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Hepatic uptake of technetium-99m diphosphonate in thalassemia major.

Two cases of thalassemia major are presented in which bone scintigraphy demonstrated diffuse hepatic uptake of Tc-99m diphosphonate. Although abnormal splenic and renal uptake of Tc-99m phosphates has been reported in patients with thalassemia major, hepatic uptake has not been reported previously. This scintigraphic finding is presumably due to increased iron deposition in the liver, resulting from increased iron turnover and retention in these patients and from multiple previous blood transfusions.

Adult↗

Visual determination of differential renal function.

Forty patients (43 studies) referred for determination of differential renal function were imaged 24 hours after intravenous administration of Tc-99m-2, 3 DMSA. Visual assessment of relative renal uptake was estimated independently by three observers at three different hospitals from analog images on standard x-ray film. The results were compared with the relative DMSA uptake obtained by summing counts in computer-assisted regions of interest placed over each kidney. There was excellent correlation between the visual estimates of each observer and the computer-generated values (r = 0.98, 0.96, and 0.98, respectively). If a computer is not available, good visual estimates of differential uptake still may be obtained when static imaging agents such as DMSA are administered.

Adult↗

CT and nuclear medicine imaging in vertebral metastases.

Three cases are presented to illustrate the value of CT in elucidating the diagnosis in cancer patients presenting with complaints that are clinically highly suspicious for osseous metastases, where isotope bone imaging and conventional radiography failed to confirm the clinician's suspicion.

Aged↗

Lymphoscintigraphic studies of lymphatic drainage from the testes.

Two colloidal radiopharmaceuticals, Au-198 and Tc-99m antimony, were used to evaluate the lymphatic drainage of the testis in experimental animals and humans. One to 24 hours after direct intratesticular injection of Au-198 colloid in dogs and 4-6 hours after injection of Tc-99m antimony colloid in men, distribution within retroperitoneal lymph nodes was demonstrated. Uptake within the para-aortic lymph nodes primarily draining the testis was decreased following proximal ligation of the spermatic vessels in dogs. Testicular lymphoscintigraphy successfully demonstrated an intact spermatic cord lymphatic communication to the para-aortic nodes in five of six patients with chronic lower-extremity lymphedema. When the intact testicle and spermatic cord were transposed to the thigh in a patient with chronic lymphedema of the lower extremity, percutaneous pedal lymphoscintigraphy successfully demonstrated uptake within the para-aortic lymph nodes draining the ipsilateral testis.

Adult↗

Bone scintigraphic demonstration of synovial chondromatosis.

Markedly increased periarticular Tc-99m diphosphonate uptake around the knee is described in a patient found to have synovial chondromatosis. The pathophysiology and possible causes of bone tracer uptake in this cartilaginous disorder are discussed.

Cartilage Diseases↗

Radioisotopic flow scanning for portal blood flow and portal hypertension.

The use of a simple, noninvasive, isotope scanning technique for the determination of relative portal blood flow and detection of portal hypertension is described. Using this technique the presence of portal hypertension was demonstrated in seven of nine patients known to have elevated portal venous pressure. By contrast, esophageal varices were demonstrated in only five of these patients, illustrating the potential value of the method. Furthermore, this technique has been adapted to the study of portal blood flow in patients with myeloproliferative disorders with splenomegaly but without disturbances in hepatic architecture. Results demonstrate that the high relative splenic flow resulting from the presence of splenomegaly may in turn be associated with elevated relative portal blood flow and portal hypertension. The theoretic reasons for the development of flow-related portal hypertension and its relationship to splenic blood flow are discussed.

Blood Flow Velocity↗

Prospective study of sequential technetium-99m phosphate and gallium imaging in painful hip prostheses (comparison of diagnostic modalities).

Twenty-two painful hip prostheses were studied prospectively with plain radiography, aspiration and arthrography, Tc-99m phosphate bone imaging, and gallium imaging to evaluate loosening, infection, or both and to compare the accuracy of these modalities. Fifteen prostheses were revised yielding 14 loose femoral and eight loose acetabular components. Five proved to have infected prostheses. Arthrograms, plain radiographs, and bone scans are highly sensitive in detecting loosening of the femoral component. This study confirmed a previous retrospective study in demonstrating that accuracy of diagnosis of an abnormal acetabular component using all four modalities is less than that for the femoral component. In infected prostheses, phosphate bone imaging showed high sensitivity of a pattern that accurately diagnosed all the infected cases, whereas gallium imaging missed one case.

