90% respectively. There was 2.7% of ‘indeterminate lesion’ in the first WB planar bone scintigraphy, 5.4% in the second WB planar bone scintigraphy, and 5.4% in the first SPECT-CT. The indeterminate lesions were resolved in the second SPECT-CT. Conclusion: SPECT- CT is useful in differentiating degenerative disease from metastatic lesions in the spine.
    Matched MeSH terms: Whole Body Imaging
  12. Features of post-radioiodine whole body scan in non-invasive Follicular Thyroid Neoplasm with papillary-like nuclear features (NIFTP)
    Wong TH, Tan TH, Chin SC, Lee BN
    Med J Malaysia, 2018 06;73(3):181-182.
    PMID: 29962506
    Recently, encapsulated follicular variant of papillary thyroid carcinoma has been reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) to emphasize the benign nature of this entity. In our institution, we have assessed 455 patients treated with radioiodine ablation for differentiated thyroid carcinoma and 20 of them were retrospectively found to fulfill the new NIFTP criteria. There was no evidence of metastasis on post radioiodine whole body scans for NIFTP cases and these patients were in remission subsequently. The benign features of these patients' whole body scans and good clinical outcome following treatment further support NIFTP as a low risk thyroid neoplasm.
    Matched MeSH terms: Whole Body Imaging
  13. Incidental Finding of Endometrioid Adenocarcinoma of the Ovary on 131I Whole-Body Scan
    Mohd Rohani MF, Amir Hassan SZ
    Clin Nucl Med, 2022 Jan 01;47(1):e20-e22.
    PMID: 34028418 DOI: 10.1097/RLU.0000000000003698
    A 57-year-old woman was referred for radioactive iodine therapy 12 weeks after completion thyroidectomy and left modified radical neck dissection for pT2N1Mx follicular variant papillary thyroid carcinoma. After 4 weeks of l-thyroxine withdrawal, stimulated serum thyroglobulin level was less than 0.1 ng/mL with positive thyroglobulin antibody. Posttherapy 131I scintigraphy with SPECT/CT of the head and abdominopelvic region showed thyroid residual in the neck, occipital bone metastasis, and heterogenous tracer uptake in a large peritoneal mass, likely arising from the left ovary. Left salpingo-oophorectomy was performed, and histopathologic examination revealed endometrioid carcinoma of left ovary.
    Matched MeSH terms: Whole Body Imaging
  14. Body surface area measurement and soft clustering for PASI area assessment
    Hani AF, Prakasa E, Nugroho H, Affandi AM, Hussein SH
    Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:4398-401.
    PMID: 23366902 DOI: 10.1109/EMBC.2012.6346941
    Psoriasis is a common skin disorder with a prevalence of 0.6 - 4.8% around the world. The most common is plaques psoriasis and it appears as red scaling plaques. Psoriasis is incurable but treatable in a long term treatment. Although PASI (Psoriasis Area and Severity Index) scoring is recognised as gold standard for psoriasis assessment, this method is still influenced by inter and intra-rater variation. An imaging and analysis system called α-PASI is developed to perform PASI scoring objectively. Percentage of lesion area to the body surface area is one of PASI parameter. In this paper, enhanced imaging methods are developed to improve the determination of body surface area (BSA) and lesion area. BSA determination method has been validated on medical mannequin. BSA accuracies obtained at four body regions are 97.80% (lower limb), 92.41% (trunk), 87.72% (upper limb), and 83.82% (head). By applying fuzzy c-means clustering algorithm, the membership functions of lesions area for PASI area scoring have been determined. Performance of scoring result has been tested with double assessment by α-PASI area algorithm on body region images from 46 patients. Kappa coefficients for α-PASI system are greater than or equal to 0.72 for all body regions (Head - 0.76, Upper limb - 0.81, Trunk - 0.85, Lower limb - 0.72). The overall kappa coefficient for the α-PASI area is 0.80 that can be categorised as substantial agreement. This shows that the α-PASI area system has a high reliability and can be used in psoriasis area assessment.
    Matched MeSH terms: Whole Body Imaging/methods*
  15. Fulltext One stop centre staging by contrast-enhanced 18F-FDG PET/CT in preoperative assessment of ovarian cancer and proposed diagnostic imaging algorithm: a single centre experience in Malaysia
    Subapriya Suppiah, Andi Anggeriana Andi Asri, Fathinul Fikri Ahmad Saad, Hasyma Abu Hassan, Norhafizah Mohtarrudin, Chang, Wing Liong, et al.
    Malaysian Journal of Medicine and Health Sciences, 2017;13(2):29-37.
