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Biomedical subjects

S M Gruenewald

Publications and source records attributed to S M Gruenewald.

At least 37 records · Page 2Linked to original sources
PubMed1993

The significance of isolated gallium-67 uptake in the hilar lymph nodes of an untreated lymphoma patient.

A 69-year-old woman presented with non-Hodgkin's lymphoma of the right ilioinguinal region in whom bilateral uptake of Ga-67 in hilar lymph nodes was noted on thoracic SPECT. There were no Ga-67 abnormalities elsewhere within the thorax, and a chest CT scan was also normal. The patient received radiotherapy to the inguinal region and remained in clinical remission for 28 months following treatment. She subsequently relapsed at a number of peripheral lymph node sites, but not in the chest. The authors postulate that isolated hilar uptake of Ga-67 SPECT may not be clinically significant in some untreated patients with lymphoma. This scintigraphic finding should be interpreted cautiously, particularly when other chest imaging studies remain negative.

Aged↗
PubMed1993

A case of metastatic malignancy masquerading as a hepatic hemangioma on labeled red blood cell scintigraphy.

A 36-yr-old woman with a past history of gastric neuro-endocrine carcinoma (carcinoid tumor) underwent 99mTc-red blood cell (RBC) scintigraphy for evaluation of a 2-cm echogenic liver mass demonstrated on ultrasound. Scan findings were typical of a cavernous hemangioma. On follow-up, however, there was progressive lesion enlargement; histopathology of the resected mass revealed neuro-endocrine carcinoma. This case report, one of the few examples of a false-positive 99mTc-RBC scan, highlights the need for cautious evaluation of focal liver masses, even when there are typical scintigraphic features of cavernous hemangioma.

Adult↗
PubMed1992

Volume expanded diuretic renography in the postnatal assessment of suspected uretero-pelvic junction obstruction.

Controversy surrounds the role of 99mTc-diethylenetriamine pentaacetic acid renography in suspected uretero-pelvic junction obstruction in early life. Accordingly, we retrospectively reviewed 18 patients (28 hydronephrotic kidneys) with a mean age of 2 mo (range: 1 wk-6 mo) who underwent a total of 36 scans using intravenous volume expansion (10 ml/kg) and furosemide diuresis (1 mg/kg). Initial scans were classified as obstructed, not obstructed or indeterminate using differential renal function, furosemide washout T 1/2 and visual assessment of tracer clearance. Those initially classified as obstructed (n = 8) have been surgically confirmed. In the indeterminate (n = 6) and nonobstructed (n = 14) groups, three and two kidneys, respectively, developed obstruction on progress scans. Mean follow-up in the nonsurgical patients was approximately 9 mo (range: 4-17 mo). A total of 13 kidneys had developed obstruction by renographic criteria, and to date 12 have surgical confirmation. Our data indicate that: (1) scans classified as obstructed correlate well with surgery; (2) an initial classification of indeterminate or nonobstructed does not exclude later development of obstruction; and (3) serial scans correctly stratify children with possible uretero-pelvic junction obstruction.

Female↗
PubMed1990

Tc-99m DTPA uptake in Paget's disease of the left ilium.

Skeletal visualization during dynamic renal imaging is an uncommon finding that has previously been related to underlying neoplastic disease. The authors report a case of active Paget's disease of the left ilium resulting in uptake of Tc-99m DTPA in the arterial flow and early blood pool images. This report emphasizes that it is the increased blood flow, rather than the bone pathology per se, that determines uptake of Tc-99m DTPA in Paget's disease.

Bone Neoplasms↗
PubMed1990

Vascular compression of the superior infundibulum causing calyceal obstruction. Scintigraphic findings.

Radionuclide imaging in obstructive uropathy has concentrated on disorders of the pelviureteric junction and lower urinary tract. There is a paucity of information, however, available on the scintigraphic manifestations of disorders of the calyces and infundibulum. These conditions may be responsible for similar symptoms, and thus recognition of abnormal retention of activity within one or more calyces offers important diagnostic information. One of these disorders is vascular obstruction of the superior infundibulum, and this report describes the radionuclide appearance of this surgically curable condition.

Adolescent↗
PubMed1990

Diagnosis and treatment of antenatal uropathies.

