[Show abstract][Hide abstract] ABSTRACT: Bone loss is a major complication of primary hyperparathyroidism (PHPT), and it has significant implications in the treatment of this disease. Bone turnover was measured in patients with PHPT, using quantitative bone SPECT (QBS), to determine if the rate of bone loss could be predicted before a significant decrease in bone mass occurs.
Forty-six patients were included in the study. QBS and bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN) were done at baseline. The percent deviation of QBS in patients with PHPT from the values in normal matched controls was calculated. BMD was measured again after a mean of 17.5 mo in 38 patients, and in 29 patients a repeat BMD study was done after a mean of 41.4 mo. The change in BMD in patients with high and normal QBS values was compared using the nonparametric Mann-Whitney test. Regression analysis tested the correlation between baseline QBS values and BMD changes over time.
For the FN, there was a statistically significant difference in the BMD change between patients with high and normal QBS values for short-term follow-up (-2.82%+/-4.80% versus 1.45%+/-4.67%, p < 0.05) and for long-term follow-up (-3.53%+/-5.34% versus 0.92%+/-2.40, p < 0.02). There was a negative correlation in the FN, r=-0.48 between QBS values and the percentage of change in BMD. There was no significant difference between the percentage of change in BMD in the LS in patients with high and normal QBS values for either short- or long-term follow-up.
The results of this study show that QBS can predict bone loss in the FN in patients with PHPT. QBS can thus indicate the need for surgery at an early stage of the disease to prevent bone loss.
Full-text · Article · Oct 1998 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: A 59-yr-old man with chronic renal failure was admitted for evaluation of generalized skeletal pain and frontal bone mass, which was lytic on radiography. Bone scintigraphy demonstrated several foci of moderately increased uptake, without involvement of the skull mass. Radiographs of these lesions were compatible with brown tumors. Serum parathormone level was elevated and CT demonstrated a lower right cervical mass, consistent with parathyroid tumor. Following the removal of the mass and decrease in parathormone levels, the patient suffered from a prolonged period of hypocalcemia and his bone pain worsened. Repeat bone scintigraphy showed an increase in the number and intensity of the areas of focal uptake, consistent with hungry bone syndrome. This flare-up phenomenon is due to an increase in bone metabolism and is an uncommon finding following parathyroidectomy for primary hyperparathyroidism.
Preview · Article · Sep 1996 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: The deteriorating effects of corticosteroids on bone structure and metabolism have been well documented since they were first reported by Harvey Cushing in 1932. The main effects of corticosteroids causing osteoporosis include: direct suppression of osteoblasts, indirect stimulation of osteoclasts mediated by cytokinins and prostaglandins, and secondary hyperparathyroidism due to both decreased gut absorption and increased urinary excretion of calcium. Corticosteroids also have a suppressive effect on both gonadal function, adrenal androgens in women, as well as catabolic effects on muscle and bone matrix proteins. Therefore, high corticosteroid levels result in pathologic bone fractures. The authors describe a 33-year-old woman with adrenal Cushing's syndrome who had multiple pathologic fractures, including bilateral pelvic fractures, which mimicked bone metastases on bone scintigraphy. These findings resolved completely after the resection of the adrenal tumor. When a patient presents with multiple pathologic bone fractures, demonstrated on both radiography and scintigraphy, one should consider a diagnosis of metabolic bone disease, as well as other diagnostic possibilities.
No preview · Article · Jul 1996 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.
No preview · Article · Feb 1996 · Journal of Clinical Epidemiology
[Show abstract][Hide abstract] ABSTRACT: Tc-99m labeled RBC scintigraphy is a sensitive, noninvasive method for detection of acute gastrointestinal bleeding. Because most gastrointestinal bleedings are intermittent, RBC scintigraphy establishes that the patient is actively bleeding at the time of imaging, and directs angiography to the general area of the bleeding site for accurate detection of its anatomic location. The authors present a patient who had massive bleeding from a common hepato-jejunal-anastomosis after surgical repair of common hepatic duct obstruction. Labeled RBC scintigraphy demonstrated the exact anatomic bleeding site, therefore, angiography could be avoided.
