The Usefulness of Measurement of Whole Body Count in Assessing Bone Marrow Metastasis in Cancer Patients with Increased Periarticular Bone Uptake on Follow-up Bone Scan: A Comparison with Bone Marrow Scan / 대한핵의학회잡지

PURPOSE: Increased periarticular uptake could be associated with peripheral bone marrow expansion in cancer patients with axial bone marrow metastasis. We compared bone scan and bone marrow scan to investigate whether the increased whole body count in patients with increased periarticular uptake on bone scan is useful in the diagnosis of axial marrow metastasis, and evaluate the role of additional bone marrow scan in these cases. MATERIALS AND METHODS: Twelve patients with malignant diseases who showed increased periarticular uptake on bone scan were included. Whole body count was measured on bone scan and it is considered to be increased when the count is more than twice of other patients. Bone marrow scan was taken within 3-7 days. RESULTS: Five hematologic malignancy, 3 stomach cancer, 2 breast cancer, 1 prostate cancer and 1 lung cacner were included. All three patients with increased whole body count on bone scan showed axial marrow suppression and peripheral marrow expansion. Eight of 9 patients without increased whole body count showed axial marrow suppression and peripheral marrow expansion. One turned out to be blastic crisis of chronic myelogeneous leukemia, and seven showed normal axial marrow with peripheral marrow expansion in chronic anemia of malignancy. The last one without increased whole body count showed normal bone marrow scan finding. CONCLUSION: Increased whole body count on bone scan could be a clue to axial bone marrow metastasis in cancer patients with increased periarticular uptake, and bone marrow scan is a valuable method for differential diagnosis in these cases.

Tl-201 Per Rectum Scintigraphy in Chronic Liver Disease: Assessment of Tl-201 Uptake Indices / 대한핵의학회잡지

PURPOSE: Heart to liver ratio on T1-201 per rectal scintigraphy (shunt index) is known to be useful in the assessment of portal systemic shunt. We assessed T1-201 uptake pattern and early liver/heart uptake rate of T1-201 and correlated with shunt index in patients with chronic active hepatitis (CAH) and liver cirrhosis (LC). MATERIALS AND METHODS: Fifty eight patients with biopsy-proven chronic liver disease (35 with CAH, 23 with LC) underwent T1-201 per rectum scintigraphy after instillation of 18.5 MBq of T1-201 into the upper rectum. We evaluated hepatic uptake (type 1: homogeneous, 2: inhomogeneous segmental, 3: inhomogeneous nonsegmental) and extrahepatic uptake of spleen, heart and kidney (grade 0: no uptake, 1: less than liver, 2: equal to liver, 3: greater than liver). We measured the early liver/heart uptake rate (the slope of the liver to heart uptake ratio for 10 min) and shunt index (heart to liver uptake ratio). T1-201 uptake pattern and early liver/heart uptake rate of T1-201 was correlated with the pathologic diagnosis and shunt index. RESULTS: Hepatic uptake patterns of type 1 and 2 were dominant in CAH (CAH: 27/35, LC: 8/23), and type 3 in LC (CAH: 8/35, LC: 15/23) (p<0.005). The grades of extrahepatic uptake were higher in LC than in CAH (spleen: p<0.001, other soft tissue: p<0.005). The early liver/heart uptake rate of CAH (0.110+/-0.111) was significantly higher than that of LC (0.014+/-0.090) (p<0.001). The sensitivity and specificity of the early liver/heart uptake rate were 77.7% and 67.7% in differentiating LC from CAH. There was negative correlation between early liver/heart uptake rate and shunt index (r=-0.3347, p<0.01). CONCLUSION: Hepatic and extrahepatic uptake pattern and early liver/heart uptake rate on T1-201 per rectum scintigraphy are useful in the assessment of portal systemic shunt in patients with chronic liver disease.

Effect of Degenerative Change of Lumbar Spine on Lateral Bone Mineral Density Measurement Using Dual EnergyX-ray Absorptiometry: Usefulness of Measurement in the Supine Lateral Projection

PURPOSE: To evaluate the usefulness of supine lateral bone mineral density (BMD) measurement using DXA bycomparing AP and lateral spine BMD in patients with degenerative change. MATERIALS AND METHODS: Six hundred andseventy-two women underwent AP and lateral BMD measurement of L-spine, using DXA. Spur changes and end-platesclerosis were considered as degenerative change, and osteoporosis was defined according to WHO criteria. Theratio of mid-lateral BMD to AP BMD was calculated and the differences in ratio were analyzed in the degenerativegroup and controls, according to aging and osteoporosis, using the t test and ANOVA. The correlation coefficiencybetween aging and AP BMD and lateral BMD, respectively, was calculated. RESULT: The mLat/AP ratio in the controland degenerative group was 0.710(0.005 / 0.622(0.028 (p=0.003) in the 40-49-year-old group, 0.663(0.006 /0.612(0.016 (p=0.002) in the 50-59-year-old group, 0.626(0.015 / 0.552(0.023 (p=0.007) in the 60-69 year-oldgroup, and 0.717(0.028 / 0.600(0.045 (p=0.076) in those aged over 70. The ratio was 0.656(0.015 / 0.598(0.038(p=0.099) in osteoporosis, 0.684(0.008 / 0.596(0.016 (p=0.000) in osteopenia, and 0.688(0.005 / 0.583(0.019(p=0.000) in normal subjects, showing that lateral BMD is more sensitive than AP BMD, especially in thedegenerative group. There was negative correlation between aging and AP BMD(r= -0.545), lateral BMD(r= -0.571),and mid-lateral BMD(r=-0.583). CONCLUSION: In a selective group of patients with degenerative change, supinelateral BMD measurement of L-spine is useful.