Hot nose after I-131 sodium iodide thyroablation therapy.
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Adult↗
Biomedical subjects
H N Wellman
Publications and source records attributed to H N Wellman.
Contrast and nuclear arthrography in loosening of the uncemented hip prosthesis.
The recent popularity of ingrowth or uncemented hip arthroplasties has presented problems in the radiographic diagnosis of loosening because there is no longer a cement interface in which lucencies may be seen. We evaluated a combination of positive contrast and nuclear arthrography to see whether these studies could accurately detect loosening of uncemented femoral components of hip prostheses. We performed routine contrast and nuclear arthrography in 21 patients with ingrowth total hip arthroplasties or bipolar endoprostheses. The results were surgically confirmed in 12 patients. The contrast arthrogram was true positive in 5 and false negative in 5. There were no false positives and 2 true negatives. The nuclear arthrogram was true positive in 7 patients, false negative in 3, and true negative in 2. Taken together, there was only 1 patient in whom both contrast and nuclear arthrography were false negative, and there were no false positives. Thus, when either contrast or nuclear arthrography is positive, the sensitivity of the combined procedures is 90%; when both studies are negative, the specificity is 100%. The combination of contrast and nuclear arthrography is an accurate method of determining loosening of the femoral component of an uncemented hip arthroplasty or bipolar endoprosthesis in the patient with postoperative hip pain.
Adult↗
Neuronuclear medicine.
The importance of the development of the medical neurosciences is evidenced by the fact that the President of the United States and Congress have declared the 1990s the "decade of the brain." Special emphasis will be placed on managing and treating brain disease and, in particular, salvaging damaged brain from cerebral artery disease, trauma, tumor, and so forth. The advent of brain or cerebral care units in hospitals can be anticipated, analogous to the commonly available coronary care unit that resulted from recent concerted efforts to "conquer" heart disease. This effort will probably lead to a markedly expanded purview for clinical research in central nervous system disease. During the past year, a virtual explosion of publications in the mainstream medical literature on the basic and clinical utilization of nuclear medicine in the neurosciences has occurred. More than 400 substantive papers were published and the majority dealt with some aspect of positron-emission tomography. The more clinically pertinent of these papers are reviewed.
Brain↗
Regional sympathetic denervation after myocardial infarction in humans detected noninvasively using I-123-metaiodobenzylguanidine.
Transmural myocardial infarction in dogs produces denervation of sympathetic nerves in viable myocardium apical to the infarct that may be arrhythmogenic. It is unknown whether sympathetic denervation occurs in humans. The purpose of this study was to use iodine-123-metaiodobenzylguanidine (MIBG), a radiolabeled guanethidine analog that is actively taken up by sympathetic nerve terminals, to image noninvasively the cardiac sympathetic nerves in patients with and without ventricular arrhythmias after myocardial infarction. Results showed that 10 of 12 patients with spontaneous ventricular tachyarrhythmias after myocardial infarction exhibited regions of thallium-201 uptake indicating viable perfused myocardium, with no MIBG uptake. Such a finding is consistent with sympathetic denervation. One patient had frequent episodes of nonsustained ventricular tachycardia induced at exercise testing that was eliminated by beta-adrenoceptor blockade. Eleven of the 12 patients had ventricular tachycardia induced at electrophysiologic study and metoprolol never prevented induction. Sympathetic denervation was also detected in two of seven postinfarction patients without ventricular arrhythmias. Normal control subjects had no regions lacking MIBG uptake. This study provides evidence that regional sympathetic denervation occurs in humans after myocardial infarction and can be detected noninvasively by comparing MIBG and thallium-201 images. Although the presence of sympathetic denervation may be related to the onset of spontaneous ventricular tachyarrhythmias in some patients, it does not appear to be related to sustained ventricular tachycardia induced at electrophysiologic study.
3-Iodobenzylguanidine↗
HIPDM-SPECT in patients with medically intractable complex partial seizures. Ictal study.
