TC-99M-labeled red blood cell scintigraphy in the investigation of patients with hepatic carvenous hemangioma

Objective to evaluate the diagnostic accuracy of 99m tc-red blood cell scintigraphy in the diagnosis of hepatic cavernous hemangiomas. Patients and methods sixty three patients, 56 females [89%] and 7 males [11%], with ages between 22 and 54 years [median 33 years] were investigated for liver masses found on ultrasonography of the abdomen. All the patients had undergone 99m tc-liver-spleen scan followed 99m tc-red blood cells scintigraphy. The size of the lesions ranged between 3 and 9 cm. The final diagnosis was reached through cytology, and/or histopathology or follow up for more than 3 years. Results a total of 70 lesions were found as a single lesion in 60 patients and multiple [i.e. total of 10 lesions] in the other 3 patients. The results of 99m tc-red blood cells scintigraphy, compared to the results of the final diagnosis, showed sensitivity and specificity rates of 100% and 89% respectively positive and negative predictive values of 98% and 100% repectively, and accuracy rate of 98.6%. a single false positive case was a hepatocellular carcinoma. Conclusion 99m tc-red blood cell scintigraphy is highly accurate in the diagnosis of liver cavernous hemangioma and should characterize liver mass found on ultrasonography and suspected for hemangioma

Radionuclide esophageal transit time for the assessment of pneumatic dilation in patients with achalasia

The aim of this study was to assess the value of radionuclide esophageal transit time [RET] in prediction of the results of pneumatic dilation in patients with achalasia. Patients and methods: Thirty patients [13 males] with a mean age of 37 +/- 15.6 years [range 17-73 years] were included in the study. All patients were diagnosed to have idiopathic achalasia of the cardia and selected for pneumatic dilation. Each patient had three RET, two the same day of dilation [pre and postdilation] and a third follow up one within three months of dilation [4 patient failed to come for follow up and were excluded]. Several parameters were derived from RET studies, T/50: time required for 50% of activity in the esophagus to be cleared, T/10: time required for 90% of activity in the esophagus to be cleared and percentage clearance at 10 min. These parameters were compared to response of dysphagia to dilation. It was evident that the higher the esophageal clearance postdilation, the better the outcome. When immediate post dilation clearance was 85% or more the success rate was 83.3% whereas when it was 20-50% the RET appears to be a useful quantitative procedure in the assessment of pneumatic dilation outcome in achalasia patients

Hepatobiliary scintigraphy in the distinction between biliary hypoplasia and biliary atresia

The aim of this work is to see whether distinction between biliary atresia and biliary hypoplasia is possible or not and to present the value and usefulness of hepatobiliary scintigraphy in the investigation of infants with persistent hyperbilirubinemia. Seventy-seven patients of the age between five days and six months [average 62 days], 43 females and 34 males of which 65 Saudi, and 12 non-Saudis were investigated. Laboratory tests, abdominal ultrasound, hepatobiliary scintigraphy, liver biopsy explorative laparatomy and intraoperative cholangiography were performed whenever indicated. The findings on hepatobiliary scintigraphy of nonvisualization of the gallbladder and no activity in the bowel upto 24 hours post injection were considered consistent with the diagnosis of biliary atresia. Minimal bowel activity, or visualization of the gallbladder where consistent with biliary hypoplasia. In addition, the liver in the two entities appeared in a different shape and can be used as an additional distinctive feature. Thirty-four infants were diagnosed by hepatobiliary scintigraphy as having biliary atresia. Only 3 of the 34 were false positives as compared to cholangiogram and liver biopsy results. Five cases were biliary hypoplasia. Hepatobiliary scintigraphy in infants with persistent hyperbilirubinemia can be distinguished between BA and BH in a simple and noninvasive approach