No preview · Article · Jan 1996 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Eleven patients, each with a painful solitary cold nodule of the thyroid were evaluated. All patients had subacute thyroiditis associated with neck pain and tenderness. Despite elevated sedimentation rate and increased thyroglobulin levels, nine of the patients were euthyroid, and I-131 uptake was normal in six. In all patients, thyroid scintigraphy demonstrated a solitary cold nodule that resolved regardless of anti-inflammatory therapy. Granulomatous subacute thyroiditis is characterized by decreased I-131 uptake accompanied by transient hyperthyroidism. The uncommon localized variant of this entity may present with a painful solitary nodule, normal or only moderately decreased I-131 uptake, and should be suspected even in euthyroid patients.
No preview · Article · Dec 1995 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: We examined prospectively the hypothesis that the adequacy of initial dilatation may be a major determinant of the late result of coronary angioplasty and that a better assessment of initial dilatation can be made from a combined angiographic and perfusion study than from angiography alone. Angiographic and perfusion (thallium-201 single-photon-emission computed tomography) measurements were made very early (18 to 24 hours) after coronary angioplasty in 59 patients (67 lesions) and also immediately (37 +/- 16 minutes) after the procedures in 19 of them (23 lesions). The early measurements, singly, in combination, and as a restenosis index (restenosis index = thallium-201 ischemic score (units) - minimal luminal area (squared millimeters) were examined as predictors of the late angiographic result. At late angiography (5.5 +/- 2.2 months after angioplasty), residual stenosis was related to the immediate and very early postangioplasty minimal luminal dimension, thallium-201 ischemic score, and restenosis index, and also to day-1 loss and lesion length. The combination of a normal result in the immediate or early thallium-201 perfusion study with a large ( > or = 2 mm) angiographic luminal dimension stratified a group of patients with better long-term results after angioplasty and a lower incidence of late restenosis (p = 0.03). The findings emphasize the importance of the initial procedure as a determinant of the late result of angioplasty.
No preview · Article · Sep 1995 · American Heart Journal
[Show abstract][Hide abstract] ABSTRACT: To determine whether quantitative bone scintigraphy (QBS) with single-energy photon emission computed tomography (SPECT) can help predict which patients with chronic renal disease will show bone mineral density (BMD) loss.
In 18 patients, the percentage of injected dose of technetium-99m methylene diphosphonate per cubic centimeter of bone was measured with QBS SPECT in the lumbar vertebrae and femoral neck. The differences in BMD over an average of 20 months were measured and compared with SPECT measurements. QBS values were also compared with serum bone turnover markers.
There was a negative correlation (r = -.54, P < .05 for the lumbar spine and r = -.60, P < .01 for the femoral neck) between QBS values and bone loss. Positive and negative predictive values, sensitivity, and specificity of QBS for bone loss in the lumbar spine were 78%, 71%, 78%, and 71%, respectively, and in the femoral neck, 82%, 100%, 100%, and 78%, respectively. Differences between predictive values of serum bone turnover markers were not statistically significant.
QBS with SPECT enabled prediction of rapid bone loss in patients with renal disease.
[Show abstract][Hide abstract] ABSTRACT: The authors describe a patient with a known lingual thyroid and hypothyroidism in whom hyperparathyroidism developed. A large parathyroid adenoma was detected using TI-201 scintigraphy, whereas ultrasonography and computerized tomography failed to detect the lesion. In this patient, the thyroid remained in its original embryonal site in the pharyngeal floor, while the parathyroid glands migrated normally to their final anatomical location. In adult life, both glands showed abnormal function: the thyroid gland was hypofunctioning, and the parathyroid gland was hyperfunctioning due to parathyroid adenoma. A lingual thyroid is often associated with hypothyroidism. However, the association of a parathyroid adenoma in a normally located parathyroid gland, with an ectopic thyroid is uncommon. TI-201/Tc-99m scintigraphy was able to distinguish between the different locations of the two structures and to establish the diagnosis.
No preview · Article · May 1995 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Extrapulmonary tuberculosis Is uncommon In the western world. In the United States, skeletal involvement accounts for 1-2% of all cases of tuberculosis and about 10% of extrapulmonary disease. As a result of lymphohematogenous dissemination, infection of bone and joints with Mycobacterlum tuberculosis occurs concomitantly with the pulmonary Infection. Because malignant bone disease is more common even in children, the diagnosis of tuberculosis may be delayed. Ga-67 scintigraphy is generally used for follow-up in soft tissue and bone infection. However, its pattern in multifocal osteoarticular tuberculosis has not been reported. The authors describe the scintlgraphic patterns of bone and Ga-67 imaging in a 12-year-old girl with multifocal bone and joint tuberculosis.
