Tc-99m MDP bone scan artefact. Abdominal soft tissue uptake secondary to subcutaneous heparin injection.
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Biomedical subjects
Publications and source records attributed to M Fernandez-Ulloa.
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Four cases of skeletal photon-deficient areas in In-111 white blood cell (In-111 WBC) images are reported. These were found in patients with lymphoma, vertebral osteomyelitis, and following radiotherapy and extensive surgical procedures. We emphasize that these photopenic lesions, although uncommon, may represent tumor involvement or benign processes, including osteomyelitis. Possible mechanisms to explain this phenomenon are discussed.
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Bone scintigraphy is a very useful technique for detection of aseptic necrosis. We have used this diagnostic tool in a patient to detect aseptic necrosis of the talus, a common complication stemming from foot injuries. The scintigraphic pattern is rather typical and antedates any other radiographic changes. This technique appears to be very useful for diagnosis and follow-up of aseptic necrosis occurring during talar injuries.
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In three patients with skeletal infectious disease, scintigrams with a Tc-99m bone-seeker and In-111-tagged leukocytes, made within 24 hr of each other, showed striking similarities. In two cases, the findings from the In-111 WBC images were ultimately determined to be artefacts due to Tc-99m crosstalk within the 173-keV photopeak of In-111. In the second case, the error was traced to failure to use a pure In-111 source for energy calibration: the camera had been peaked on the radiation from the patient himself, who had had an earlier Tc-99m bone scan.
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The normal intestinal secretion of 9-15% of an administered dose of gallium-67 may prevent early detection of intra-abdominal disease. We randomized 50 patients to receive either no bowel preparation or 30 cc of milk of magnesia plus 5 cc of cascara. No significant difference was found between the two groups in frequency with which gallium interfered with readings or time to complete the study.
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Duodenogastric reflux (DGR) as seen on hepatobiliary scintigraphy has been reported as a useful secondary sign for the diagnosis of acute cholecystitis. We evaluated the association of reflux with cases of acute cholecystitis as compared to those with chronic cholecystitis or other conditions. Thirty-six of 198 patients referred for hepatobiliary imaging showed DGR (18%). Among 26 patients with acute cholecystitis, 6 (23%) had DGR as compared to 9/40 (23%) cases with chronic cholecystitis, 3/12 cases with acute pancreatitis, 4/13 cases with previous cholecystectomy, and 3/8 cases with duodenal ulcer. No statistically significant differences were found between the prevalence of DGR in cases with acute cholecystitis and those with chronic cholecystitis or other nonacute cholecystitis diagnostic categories. Although acute cholecystitis is a condition frequently associated with DGR, such reflux is a nonspecific finding and should not be considered as a secondary sign of acute cholecystitis when interpreting hepatobiliary scans.