Hepatobiliary scintigraphy in the diagnosis of choledochal cysts in children

The objective is to present the usefulness of hepatobiliary scintigraphy in the investigation of children with suspected choledochal cysts through our experience in King Khalid University Hospital at King Saud University, Riyadh. Seven patients aged between 1 and 10 years [average 4.8 yrs] comprising six females and one male were investigated. Laboratory tests, abdominal Ultrasound and/or CT, and cholangiography were performed whenever indicated, Persistent activity in a dilated common bile duct, with or without dilatation of intrahepatic bile ducts, was considered a positive indicator for choledochal cyst disease. Four children with cystic dilatation [type I] were diagnosed by hepatobiliary scintigraphy, one saccular [type II], and two cases of Caroli's disease [type V]. The diagnosis of choledochal cyst was proven by surgery with histological confirmation. Visualization of the gallbladder occurred in one case only. The common bile duct was seen in four cases. Late activity in the bowel was noted in two cases

Hepatobiliary scintigraphy in persistent direct hyperbilirubinemia in the neonate

To present the value and usefulness of hepatobiliary scintigraphy in the investigation of infants with persistent hyperbilirubinemia through our experience in King Khaled University Hospital at King Saud University, Riyadh. King Khalid University Hospital, Departments of Nuclear Medicine, Pediatrics and Pediatric Surgery. Patients and methods: Seventy-seven patients aged between 5 days and 6 months [average 62 days], 43 females and 34 males, 65 Saudi and 12 non-Saudi were investigated. Laboratory tests, abdominal ultrasound, hepatobiliary scintigraphy. liver biopsy, explorative laparatomy and intraoperative cholangiography were performed whenever indicated. The findings on hepatobiliary scintigraphy of non-visualization of the gallbladder and no activity in the bowel up to 24 hours post injection [p.i] were considered consistent with the diagnosis of biliary atresia. Thirty four infants were diagnosed by hepatobiliary scintigraphy as having biliary atresia. Only 3 of the 34 were false positives as compared to liver biopsy results. Twenty-nine of the other 43 patients showed bowel activity sometime between 6 and 8 hours p.i. whereas the other 14 showed it at 24 hours p.i. Fourteen cases of the 19 with hepatitis showed decreased and delayed liver uptake in an irregular pattern. The other 5 cases of hepatitis showed good liver uptake similar to that seen in cases with biliary atresia. Hepatobiliary scintigraphy has become an essential part of the investigational work-up plan of infants with persistent hyperbilirubinemia before and after surgery because it is a simple and noninvasive technique

Assessment of myocardial perfusion with single photon emission tomography

In order to compare Tc-99m-Sestamibi to T1-201 in the assessment of myocardial perfusion in the presence of coronary artery disease, 100 patients were studied with single photon emission computerized tomography [SPECT]. Segmental analysis was carried out on 77 patients who underwent cardiac angiogram. The overall sensitivity and specificity rates in patients with myocardial infarction were respectively 92.5% and 98% for MIBI, 86.6% and 95% for Tl; whereas in patients with chest pain, they were respectively 76.7% and 80% for MIBI, 69.8% and 70.5% for Tl. Tc-MIBI correctly detected 11 lesions that were normal on Tl-201, whereas the latter detected one lesion that was missed by Tc-MIBI. Concluding, we have the impression that Tc-MIBI not only correlated well with Tl-201 but also showed marginal superiority over Tl-201. Thus, Tc-MIBI is a valid alternative to Tl whenever the latter is not available

Congenital hypothyroidism: clinical and laboratory characteristics in infants detected by neonatal screening

A pilot cord serum thyroid-stimulating hormone [TSH] screening program for congenital hypothyroidism began in December 1988 at the Ministry of Health Maternity Hospitals in Riyadh. Out of 40,000 infants screened, 15 infants with congenital hypothyroidism have been detected. Of these, five had athyreosis, eight with ectopic thyroid glands, interestingly five of which had positive perchlorate discharge test suggestive of organification defects, and two had normally located glands with a perchlorate discharge test suggestive of organification defects. The female to male ratio was 1.5:1. The clinical characteristics in our cases were not different from that previously reported. Although there was no significant difference in the mean cord T4 values among the different groups, the mean T4 values at recall in the aplastic group is significantly [P < 0.001] lower than the cord results [60.3 versus 15.3] and that is of recall for the ectopic group [15.3 versus 47.0]. There was no significant difference in the mean TSH among the different groups in the cord and recall samples. The skeletal maturation was more delayed in the athyrotic group. The mean age at the time of recall was 17.8 days [range 6 to 64] and the mean age at the start of therapy was 20 days [range 8 to 64]