Both interictal and ictal N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3,propanediamine -single photon emission computed tomography (HIPDM-SPECT) were performed in 16 patients with medically intractable complex partial seizures. Ictal HIPDM-SPECT localized epileptic foci in 13 of 14 patients with unilateral temporal focus and provided confirmative evidence of epileptic focus in 11 patients by demonstrating maximally increased regional cerebral perfusion (rCP) in epileptic foci that had shown decreased rCP in a previous interictal study. Ictal HIPDM-SPECT in two patients with bitemporal foci showed more complicated patterns consisting of slightly increased rCP in bilateral multifocal regions. Ictal HIPDM-SPECT was particularly useful for investigating epileptic foci, and correlation with simultaneously recorded ictal electroencephalograms provided further insight for localizing epileptic foci.
Brain↗
Evaluation of metallic osseous implants with nuclear medicine.
Nuclear medicine has proven to have a valuable role in the evaluation of osseous metallic implants, particularly with joint prostheses, but can assist with evaluation of other appliances as well. The nuclear arthrogram has become an invaluable adjunct to simultaneously performed radiographic contrast arthrography. This application has been best evaluated in what is one of the most common of orthopedic prosthesis problems, namely, loosening of total hip prostheses. Experience indicates that both sensitivity and specificity of loosening of the femoral component can be increased to over 90% through combined use of nuclear with radiographic contrast arthrography. Furthermore the combination of routine skeletal scintimaging with the nuclear arthrogram adds a significant dimension to precise localizing of the nuclear arthrographics agent In-111 chloride. Nuclear medicine also plays an important role in further evaluating the presence of infection associated with metallic implants with In-111 WBC preparations being superior to Ga-67 as the radiopharmaceutical tracer. Infection has been detected with a sensitivity of 73% and a specificity of 93% in our series using combined In-111 WBC and simultaneous skeletal imaging with conventional Tc-99m MDP. Acute infections are more readily identifiable than chronic in association with prostheses.
Hip Prosthesis↗
Scintigraphic and electrophysiological evidence of canine myocardial sympathetic denervation and reinnervation produced by myocardial infarction or phenol application.
Epicardial phenol application or transmural myocardial infarction in dogs produces sympathetic denervation of myocardium apical to the site of the intervention. Because efferent denervation is probably postganglionic, reinnervation most likely occurs but has not been shown. We investigated whether 123I-labeled metaiodobenzylguanidine (MIBG), a norepinephrine analogue taken up by sympathetic nerve terminals, could provide a scintigraphic image that would detect apical sympathetic denervation and possible reinnervation. Dogs underwent MIBG scintigraphic imaging at various times after phenol application or transmural myocardial infarction. The results of MIBG scintigraphy were correlated with electrophysiological responses obtained during ansae subclaviae and norepinephrine stimulation to establish the presence of neural denervation and reinnervation. Apical defects in the MIBG scan, which were associated with either normal perfusion by thallium or a smaller-sized defect, were found consistently in dogs that had apical sympathetic innervation. MIBG scintigraphic images returned to normal after 14 weeks (mean) at a time when reinnervation was shown to have occurred. Thus, the results of MIBG scintigraphy correlated accurately with the presence of denervation and reinnervation established by neuroelectrophysiological testing. Supersensitive refractory period shortening in response to norepinephrine infusion was present after denervation and persisted for more than 3 weeks after scintigraphic and electrophysiological evidence of reinnervation. Conclusions are that 1) MIBG can be used noninvasively to determine the presence of regional myocardial efferent sympathetic denervation and subsequent reinnervation, 2) reinnervation occurs after phenol application or transmural myocardial infarction, and 3) denervation supersensitivity persists even after reinnervation occurs.
3-Iodobenzylguanidine↗
Combined bone scintigraphy and indium-111 leukocyte scans in neuropathic foot disease.
