Subject(s)
Neoplasms, Second Primary/diagnostic imaging , Ovarian Neoplasms/diagnostic imaging , Radiopharmaceuticals , Teratoma/diagnostic imaging , Adult , Cobalt Radioisotopes , Female , Humans , Iodine Radioisotopes/therapeutic use , Neoplasms, Second Primary/surgery , Ovarian Neoplasms/surgery , Radionuclide Imaging , Radiopharmaceuticals/therapeutic use , Teratoma/surgery , Thyroid Neoplasms/physiopathology , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms/surgery , Thyroid Nodule/physiopathology , Thyroid Nodule/radiotherapy , Thyroid Nodule/surgery , Thyroidectomy , Treatment OutcomeABSTRACT
Renovascular disease is an important cause of hypertension in children and is associated with considerable morbidity and mortality risks. Secondary hypertension is more common in children than in adults, with children accounting for 75% to 80% of cases. In 70% of secondary hypertension in children, the cause is fibromuscular hyperplasia. Other associated conditions are aorto-aortitis, the midaortic syndrome, and Williams-Bueren syndrome. Imaging techniques have an important role in the early discovery of renal artery stenosis. Although renal arteriography remains the definitive method, noninvasive and less invasive radiographic procedures such as ultrasonography with duplex Doppler scanning and radionuclide scintigraphy have been used as adjunct diagnostic tools in children. The authors describe three young children with renovascular hypertension in whom dynamic radionuclide scintigraphy with Tc-99m MAG3 played an essential role in the diagnosis of renovascular hypertension.
Subject(s)
Hypertension, Renovascular/diagnostic imaging , Radiopharmaceuticals , Renal Artery Obstruction/diagnostic imaging , Technetium Tc 99m Mertiatide , Child , Child, Preschool , Female , Fibromuscular Dysplasia/complications , Humans , Hypertension, Renovascular/etiology , Male , Radioisotope Renography , Renal Artery Obstruction/etiologyABSTRACT
OBJECTIVE: To determine to what extent the 'non-diagnostic' lung scans made because of a clinical suspicion of pulmonary embolism enable further determination of the risk of pulmonary embolism. DESIGN: Retrospective. METHOD: All non-diagnostic lung perfusion ventilation scans made in the Academic Medical Centre of Amsterdam in 1997 of 114 patients in succession (55 males and 59 females aged 27-85 years) were subjected to blind and independent re-evaluation by three observers (an experienced nuclear medicine expert, an experienced and an inexperienced intern) who, using a lung segment chart, estimated the risk of embolism as < 25%, 25-50%, 50-75% and > 75%. They did this first without and then with the chest X-ray. The findings were grouped on the basis of accordance or non-accordance with the pulmonary angiogram. The interobserver agreement was calculated by means of kappa statistics. RESULTS: Of 58 patients the lung scan could be compared with a chest X-ray and a pulmonary angiogram. In 43 patients with a normal angiogram the observers in an average of 50% of the scans estimated the risk of pulmonary embolism as < 25%, as against 25-50% in 27%, 50-75% in 9% and > 75% in 5%. In 15 patients with a deviant pulmonary angiogram, these figures were 22%, 38%, 20%, and 12%, respectively. The interobserver kappa for evaluation without chest X-ray was < or = 0.16, as against < or = 0.41% with the chest X-ray. CONCLUSIONS: A reliable classification of the risk of pulmonary embolism was not possible on the basis of non-diagnostic lung scans, regardless of whether the patient did or did not have pulmonary embolism. The interobserver variability was less when the lung scan was evaluated together with the chest X-ray, but even so it was unacceptably high.