Adult↗

Lymphedema of the lower extremities: evaluation by microcolloidal imaging.

Contrast lymphangiography has been the traditional radiographic method for imaging the lymphatic system of the lower extremities. Because of the difficulty in performing the procedure and its potential side effects, radionuclide lymphangiography is a safe and reliable alternative. Technetium-99m labeled to antimony trisulfide colloid was used in nine patients presenting with lymphedema of the lower extremities. The procedure was relatively simple to perform, and no adverse effects were noted.

Abdomen↗

Tc-99m white cell scintigraphy in suspected acute infection.

The usefulness of In-111 labeled white cells in acute infection is well documented but the role of Tc-99m labeled white cell scintigraphy (WCS) has not been as clearly established. Using stannous fluoride colloid and a simple labelling procedure with 20 ml of autologous whole blood, three cases are presented in which Tc-99m WCS established unexpected diagnoses in patients who had remained undiagnosed despite extensive investigation.

Acute Disease↗

Myocardial clearance of Tc-99m hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI) in patients with coronary artery disease.

Myocardial clearance of the new cationic, lypophilic myocardial perfusion agent, Tc-99m-hexakis-2-methoxy-2-methylpropyl isonitrile (MIBI) was studied in nine patients with coronary artery disease. Regional time-activity curves were determined from serial postexercise myocardial SPECT images after a single dose of Tc-99m MIBI. There were significant differences between the clearance rates from normal and ischemic myocardium. Tc-99m MIBI washout from normal myocardium was 27 +/- 8% by 6 hours after injection. Clearance from mild myocardial defects (initial activity greater than 60% of the activity in normal myocardium) was 16% by 6 hours in six patients. No washout was detected by 6 hours in the three patients with severe myocardial defects. The ratio between the activity in ischemic and normal myocardium increased from 0.70 +/- 0.08 to 0.80 +/- 0.13 and 0.84 +/- 0.13 at 4 and 6 hours after injection in the patients with mild defects. In the patients with large defects, the ratio increased from 0.42 +/- 0.09 to 0.54 +/- 0.07 at 6 hours. It is concluded that, while redistribution is substantially slower than with Tl-201, image interpretation and data evaluation should be approached cautiously when imaging is delayed 4 hours or more after injection of Tc-99m MIBI. Quantitative techniques aimed at evaluating the extent and intensity of myocardial ischemia will be particularly affected.

Aged↗

Porous-coated acetabular component. Quantitative assessment of normal radiophosphate uptake as a function of implant age.

A computer-assisted quantitative analysis was undertaken of normal radiophosphate bone uptake adjacent to the porous-coated acetabular component in asymptomatic patients. Implants ranged from 1.6 to 49 months of age. In 62 hips, it was found that implants newer than 12 months of age had uptakes that were significantly greater than those 12 months or older. Between 12 and 49 months, there was no correlation with age, indicating a stabilization of the remodeling process.

Acetabulum↗

Tc-99m MIBI SPECT in the assessment of myocardial reperfusion after percutaneous transluminal coronary angioplasty.

Tc-99m MIBI SPECT was used to assess the early benefits of successful percutaneous transluminal coronary angioplasty (PTCA) in nine consecutive patients. SPECT stress studies were done by artificial cardiac pacing just prior to PTCA and 16-20 hours later, with perfusion images obtained 2-3 hours after pacing stress and Tc-99m MIBI injection. Angiographic restenosis was demonstrated in three patients at a later date, and all of these showed no significant improvement on the perfusion study after PTCA. All four patients asymptomatic at 7 months following PTCA had an average 15% improvement in segmental perfusion after the procedure. In two patients symptomatic after PTCA, one showed angiographic patency and had greater than 15% improvement in perfusion, while the second showed no scintigraphic improvement (no angiographic data obtained). This preliminary study suggests that Tc-99m MIBI is an important adjunct to angiography in estimating the amount of myocardium "at risk" before and after PTCA.

Aged↗