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Biomedical subjects

D Fink-Bennett

Publications and source records attributed to D Fink-Bennett.

At least 19 recordsLinked to original sources

Patterns of abnormal FDG uptake by various histological types of non-small cell lung cancer at initial staging by PET.

The aim of this study was to identify useful patterns of abnormal fluorine-18 fluorodeoxyglucose (FDG) uptake by different types of non-small cell (NSC) lung cancer and to assess their clinical implications. One hundred and three sequential patients with newly diagnosed, pathology-proven NSC lung cancer were included. FDG positron emission tomography (PET) images were acquired using a dedicated PET scanner. There were 35 squamous cell carcinomas (SQC), 17 large cell cancers (LGC), 38 adenocarcinomas (ADC), 1 bronchioloalveolar carcinoma (BAC) and 12 non-classified NSC cancers. PET images were categorized into detectable patterns of necrotic center in the primary tumor, satellite lesions (T4), hilar lymph nodes (N1), and N2, N3, and M1 lesions by visual interpretation of PET images for SQC, LGC, and ADC (n=90; BAC and non-classified NSC cancers were excluded). The PET lesions were correlated with surgical pathology and with CT findings in inoperable cases. Necrosis was more commonly present in the primary tumors of LGC (53%) and SQC (43%) than in those of ADC (26%) (P<0.0001 and <0.01, respectively). The frequencies of nodal uptake in ADC, SQC and LGC were similar (71%, 60%, and 59%, respectively). However, M1 lesions were present significantly more often in LGC (41%) and ADC (34%) than in SQC (3%) (both P<0.0001). Significantly more surgically inoperable cases were found by PET (T4, N3, M1) in ADC (50%) and LGC (41%) than in SQC (26%) (P<0.001 and <0.02, respectively). Our results suggest a wide variation of PET findings for different types of NSC lung cancer. Identification of these patterns is useful in clinical PET interpretation, in that knowledge of the most probable association between the PET patterns and the histological types will facilitate initial staging and planning of management.

Adenocarcinoma↗

Indium-111 OncoScint CR/OV and F-18 FDG in colorectal and ovarian carcinoma recurrences. Early observations.

Indium-111 satumomab pendetide (In-111 OncoScint) planar and SPECT imaging and F-18 FDG positron emission tomography (PET) have been found individually to be helpful in the detection of recurrent colorectal and ovarian cancer, but have not been compared. Twelve patients who were examined for recurrent colorectal or ovarian carcinoma underwent both In-111 OncoScint imaging and F-18 FDG PET imaging. All had normal or equivocal results of CT or MR studies. Tumor detection abilities were similar in most cases. However, Oncoscint demonstrated an advantage in the detection of carcinomatosis. PET demonstrated an advantage in detecting focal tumor recurrence in one case and, not unexpectedly, in detecting liver metastases. All positive nuclear studies for tumor were found to be true-positives at pathology (7 patients), or by diagnostic new CT changes (1 patient). Finally, unreported, bone marrow, bowel, and colostomy sites appear to be normal sites of localization of F-18 FDG 1 hour after injection.

Aged↗

Raccoon eyes and the MIBG super scan: scintigraphic signs of neuroblastoma in a case of suspected child abuse.

The authors report on an infant suspected of having been abused, who presented with periorbital edema and ecchymoses (clinical "raccoon eyes"). The pattern of the nuclear medicine bone scan suggested neuroblastoma rather than trauma. Both the bone scan and the subsequent MIBG scan revealed multiple abnormalities, including markedly increased activity around the orbits, that we termed the scintigraphic raccoon eyes sign. In addition, the grossly abnormal MIBG scan demonstrated avid uptake of MIBG throughout the entire skeleton with essentially complete absence of visualization of the liver and heart (the MIBG super scan ). These signs have not previously been described in an infant or a child with neuroblastoma.

3-Iodobenzylguanidine↗

Nuclear medicine in the acutely ill patient--I.

Nuclear medicine techniques yield unique physiologic information about many organ systems. These types of studies can be extremely useful in the acutely ill patient. Pulmonary scintigraphy is the procedure of choice for screening dyspneic patients for pulmonary emboli. Hepatobiliary scintigraphy has a definite role in the evaluation of patients with abdominal pain and those with postbiliary tract surgical complications.