Thirty-five patients with significant fetal hydronephrosis detected on antenatal ultrasound had postnatal investigations which included ultrasound, 99mtechnetium diethylenetriamine pentacetic acid (99mTcDTPA) renal scans and micturating cystourethrograms. Antenatal and postnatal ultrasound were unable to determine reliably the level of obstruction causing the hydronephrosis. The 99mTcDTPA renal scan was useful in determining the necessity and timing of surgery, but could not exclude vesico-ureteric reflux. Seven patients required surgery in the neonatal period and a further seven children had surgery because of deterioration of the scan appearance on follow-up studies performed at 3, 6 and 12 months of age and then at longer time intervals. Twenty patients (almost 60%) have been managed conservatively for a mean of 28 months (range: 12 months-7 years) with no deterioration in renal function.

Female↗
PubMed1989

Can quantitative renography predict the outcome of treatment of atherosclerotic renal artery stenosis?

The accuracy of quantitative gamma camera renography in predicting outcome of treatment was assessed in 31 patients with atherosclerotic renal artery stenosis. Glomerular filtration rate, renal perfusion, relative renal function, and mean parenchymal transit time were calculated before and after treatment (renal artery angioplasty or vascular surgery). Patients were also assessed during the follow-up period of up to 6 years. On the pre-treatment study, nine patients did not have prolongation of parenchymal transit time in the kidney on the side of the renal artery stenosis. Despite technically successful angioplasties, none of these patients showed a significant reduction in blood pressure or improvement in renal function. Twenty-two patients had prolongation of parenchymal transit time in the affected kidney. Three suffered complications of treatment, and the remaining 19 showed improvement in blood pressure control, reduction in parenchymal transit time, and improvement in relative renal function. Quantitative renography accurately predicted those patients who improved following intervention for atherosclerotic renal artery stenosis. On progress evaluation, patients with recurrent stenoses were easily identified.

Adult↗
PubMed1989

Atypical appearance of an hepatic hemangioma with technetium-99m red blood cell scintigraphy.

Three-phase 99mTc red blood cell scintigraphy is an established technique for distinguishing hemangiomas from other focal liver lesions. The most widely recognized feature is the perfusion to blood-pool "mismatch" characterized by decreased or normal arterial perfusion, with lesion activity which progressively increases over 1-2 hr. Although increased arterial vascularity of hemangiomas has been described, such cases either involved small portions of the lesion only or occurred in lesions not conclusively proven to be hemangiomas. We report a case of an angiography proven hemangioma with increased arterial vascularity involving a significant portion of the lesion as well as intense early blood-pool activity similar to that seen on delayed imaging. This case emphasizes the diverse appearance of hepatic hemangiomas using 99mTc blood cell scintigraphy.

Adult↗
PubMed1988

Cutaneous gallium uptake in patients with AIDS with mycobacterium avium-intracellulare septicemia.

Gallium imaging is increasingly being used for the early detection of complications in patients with AIDS. A 26-year-old homosexual man who was HIV antibody positive underwent gallium imaging for investigation of possible Pneumocystis carinii pneumonia. Widespread cutaneous focal uptake was seen, which was subsequently shown to be due to mycobacterium avium-intracellulare (MAI) septicemia. This case demonstrates the importance of whole body imaging rather than imaging target areas only, the utility of gallium imaging in aiding the early detection of clinically unsuspected disease, and shows a new pattern of gallium uptake in disseminated MAI infection.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Three-hour volume of distribution method: an accurate simplified method of glomerular filtration rate measurement.

Eight hundred studies of glomerular filtration rate (GFR) measurements were performed by the standard slope-intercept method using [99mTc]DTPA and results were compared with a simultaneous measurement of the 3-hr tracer volume of distribution. A wide range of human renal function was studied and a nonlinear relationship between GFR and the volume of distribution resulted with an excellent correlation (r = 0.989). Agreement between the two measured parameters was not constant for all levels of renal function with the greatest accuracy being found for GFR = 60 to 100 ml/min.

Blood Volume↗
PubMed1985

Comparative assessment of techniques for estimation of glomerular filtration rate with 99mTc-DTPA.

The relative accuracy of five simplified methods of measuring glomerular filtration rate was prospectively assessed using 99mTc-DTPA. The slope of the biological clearance curve, the 3-h volume of dilution and three renal tracer uptake methods (Piepsz, Gates and Nielsen) were concurrently compared with a multiple blood sampling reference method. The volume of dilution method from a single blood sample was markedly superior to the other four simplified methods which all had a similar degree of accuracy.

Glomerular Filtration Rate↗
PubMed1985

Kidney depth measurement and its influence on quantitation of function from gamma camera renography.