No preview · Article · Apr 1995 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Two patients with unusual Hodgkin's disease who initially had a painless, solitary, thyroid cold nodule are described. Fine-needle aspiration revealed lymphocytic thyroiditis in one patient and a diagnosis of Hodgkin's disease was made 1 year later. In the second patient, aspiration of the nodule demonstrated a syncytial variant of nodular sclerosis Hodgkin's disease. Both patients underwent radiologic work-up, and surgery of the thyroid was avoided. After chemotherapy, both thyroid nodules disappeared. Thyroid involvement by Hodgkin's disease may be more common than anticipated, and may present atypically as a solitary thyroid nodule. Lymphocytic thyroiditis may accompany the disease and may cause a delay in the diagnosis. Recognition of this entity and the use of fine-needle aspiration may prevent unnecessary thyroid surgery, thus maintaining intact thyroid function after therapy.
No preview · Article · Feb 1995 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: This study is based on the assumption that is bone turnover, shown by the uptake of 99mTc-MDP, indicates a high rate of bone loss in patients with osteoporosis, it could potentially predict bone loss in patients at risk before significant bone loss has occurred.
Quantitative bone SPECT (QBS) using 99mTc-MDP, expressed as the %ID/cc x 10(-3), was performed in 71 women who had osteoporosis in the lumbar vertebrae, the femoral neck or both, and in 54 age-matched normal female controls. Of the women with osteoporosis, 42 had postmenopausal osteoporosis and 29 had primary hyperparathyroidism (HPT) and osteoporosis.
QBS increased with age in the cortical bone and decreased in the trabecular bone of the normal women. Quantitative bone SPECT in the femoral neck was 3.18 +/- 1.20 and was 2.73 +/- 1.06 in the femoral shaft in 20 women with postmenopausal osteoporosis of the femoral neck. In 19 women with HPT and osteoporosis of the femoral neck, the QBS value in the femoral neck was 3.57 +/- 0.92 and in the femoral shaft 3.38 +/- 1.12. These values were also significantly higher for the femoral neck and for the femoral shaft than those of normals. Although QBS values were higher in the lumbar region in 39 women with postmenopausal osteoporosis (4.59 +/- 1.45) and in 27 women with HPT (4.30 +/- 1.52), as compared with the normal group (4.28 +/- 1.61), the difference was not statistically significant.
This study shows that bone turnover is significantly higher in the cortical bone of women with osteoporosis than in normal women.
Preview · Article · Aug 1994 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Early diagnosis of necrotizing external otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of otitis from the severe type of external otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe external otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test.
Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed.
Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study.
In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.
Preview · Article · Apr 1994 · Journal of Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: The yield of bone scintigraphy was assessed in a general hospital. A random 1:2 sample of the bone studies performed within a year was evaluated. The referral forms were judged to show absent, ambiguous or clear diagnostic questions. The indications for which the study was ordered were matched with the scintigraphic diagnosis, and yield was defined as the proportion of studies with relevant findings on scintigraphy. The overall yield was 23.5%. In cancer patients the yield was 27.2% and in repeat studies 40.2%. In non-cancer patients the yield was 19.8% and when scintigraphy was performed for the evaluation of specific disease entities it was 35.7%. Relatively low-yield indications in non-cancer patients were suspected metastases 11.1%, and evaluation of X-ray abnormalities 11.5%. An association between the clarity of the diagnostic question and the scintigraphic yield was detected in non-cancer patients. When a diagnostic question was absent the yield was 12%, ambiguous 19%, and when it was clear 26%. This correlation is probably attributed to better understanding of this common procedure, and better definition of the diagnostic question in patients with diverse clinical conditions as compared to cancer patients in whom the question always relates to the presence of bone metastases.
No preview · Article · Mar 1994 · Israel journal of medical sciences
[Show abstract][Hide abstract] ABSTRACT: Testicular tumors in infants are uncommon; yolk sac tumor is the most prevalent germ cell malignancy. When the patient is diagnosed with this tumor before two years of age and the alpha-fetoprotein level returns to normal following the surgical removal of the tumor, the prognosis is improved. Scintigraphy is performed to show increased flow and heterogeneous tracer distribution. The authors present a case of an infant who underwent testicular scintigraphy for suspected acute scrotum. The study was performed to differentiate between torsion and epididymo-orchitis. Testicular scintigraphy was consistent with an inflammatory process; however, the patient did not develop the clinical signs of epididymoorchitis. On histology, a yolk sac tumor was identified. Thus, when the clinical presentation of a swollen scrotum is uncharacteristic of infection, scintigraphy can be misleading and testicular tumor should be considered.