Abdominal Pain↗

Nuclear medicine in the acutely ill patient--II.

This article describes the usefulness of scintigraphic techniques in the evaluation of patients with infection. Nuclear medicine procedures are of great value in the patient with a fever of unknown origin and no localizing signs, as well as those with complex pulmonary infections. These studies also are useful in identifying orthopaedic infections superimposed on other bone pathology, such as prior trauma or surgery. Finally, the role of renal scintigraphy in the evaluation of renal transplants and acute renal failure is described.

Acute Disease↗

Unexpected pulmonary clumping of In-111 leukocytes attributable to indium oxine reagent.

Five cases of artifactual In-111 leukocyte pulmonary activity were noted at three local hospitals in a 4-day period. Based on the differences in the preparation of the final indium leukocyte product, the problem could be attributed to the indium oxine reagent in a specific lot. This artifact of multiple small foci of marked increased activity in the lungs (clumping pattern), attributable to the In-111 oxine reagent, has not been described previously.

Aged↗

The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis.

Recently it has been demonstrated that any child with proved acute pyelonephritis may be at risk for parenchymal scarring, whether or not reflux is present. Since cortical renal scintigraphy has been shown to detect accurately renal inflammation, we compared cortical scintigraphy with renal sonography in 46 children with documented acute pyelonephritis to determine which modality is best to detect patients at risk for renal injury. Cortical scintigraphy was abnormal in 36 children (78%) and renal ultrasonography was abnormal in 5 (11%). Reflux was demonstrated in only 20 cases (43%). We conclude that cortical scintigraphy is the preferred imaging technique for diagnosing renal inflammation, and it should be used routinely in every child with suspected acute pyelonephritis. A new imaging protocol is proposed.

Acute Disease↗

Results of surgical therapy for biliary dyskinesia.

One hundred eighty-seven patients who presented with symptoms consistent with biliary colic but had no ultrasonic evidence of cholelithiasis were observed in an effort to identify those with a functional gallbladder disorder that might benefit from surgical intervention. All patients underwent quantitative evaluation of gallbladder emptying using cholecystokinin biliary scanning, and ejection fractions less than 35% were considered abnormal. One hundred twenty-nine patients (69%) had abnormal ejection fractions, and 88 (68%) of these subsequently underwent cholecystectomy. Sixty of the surgical specimens revealed pathologic changes. Eighty-four percent of patients successfully contacted for follow-up experienced complete relief, and another 13% had partial relief of preoperative symptoms. Only two patients reported no change in symptom complex. Twenty-nine patients with abnormal ejection fractions elected not to undergo surgery. Fifty-nine percent of these patients continued to experience symptoms of biliary colic at a mean follow-up of 22 months. Of the 44 patients with normal ejection fractions, 35 (80%) reported resolution of symptoms during follow-up of medical treatment. Cholecystokinin biliary scanning can help identify patients with acalculous, functional gallbladder disease who may benefit from cholecystectomy.

Adult↗

Augmented cholescintigraphy: its role in detecting acute and chronic disorders of the hepatobiliary tree.

Cholecystagogue cholescintigraphy can be employed as a means of (1) confirming the surgeon's and/or gastroenterologist's clinical impression of symptomatic chronic acalculous biliary disease, (2) better understanding the pathophysiology of gallbladder disease, (3) preparing patients for hepatobiliary scintigraphy who have fasted for longer than 24-48 hours and who are suspected of acute cholecystitis, and (4) reducing the time required to confirm the clinical impression of acute cholecystitis. Morphine-augmented cholescintigraphy is also used to decrease the time required to determine cystic duct patency. Phenobarbital-augmented cholescintigraphy is used as a means of increasing the accuracy of hepatobiliary scintigraphy in differentiating neonatal hepatitis from biliary atresia. Nonpharmacological interventions and augmentations have been employed to maintain the high degree of accuracy of cholescintigraphy in confirming the clinical impression of acute cholecystitis. The efficacy of these modalities in detecting acute and chronic disorders of the hepatobiliary tree as well as how and why they are performed comprise the contents of this article.

Biliary Tract Diseases↗