Both total and relative renal function assessed from gamma camera renography are influenced by the depths of the kidneys in the body. Despite the ease with which renal depths may be measured (by ultrasound or nuclear medicine lateral scans), when calculating the total uptake function it is common practice to estimate the renal depth from the patient's weight-to-height ratio. Furthermore, it is often assumed that there is no significant effect on relative function measurements due to different depths of right and left kidneys. Our data, from 150 consecutive patients, does not support this assumption or the use of calculated depth estimates and highlights the need for accurate kidney depth measurement.

Adolescent↗
PubMed1985

Predictive value of quantitative renography for successful treatment of atherosclerotic renovascular hypertension.

Twenty patients with severe atherosclerotic renal artery stenosis were studied by quantitative gamma camera renography before angioplasty or surgery. Sixteen patients were treated by angioplasty and two each by bypass surgery and nephrectomy. Total and relative renal function, renal perfusion, and tracer transit times through the affected and contralateral kidney were calculated. All but one of the angioplasty patients and one of the two bypass surgery patients also had quantitative renography performed one to two weeks after treatment to assess changes in renal function. In the remaining four patients, changes in renal function were assessed by serial serum creatinine estimations. Patients were classified as cured, improved, or not improved according to their blood pressure response. Five had evidence of unilateral functionally significant stenoses and normal contralateral kidneys (four cured, one improved). Ten had functionally significant stenoses but with abnormal contralateral kidneys (all improved). Five had no evidence of functionally significant stenoses (all not improved). Quantitative renography provides functional and prognostic information to complement anatomical assessment by angiography. It is a simple, safe, and non-invasive means of predicting the outcome for patients with hypertension and renal artery stenosis.

Adult↗
PubMed1984

Antenatal diagnosis of urinary tract abnormalities: correlation of ultrasound appearance with postnatal diagnosis.

A review was made of the natural history of the urinary tract abnormalities diagnosed antenatally in 18 fetuses in order to correlate the ultrasound appearance with subsequent postnatal diagnosis and prognosis. Unilateral disease, both obstruction and multicystic renal disease, was associated with a good prognosis. Bilateral dysplastic kidneys had a very poor prognosis. The antenatal ultrasound demonstration of bladder distention and/or hydronephrosis, however, does not always signify true obstruction of the urinary tract. This is important in view of the recent introduction of in utero interventions to preserve renal function and prevent pulmonary hypoplasia.

Dilatation, Pathologic↗
PubMed1983

Advances in diagnosis and treatment of renovascular hypertension.

In approximately 5% of the hypertensive population, hypertension is of a renovascular origin. Some of these patients may be cured of their disease by the modern treatment of transluminal dilatation of the stenosed renal artery. They no longer require hazardous surgery or life-long antihypertensive medication with its associated problems of side-effects, expense, and patient compliance. Decisions need to be made about which hypertensive patients should be investigated, how extensively, and the tests which should be performed to identify patients with this remediable form of hypertension.

Angioplasty, Balloon↗
PubMed1983

Renovascular hypertension: quantitative renography as a screening test.

The accuracy and reliability of quantitative gamma camera renography in screening for functionally significant renovascular hypertension was investigated. Renal perfusion, total and relative renal function, and parenchymal transit times were measured in 141 patients with recently diagnosed or severe hypertension. Renal angiography was performed in 13 of the 15 patients diagnosed as having evidence of renovascular hypertension. In all 13 either occlusion or significant stenosis of the renal artery was correctly predicted. Previous studies utilizing static images, playback buffers, and renograms have shown that these methods have excellent sensitivity, but relatively low specificity because of false-positive results. The addition of computer quantitation, including measurement of parenchymal transit times, has greatly improved the accuracy of this test. Quantitative renography can now be regarded as a reliable means of selecting patients for transluminal dilatation of stenosed renal arteries and for follow-up after this procedure.

Adolescent↗
PubMed1982

Quantitative renal imaging and its place in urological investigation.

Recent developments in renal nuclear medicine enable accurate quantification of useful physiological parameters. These include renal perfusion, total and relative renal function, tracer transit times, and residual urine volume. The intravenous pyelogram (IVP) demonstrates renal excretion and, although both the IVP and renal ultrasound scanning provide excellent structural information, neither is able to assess renal function adequately. In renal medicine, the prime concern is often not structure but function, and quantitative renography provides this essential information.

Glomerular Filtration Rate↗