No preview · Article · Mar 1994 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: We compared the acute hemodynamic effects of captopril and nitrates in 11 patients with severe congestive heart failure and grade IV cardiac disability. Pressures were measured using a Swan-Ganz catheter system; cardiac output and stroke index were measured by thermodilution, and left-ventricular (LV) volumes and ejection fraction were calculated simultaneously with the hemodynamic measurements from radionuclide ventriculography. Measurements were made in each of 4 treatment states: control, sublingual isosorbide dinitrate (ISDN; 5 and 15 mg), oral captopril (50-200 mg daily) and during combined therapy with captopril and ISDN. Captopril produced a fall in mean arterial pressure (p < 0.01) from 81 +/- 14 to 72 +/- 13 mm Hg and a rise in stroke index from 30 +/- 5 to 35 +/- 91/min/m2 (p < 0.05), while LV ejection fraction increased from 18 +/- 5 to 21 +/- 7% (p < 0.05). ISDN reduced mean arterial, pulmonary arterial, right-atrial and wedge pressure. The combination of captopril and ISDN produced a greater fall in mean arterial pressure, a further rise in ejection fraction to 22 +/- 8% (p < 0.05), a fall in systemic (p < 0.05) and pulmonary vascular resistance (p < 0.01) and a rise in cardiac (p < 0.01) and stroke work index (p < 0.01), while the beneficial effects of ISDN on right-atrial, pulmonary arterial and wedge pressure were again achieved. LV contractility, assessed from end-systolic stress-shortening relations, was essentially unaltered or decreased very slightly. The study showed that combined therapy with captopril and nitrates produced acute hemodynamic benefits superior to those achieved by treatment with captopril or nitrates alone.
[Show abstract][Hide abstract] ABSTRACT: Perfusion vascularity mismatch is characteristic of liver cavernous hemangiomas. The large blood volume and slow perfusion are responsible for this pattern. Often a large lesion demonstrate "cold" areas within the hemangioma, which are explained by slow or absent perfusion due to localized thrombosis. The authors present a polyvinyl- chloride worker with a large liver lesion whose Tc-99m RBC scintigraphy was consistent with cavernous hemangioma with a "cold" area. The lesion was diagnosed at surgery as hemangiosarcoma. It is concluded that malignant vascular lesions of the liver cannot be differentiated from the benign lesions by RBC imaging alone, because they may demonstrate similar patterns.
No preview · Article · Dec 1993 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Nine patients with adult respiratory distress syndrome (ARDS) were studied with Ga-67 imaging in search for a site of infection. Different degrees and two patterns of Ga-67 lung uptake scoring in comparison with liver uptake were demonstrated. All patients had diffuse lung uptake, whereas five of them also showed additional focal lung activity. In only one patient was an abdominal focal uptake detected. Chest radiographs of all patients revealed diffuse and focal lung infiltrates that correlated with the Ga-67 uptake patterns. Therefore, Ga-67 imaging was unhelpful in differentiating patients with ARDS with lung infection from patients without lung infection. The intensity of Ga-67 uptake, as expressed by Ga-67 scoring, correlated with the course and outcome of ARDS. Patients exhibiting a high Ga-67 score had long periods of hospitalization and eventually died (four patients), whereas those who had low Ga-67 scores had a short disease course and survived (five patients). It is concluded that Ga-67 imaging in ARDS patients is unable to detect lung infection; however, it may be useful in the assessment of patients' prognosis.
No preview · Article · Dec 1992 · Clinical Nuclear Medicine
[Show abstract][Hide abstract] ABSTRACT: Two hundred and twenty five liver hemangiomas in 166 patients were studied with Tc-99m labeled RBC and are the basis for this atlas. All hemangiomas showed various presentations of the perfusion blood pool mismatch, which is the basis for diagnosis. The size of the hemangiomas was the factor that determined the mixing of the Tc-99m RBC with the blood and, hence, the sequence of visualization of the lesion. Hemangiomas may appear as multiple lesions on liver scan and imitate metastases. Ninety-five hemangiomas appeared in 36 patients as multiple focal abnormalities. Hemangiomas are extremely variable in size. They may be huge (31 hemangiomas) and sometimes occupy most of the abdomen. Or they can be very small and are then detected only by SPECT (two cases). Thrombosed large hemangiomas appear as focal defects on Tc-99m RBC.
No preview · Article · May 1992 · Clinical Nuclear Medicine