Unusual pattern of marrow distribution following treatment of aplastic anemia.
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Biomedical subjects
Publications and source records attributed to B A Sayle.
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Five hundred three planar and SPECT hepatic studies were reviewed separately by two experienced observers looking for focal disease. An equivocal reading meant referral to ultrasound or computed tomography (US/CT). The increase in correct readings and decrease in US/CT referrals per 100 positive and per 100 negative SPECT readings were calculated, then the increase in correct readings and decrease in US/CT referrals for various positive rates of liver involvement determined. At our institution, the overall positive rate is approximately 13% yielding 1.1 and 0.83 more correct readings and 1.8 and 2.0 fewer US/CT referrals per 100 cases for each reader, respectively; a marginal benefit for SPECT over planar scintigraphy.
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A practical approach to the hyperthyroid patient with a single lobe visualized on thyroid scintigraphy, and its impact on therapy is discussed. An illustrative case is also presented.
Twenty patients with ununited fractures and a suspicion of infection had In-111 chloride imaging. Surgically obtained cultures were positive for infection in 12 and negative in eight patients. In-111 chloride images were positive in all 12 patients with infection but also were positive in six of the patients with negative cultures. It is not possible to differentiate infected from noninfected ununited fractures by In-111 chloride imaging.
Twenty-three patients with hepatic cirrhosis and focal defects on Tc-99m sulfur colloid (SC) scintigrams were restudied with In-111 chloride to determine if indium localization in the focal defect is indicative of a hepatoma. Seven of eight patients with proven hepatomas had positive studies; however, six of 15 patients without hepatomas also had studies interpreted as positive. Thus, In-111 chloride is highly sensitive for the detection of hepatomas, and a negative indium study would militate against this diagnosis. The high false-positive rate found may be due to technical factors rather than a lack of specificity of localization; the experience of others seems to support this impression. At present, In-111 chloride scintigraphy for focal hepatic defects appears to be useful in ruling out hepatoma.
Eight patients with anemia and chronic renal disease being maintained by chronic hemodialysis were evaluated with In-111 chloride bone marrow imaging and bone marrow core biopsies. There was no correlation between the erythrocyte cellularity of the marrow and the indium bone marrow scan grade in any patient. Bone marrow imaging can not be used as an indicator of the presence of erythroid marrow in these patients.
Sixty-eight patients with clinically suspected chronic osteomyelitis were studied with [111In]chloride. Fifty-four images were categorized as true positive; seven were categorized as true negative. There were four false-positive studies, two of which were associated with healing cancellous bone grafts. There were three false-negative studies in patients previously treated with long-term antibiotic therapy. Images in eight noninfected healing fractures 3 to 8 mo old were normal. Three patients with infected total hip prostheses had positive images. Two patients with loose prostheses had negative images. This study shows that [111In]chloride imaging is an accurate way to localize chronic osteomyelitis and may overcome some of the disadvantages of [67Ga]citrate such as localization in noninfected healing fractures and in some loose [67Ga]citrate such as localization in noninfected healing fractures and in some loose prostheses.
Thirty-three patients with painful joint prostheses and a suspicion of infection were imaged with [111In]chloride. A final diagnosis was established by culture in 19. Of these, 12 were categorized as true positives and three as true negatives. There were two false-positive studies, occurring in patients with knee prostheses. In both, the culture was obtained by aspiration. Two false negatives were in patients with hip prostheses, one of whom had been on long-term antibiotic suppressive therapy. The sensitivity was 86%, specificity 60%, and accuracy 79%. Seventeen of the proven cases had bone imaging prior to [111In]chloride imaging. All 17 static images were positive and were not helpful in differentiating loosening from infection. Using increased uptake on the blood-pool image as a criteria for infection, the sensitivity was 89%, but the specificity was 0. Adding flow studies made little difference in interpreting the blood-pool images. This study shows that [111In]chloride accurate in evaluating infection in prosthesis than bone imaging.
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A patient with sickle cell anemia was hospitalized because of an acute erythropoietic aplastic crisis. 111In chloride bone marrow scintigraphy performed during the aplastic crisis showed markedly impaired uptake of the radionuclide and simultaneous 59Fe clearance T 1/2 studies were prolonged (420.9 min). Following recovery from the aplastic crisis 111In scintigraphy revealed an expanded marrow and the radioiron clearance T 1/2 was accelerated (20.9 min). The clinical course, hemograms and bone marrow aspirations correlated with marrow scintigraphy. 111In appears to be a valuable marrow scanning agent for assessing the presence of intramedullary erythropoietic activity.
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