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H Van der Wall

Publications and source records attributed to H Van der Wall.

At least 19 recordsLinked to original sources
PubMed2007

Lateral hip pain: does imaging predict response to localized injection?

Lateral hip pain is a common complaint in patients with a history of lower back pain from spinal disease. These patients often are diagnosed and treated for trochanteric bursitis because of localized pain and tenderness in the lateral hip. We presumed numerous scintigraphic features could provide diagnostic criteria for diagnosing gluteus medius tendinitis and trochanteric bursitis. A study was designed to assess the scintigraphic criteria for diagnosis of trochanteric bursitis and to evaluate the relationship of trochanteric bursitis to gluteus medius tendinitis and lumbar degenerative disease in predicting relapse after injection. We evaluated 97 patients with greater trochanteric pain syndrome to find a correlation between trochanteric bursitis, gluteus medius tendinitis, and spinal degenerative disease using scintigraphy and magnetic resonance imaging. We also evaluated predictors for responding to trochanteric injection of local anesthetic/glucocorticoid injection. We found a correlation between lumbar degenerative disease, gluteus medius tendinopathy, and trochanteric bursitis. Of these, 30 of 48 patients (63%) responded to injection of local anesthetic and glucocorticoids. The major predictor of relapse of pain after injection in 18 patients was the presence of moderate to severe lumbar degenerative disease seen on scintigraphic imaging. We propose a mechanistic model of the greater trochanteric pain syndrome to explain the interrelationship and response to therapy. Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis.

Adult↗
PubMed2005

Degenerative spondylolysis: a concise report of scintigraphic observations.

OBJECTIVES: Spondylolysis is traditionally thought to be a diagnosis of adolescence and childhood, and is ascribed to mechanical stress through the immature pars interarticularis. Over the last 4 yr we have noted a presentation of spondylolysis in association with hypertrophic zygapophyseal joint disease in the lumbar spine in an older age group. METHODS: Records of 94 patients presenting with low back pain were examined. A pattern of intense zygapophyseal joint uptake in association with extended uptake in the pars interarticularis was ascribed as degenerative spondylolysis. RESULTS: The ages of the 94 cases ranged from 33 to 80 yr (mean 64 yr). There were 53 males and 41 females. In the group with degenerative spondylolysis the mean age was 72 yr, with four females and two males. None of these six patients gave a history of childhood spinal disease or back pain and all were relatively inactive in terms of current participation in sport. All cases of spondylolysis were confirmed by computed tomography scanning. CONCLUSION: The finding of hypertrophic zygapophyseal joint disease in association with spondylolysis is easily recognized by scintigraphic tomographic imaging.

Adult↗
PubMed2001

Hypertrophic pulmonary osteoarthropathy without clubbing of the digits.

Hypertrophic osteoarthropathy (HOA) typically occurs concurrently with clubbing of the digits, with isolated HOA being reported only rarely. We report two patients with intra-thoracic malignancy in whom HOA, demonstrated on bone scintigraphy, developed in the absence of clubbing. We also report the novel observation of involvement of the metatarsal and metacarpal bones by HOA.

Aged↗
PubMed2001

SPET of a computerised model of diffuse lung disease.

Emphysema is a common and debilitating disease that is the commonest cause of end-stage respiratory failure. Treatment is either by lung transplantation or by lung volume reduction surgery (LVRS) that improves the biomechanics of respiration. Patient selection for LVRS hinges on the demonstration of heterogeneous disease, predominantly involving the upper lobes, as a good surgical outcome is most likely in these patients. We used a virtual model of lung scintigraphy to compare planar with tomographic scintigraphy for the detection of diffuse lung disease. Lesions of the magnitude of the lung acinus, as well as larger and smaller lesions, were distributed throughout the lungs in volumes from 2% to 50%. Single-photon emission tomography does not add incremental value to planar images for the detection of diffuse lung disease.

Adult↗
PubMed2001

Importance of positioning and technical factors in anatomic localization of sporting injuries in scintigraphic imaging.

Sports medicine is becoming increasingly important as more people take up exercise for health and well-being. It is adding to the spectrum of acute and chronic injuries that have traditionally been seen in elite or professional athletes. Because of its high sensitivity and lesion contrast, bone scintigraphy has traditionally played a key role in the detection of such injuries. This role has been reduced in recent times by the increased use of magnetic resonance imaging (MRI), which has functional capability, high-contrast resolution, and high-spatial resolution. Bone scintigraphy has the capability of detecting early cortical ligament avulsion and enthesopathic disease before the onset of edema or changes in bone marrow that are detected by MRI. If this capability is added to more precise anatomic localization of lesions, we may see a resurgence in its use in sports medicine. A number of techniques are presented in this article, encompassing positioning, special views, and tomographic reconstructions, that can significantly improve the accuracy of localization of scintigraphic abnormalities with reference to anatomic models or sources of cross-sectional anatomy.