Bone mineral content and bone mineral density values measured by single photon absorptiometry among healthy Saudi population

Several noninvasive methods for assessing bone mass have emerged over the last two decades, namely, single photon absorptiometry [SPA], dual photon absorptiometry, and quantitative computerized tomography. These techniques have proved to be sensitive and reproducible, with absorptiometry causing minimal radiation exposure. Several studies on osteoporosis have shown that its frequency varies in different racial groups; for example, Hispanics and Blacks in the USA appear to be the least affected by osteoporosis. It was therefore important to establish the normal standard of measurements of bone mass among healthy Saudi population using SPA to be used for clinical applications such as predicting the risk of fractures, monitoring the response to therapy, and quantitating the severity of metabolic bone disease

Safety and diagnostic value of intravenous dipyridamole thallium Scintigraphy in patients with suspected coronary artery disease

Thallium-201 myocardial perfusion imaging [T1-201 MPI] performed in patients after maximum exercise is widely used to evaluate patients with suspected coronary artery disease [CAD]. Intravenous dipyridamole [DP], by virtue of its potent coronary vasodilatation effect, can produce results similar to those of maximum exercise. To evaluate the safety and diagnostic usefulness of intravenous DP thallium imaging, 100 patients with suspected or known CAD were studied. Thirty-two patients were referred for diagnostic cardiac catheterization and these patients also underwent exercise T1-201 MPI. The sensitivity and specificity of T1-201 MPI studies were 92% and 83%, respectively, for DP; and 88% and 83%, respectively, for exercise T1-201 studies. Of the 100 patients studied, 44 had some adverse effects. Noncardiac side effects were transient and required no treatment. Chest pain was the most common cardiac side effect, occurring in 24 patients, and ischemic electrocardiograpic changes were seen in 14 patients. Intravenous aminophylline [125mg] was used in 13 patients to reverse these effects. No patient suffered myocardial infarction or severe arrhythymia, and none died. We concluded that T1-201 MPI after coronary vasodilation with intravenous dipyridamole is a safe and better noninvasive procedure for the evaluation of CAD in patients who are unable or not expected to achieve adequate exercise level

Pheochromocytoma: diagnosis and treatment

Pheochromocytoma [PH] is a catecholamine producing tumour. It causes hypertension which in most instances can be cured by surgery. The majority of tumours are found intraadrenally. Hypertension as well as symptoms related to sympathetic overactivity are classical clinical presentations of PH, and a wide range of atypical presentations have been described in the past. A high index of suspicion is important in order to make the diagnosis of PH. Tumours can be found sporadically or be part of multiple endocrine tumours. A biochemical diagnosis is made by quantitative estimations of catecholamines or their metabolites in urine or by serum catecholamine estimations. Once a biochemical diagnosis is made, tumour sites can be localized by computerized tomography as well as by magnetic resonance imaging. Recently, the functional activity of PH has been used for localizing the tumour using metaiodo benzyl guanidine [MIBG] which is a catecholaminic-seeking isotope. This has been particularly useful in metastatic or extraadrenal tumours. Surgery is the definitive treatment for patients with PH. A successful outcome depends on the preoperative medical preparation with alpha and beta adrenergic blockers, and several drugs have proved to be effective in this regard. Malignant PH with metastates or with intercurrent illness that contraindicate surgery can be controlled with adrenergic blockers and/or catecholamine synthesis inhibitors. I[131]-metaiodo benzyl guanidine and chemotherapeutic agents have been tried in a small number of patients resulting in prolongation of survival in some patients with metastatic malignant PH