It is difficult to diagnose osteomyelitis in the presence of neurotrophic osteoarthropathy. We performed combined [99mTc]MDP bone scans and indium-111 (111In) leukocyte studies on 35 patients who had radiographic evidence of neuropathic foot disease and clinically suspected osteomyelitis. The [111In]leukocyte study determined if there was an infection and the bone scan provided the anatomic landmarks so that the infection could be localized to the bone or the adjacent soft tissue. Seventeen patients had osteomyelitis and all showed increased [111In]leukocyte activity localized to the bone, giving a sensitivity of 100%. Among the 18 patients without osteomyelitis, eight had no accumulation of [111In]leukocytes, seven had the [111In]leukocyte activity correctly localized to the soft tissue, two had [111In]leukocyte activity mistakenly attributed to the bone, and one had [111In]leukocyte accumulation in a proven neuroma which was mistakenly attributed to bone. These three false-positive results for osteomyelitis reduced the specificity to 83%. Considering only the 27 patients with a positive [111In]leukocyte study, the combined bone scan and [111In]leukocyte study correctly localized the infection to the soft tissues or bone in 89%. Uninfected neurotrophic osteoarthropathy does not accumulate [111In]leukocytes. We found the combined bone scan and [111In] leukocyte study useful for the detection and localization of infection to soft tissue or bone in patients with neuropathic foot disease.
Adult↗
Clinical application of single-photon-emission computed tomography studies in dementia.
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Brain↗
Comparison of purified indium-111 granulocytes and indium-111 mixed leukocytes for imaging of infections.
Several methods have been proposed for the separation and labeling of white blood cells for the diagnosis of suspected infection. We retrospectively compared 105 patients imaged with 111In purified granulocytes (GRAN) to 106 patients imaged with 111In mixed leukocytes (MIX). We found that in acute infection the sensitivity of GRAN and MIX were both high and not statistically different. In chronic infections the sensitivities were lower than for acute infections. Again, there was no significant difference between GRAN and MIX with the borderline significant exception of MIX being superior to GRAN in chronic soft tissue infections (p = 0.06). We then had independent observers blindly grade the degree of lesion visualization. We found that delayed images visualized the lesions better than early images (p = 0.0001) and acute infection was better visualized than chronic infection (p = 0.03). We concluded that, in routine clinical practice, MIX is probably the agent of choice for three reasons: (a) easier preparation, (b) comparable sensitivity in acute infection and, (c) borderline superior sensitivity in chronic infection.
Acute Disease↗
In vivo kinetics of canine leukocytes labeled with technetium-99m HM-PAO and indium-111 tropolonate.
Two weeks after the introduction of osteomyelitis in three dogs, autologous leukocytes were dual-labeled with both [99mTc]HM-PAO and [111In]tropolonate, and reinjected. Blood sampling and imaging were then performed. Two weeks later, the same dogs received simultaneous injections of singly-labeled [99mTc]WBC and [111In]WBC for comparison. For both studies, blood samples were drawn over 6 hr to determine the respective blood clearance half-time (TB) and % recovery (%R0) of cell-bound radioactivity. There were no significant differences in the average TB results of the 99mTc and 111In groups, either within or between the dual- and singly-labeled studies. The %R0 of singly-labeled [99mTc]WBC was about half that of the other groups (p less than 0.01); however, this difference was attributed to the dissimilar radiochemical purity of the [99mTc]HM-PAO reagents. Region of interest analysis of the 6 and 24 hr images revealed no significant differences between either cell label in the relative or absolute in vivo uptake at known sites of osteomyelitis, noninfected surgery, and normal bone marrow.
Animals↗
I-123 HIPDM SPECT imaging and cerebral angiography for EC-IC bypass evaluation.
The use of SPECT in conjunction with I-123 HIPDM is a promising scintigraphic approach to the assessment of regional cerebral tissue perfusion.
Adult↗
Single photon emission tomographic brain images in dementia of the Alzheimer type.
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Aged↗
Efficacy of thyroid scintigraphy in the diagnosis of intrathoracic goiter.
For evaluation of the usefulness of thyroid scintigraphy in the diagnosis of intrathoracic goiter, we analyzed the results of radionuclide thyroid scintigraphy in 54 consecutive cases with suspected upper mediastinal masses. Intrathoracic goiters were found in 42. The sensitivity, specificity, and accuracy of the scintigraphy for intrathoracic goiter were 93% (39/42), 100% (12/12), and 94% (51/54), respectively. Scintigraphic morphology, scanning technique, and pitfalls are discussed. The results show that most intrathoracic goiters do have thyroid function and that radioiodine scintigraphy is a definitive and cost-effective diagnostic procedure for this disease.