    MyJurnal
    Introduction: Suspicious adnexal masses need to be investigated thoroughly as it may represent ovarian cancer, which is the fourth most common gynaecological cancer in Malaysia. Conventional cross sectional imaging may reveal non-specific findings, thus lead to unnecessary biopsies. 18F-Fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) has emerged as a useful tool, for characterization of indeterminate adnexal masses. Most studies have been conducted in Western population, and little information is available in Asian population in general and Malaysian population in particular. Methods: Prospective study of women with suspicious adnexal masses, referred to the Centre for Nuclear Diagnostic Imaging, Universiti Putra Malaysia to undergo pre-operative whole-body contrast-enhanced 18F-FDG PET/CT scans from January 2014 to January 2016. Subjects underwent Contrast-Enhanced Computed Tomography (CECT) scans followed by positron emission tomography (PET) scans using a hybrid scanner. Two radiologists analyzed the CECT and PET/CT images by consensus; blinded to the HPE results. Then the PET/CT findings were correlated with HPE results as the gold standard. Results: 11 whole-body PET/CT scans and 18 adnexal masses (12 HPE-proven malignant lesions and 6 benign lesions) were analyzed. The sensitivity, specificity, PPV, and NPV of CECT alone compared to PET/CT was 91.7%, 50.0%, 78.6%, and 75.0% vs. 91.7%, 100%, 100% and 85.7% respectively. Conclusions: Improved diagnostic accuracy for characterizing benign and malignant adnexal masses can be achieved using contrast-enhanced 18F-FDG PET/CT, making it a potential investigation of choice which can help in treatment planning.
    Matched MeSH terms: Whole Body Imaging
  16. Concurrent Benign Iodine-Avid Thymic and Liver Cysts Mimicking Metastatic Disease on 131I Whole-Body Scintigraphy
    Kamarulzaman K, Mohd Rohani MF, Mat Nawi N, Amir Hassan SZ
    Clin Nucl Med, 2024 Mar 01;49(3):250-252.
    PMID: 38306377 DOI: 10.1097/RLU.0000000000005037
    A 57-year-old woman received radioiodine therapy post total thyroidectomy for pT3aNxMx follicular thyroid carcinoma. Posttherapy 131I whole-body scan showed 131I concentration in the chest, mediastinum, and left upper thigh with stimulated thyroglobulin (Tg) of 89 μg/L. Subsequent radioiodine therapies showed persistent 131I accumulation in the anterior mediastinal soft tissue lesions and a hypodense segment VII liver lesion visualized on SPECT/CT, suggestive of iodine-avid metastatic disease despite the undetectable serum Tg (<1.0 μg/L) with no Tg antibody interference. Biopsy of the liver lesion revealed liver cyst, and consequent removal of the mediastinal lesions showed benign thymic cysts.
    Matched MeSH terms: Whole Body Imaging
  17. Clinical determinants of fluorodeoxyglucose positron emission tomography/computed tomography in differentiated thyroid cancer patients with elevated thyroglobulin and negative (131)iodine whole body scans after (131)iodine therapy
    Shamim SE, Nang LB, Shuaib IL, Muhamad NA
    Malays J Med Sci, 2014 May;21(3):38-46.
    PMID: 25246834
    A cross-sectional prospective study has been conducted on differentiated thyroid cancer (DTC) patients using negative (131)Iodine ((131)I) whole body scans and elevated thyroglobulin (Tg) levels. The main objective of this research was to determine the prevalence of the conversion of differentiated to dedifferentiated thyroid cancer patients during follow up at the Hospital Kuala Lumpur. It has been demonstrated that fluorodeoxyglucose (FDG) uptake is inversely proportional to the iodine concentration and to differentiation of the cells.
    Matched MeSH terms: Whole Body Imaging
  18. Lethal hemorrhage from a ureteric-arterial-enteric fistula diagnosed by postmortem CT angiography
    Rashid SN, Bouwer H, O'Donnell C
    Forensic Sci Med Pathol, 2012 Dec;8(4):430-5.
    PMID: 22477359 DOI: 10.1007/s12024-012-9332-3
    Fistula formation following pelvic surgery and radiotherapy, including ureteric-arterial fistulas (UAF), is well documented, however, ureteric-arterial-enteric fistula is extremely rare. Conventional autopsy is usually required for the definitive diagnosis of pelvic vascular fistulas although an accurate diagnosis can still be complicated and challenging. The role of post-mortem computed tomography (PMCT) as an adjunct to conventional autopsy is well documented in the literature. One of the limitations of PMCT is the diagnosis of vascular conditions. Post-mortem computed tomography angiography (PMCTA) is a recently introduced technique that can assist in detecting such pathology. We present a case of post-radiotherapy ureteric-arterial-enteric fistula presenting as massive rectal and vaginal bleeding diagnosed prior to autopsy on PMCTA. The role of PMCTA in the diagnosis of such a UAF has not previously been reported in the literature.
    Matched MeSH terms: Whole Body Imaging
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