Ankle Injuries↗
PubMed2001

Reversal of medial compartment osteoarthritic uptake pattern after high tibial osteotomy.

Two cases of osteoarthritis of the knee are presented that illustrate the typical medial compartment pattern of scintigraphic uptake. In both cases the patients had significant medial joint pain. After high tibial osteotomy, the pattern of uptake was altered and paralleled the improvement in symptoms. These observations prompt several important issues regarding the cause of the uptake and may provide a way to monitor treatment response.

Adult↗
PubMed2001

Scintigraphic assessment of the acetabulum after arthroplasty with reference to cup geometry.

A unique scintigraphic appearance has been noted in uncomplicated hip prostheses which have the acetabular component inserted after under-reaming or where a cone-shaped cup is inserted. We hypothesized that the pattern of increased uptake around the superior and inferior third of the cup with relatively reduced uptake in the medial third is due to preferential loading of the rim of the cup. A prospective study of ten patients with uncomplicated hip prostheses supports the hypothesis.

Acetabulum↗
PubMed2001

Occurrence of pulmonary thromboembolism immediately after arthroplasty.

INTRODUCTION: Respiratory complications are common after arthroplasty, with pulmonary thromboembolic disease (PTE) and fat emboli being the most serious. A scintigraphic study was designed to assess the occurrence of both diseases. A prospective tomographic study of perfusion was performed within 24 h of arthroplasty. Details of the detection of fat embolism will be presented elsewhere. METHODS: Patients with previous PTE were excluded. Tomographic lung studies were acquired after 99mTc-macroaggregated albumin injection. Pre- and post-operative arterial blood gases (ABGs) and relevant chest radiography/computed tomography scans were obtained. ABGs were analysed as the difference in alveolar-arterial oxygen gradients, pre- and post-operatively (DA-a). RESULTS: Forty patients were studied (16F, 24M) with a mean age of 71 years (range 36-88 years). Of these, 16 were hip and 24 knee arthroplasties. PTE was detected in 25 of 38 (66%) patients evaluated. The value of DA-a was significantly different between patients with PTE and without PTE (P>0.05). Administration of prophylactic pre-operative low molecular weight heparin makes no difference to the early onset of PTE. CONCLUSION: There is a high incidence of PTE immediately after arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed2001

Prognostic value of 99m Tc leukocyte scintigraphy in diabetic pedal osteomyelitis.

While leukocyte scintigraphy is accurate in detection of pedal osteomyelitis, there has been little data relating the technique to outcomes. We designed a trial to examine the prognostic value of sequential 99m Tc labeled leukocyte scans to establish the diagnosis of osteomyelitis and after three to four weeks of culture-guided antibiotic therapy. Twenty-three diabetic patients with proven pedal osteomyelitis (21/23) or persistent uptake (2/23) on the sequence of scans were studied. Five additional episodes of osteomyelitis developed in the group over the period of the study. Eleven patients demonstrated persistent uptake in the sequential scans. Nine progressed to amputation. The remaining two patients were biopsy-negative for infection, did not have cutaneous ulceration and were thought to have rapidly progressive arthropathy. Sequential leukocyte scintigraphy accurately predicts the need for amputation and can circumvent ineffective prolonged antibiotic therapy.

Aged↗
PubMed2000

Creation of a three-dimensional model of human segmental lung anatomy.

OBJECTIVE: The investigation of pulmonary embolism using scintigraphic tomography requires a model of the internal architecture of the segments and subsegments in the human lung. Such a model has been developed by the segmentation and subsegmentation of an existing whole-body tissue-segmented phantom. MATERIALS AND METHODS: By using information from suitably windowed human axial CT scans, combined with the information gained from the injection of color-coded dyes into the segmental bronchi of human cadaveric lungs, the lobar and segmental boundaries were added to the existing phantom. Further refinements were added from reports in the literature regarding the predominant pattern of subsegmental bronchi in a series of human cadavers, enabling the creation of subsegmental boundaries. RESULTS: A digitized model of the segmental and subsegmental anatomy of the human lung was successfully created. External, or pleural, projections of the complex internal arrangement of the segments closely corresponded with the projections of the best available authorities on the subject. CONCLUSION: The model provides the opportunity to address several issues germane to scintigraphy and important for diagnosing pulmonary embolic disease. In particular, the model allows the manipulation of three-dimensional data sets to explore issues of importance to tomographic lung scanning.

Computer Simulation↗