Adult↗
Preliminary results of epilepsy surgery at Indiana University Medical Center.
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Electroencephalography↗
Pulmonary thromboembolism: current status report on the role of nuclear medicine.
The normal perfusion study continues indisputably to rule out the presence of pulmonary embolism (PE) with reasonable certainty. However, the abnormal perfusion study requires additional specificity. Many retrospective and one prospective correlation of contrast pulmonary angiography (CPA) have largely substantiated the efficacy of ventilation imaging and increasing specificity, especially with a high-probability (HP) interpretation to approximately a 90% predictive value. In most studies, the predictive value of a low-probability (LP) interpretation also approaches 90%. Intermediate-probability (IP) ventilation-perfusion (V-P) studies are the most frequent reason for performing pulmonary angiography, although LP studies with a stated prior clinical HP should also have CPA. Ventilation imaging technique is not as uniformly established as for perfusion studies, leading to some continued variability in interpretative criteria; yet criteria proposed by Biello and his colleagues have begun to be widely adopted. Aerosol inhalation imaging is developing, but has not been widely used, while problems continue with central airways deposition. The importance of contemporary correlative chest x-rays (CXR) especially when normal, have been emphasized, as well as new findings of the import of serial post-V-P CXRs, especially in HP studies without CPA or negative CPA. CPA continues to be the most specific diagnostic test for PE when properly performed, and is complimented and enhanced by use of prior V-P findings; although it is clear that too few CPAs are being performed. Consequently, there has been too much clinical dependence on V-P imaging. The value of prospective clinical probability estimates in patient management has been better substantiated. Reemphasis on thromboembolism as a systemic disease with use of some objective evaluation of the presence of peripheral thrombosis is becoming a part of clinical rationale, with the integrated long-leg radionuclide venograms (RNV) being one of the reasonable approaches. Multicenter studies have demonstrated, contrary to prior contentions, that V-P imaging leads to a significant net reduction and use of anticoagulants, as well as having overall significant efficacy in effecting patient management in suspected PE. Some of the controversies surrounding V-P imaging are expected to be resolved with the completion of the ongoing multiinstitute Prospective Investigation of Pulmonary Embolic Diagnosis (PIOPED) study.(ABSTRACT TRUNCATED AT 400 WORDS)
Aerosols↗
Indeterminate lung imaging. Can the number be reduced?
During a 2 1/2-year period, 1131 patients with suspected pulmonary embolism had ventilation-perfusion lung scans; 150 of these patients also underwent pulmonary angiography. In a retrospective study, these 150 patients were re-evaluated using the reference criteria of Biello and Alderson, with 62% read as indeterminate. Twenty patients who had chronic obstructive pulmonary disease with retention of Xe-133 in greater than 50% of the lung fields without corresponding radiographic abnormality were included. Ventilation/perfusion matches and mismatches could be correctly determined in 15 of these patients. These 15 of 20 studies could be correctly reclassified as low-probability, while the other five remained indeterminate. With increasing intervals between ventilation/perfusion lung imaging and the onset of symptoms, the percentage of patients with proven pulmonary emboli correctly diagnosed as high probability continuously decreased, and the percentage of studies read as indeterminate constantly increased. Serial chest radiographs suggested that the development of infiltrates in the region of the embolus convert high-probability ventilation/perfusion scans to indeterminate.
Humans↗
Localization of technetium-99m pertechnetate in peripheral nerve tumors.
Technetium-99m pertechnetate scintigraphy in three patients with pathologically proven peripheral nerve tumors (six in total) demonstrated its ability to assess accurately the size, location, and the extent of all lesions. Pertechnetate localized only in areas of abnormal nerve involvement and all lesions were better seen in delayed images than the earlier ones. Pertechnetate imaging appears to be a promising method of noninvasive evaluation of clinically evident and occult tumors of peripheral nerve origin.
Adult↗