Rapid reversal of bone scan abnormalities in a patient with type 1 primary hyperoxaluria and oxalosis.

Serial bone scanning was performed on a 23-year-old man with type 1 primary hyperoxaluria, renal failure, oxalosis, and cardiac failure. The initial bone scan (6/22/90) demonstrated diffuse increased uptake in the axial and peripheral skeleton, heart, and the soft tissues of the lower extremities. A combined liver and kidney transplant was successfully performed with subsequent resolution of the oxalosis, renal failure, and cardiac failure. A follow-up bone scan (9/24/90) demonstrated resolution of abnormal heart and soft tissue uptake, as well as decreased uptake in the long bones. This case demonstrates that bone scanning may be a useful tool in the management of patients with oxalosis. The scintigraphic findings closely paralleled the clinical response to treatment of the disease and suggested decreased total body stores of calcium oxalate.

False-positive hepatic blood pool SPECT study for hepatic hemangioma.

Radionuclide hepatic blood pool scintigraphy is an extremely sensitive and highly specific test in diagnosing cavernous hemangioma of the liver. The authors report a false-positive hepatic blood pool scintigram for hepatic hemangioma in a patient with liver metastasis from adenocarcinoma of colon.

Serial SPECT imaging in moyamoya using I-123 IMP. A method of noninvasive evaluation and follow-up.

Serial cerebral perfusion studies were performed in a patient with moyamoya disease, utilizing N-isopropyl iodoamphetamine (I-123 IMP). The SPECT findings correlated closely with those of a CT scan and magnetic resonance imaging (MRI). In fact, the perfusion defects seen on SPECT studies were larger than those seen on CT and MRI studies. The SPECT findings paralleled the patient's improving clinical course. Cerebral perfusion SPECT studies may be very helpful in the evaluation and follow-up of patients with moyamoya disease.

Image normalization and background subtraction in T1-201/Tc-99m parathyroid subtraction scintigraphy. Effect on lesion detection.

The authors have developed two computer algorithms for T1-201/Tc-99m parathyroid subtraction scintigraphy that was performed on patients who subsequently underwent surgical exploration of the neck. Both methods employed a region-of-interest drawn around the thyroid/parathyroid glands for image realignment. The first algorithm normalized the Tl-201 and Tc-99m images using the ratio of maximum counts over the thyroid in each image. The second computer algorithm incorporated Tl-201 image background correction and normalization by the average of the ratios of maximum counts computed over each quadrant in both images. In 10 patients with confirmed parathyroid adenomas or hyperplasia, the first method yielded a 44% sensitivity. Upon reanalysis with the second algorithm, the sensitivity improved to 100%. Subsequently, in a total of 22 patients with 30 abnormal glands analyzed with the second algorithm, a sensitivity of 80% (94% for adenoma and 62% for hyperplasia) was achieved, with a specificity of 91%, as confirmed by surgery.

Duodenal hematoma. A mechanical cause for enterogastric reflux in cholescintigraphy.

Enterogastric reflux occurs in normal and abnormal conditions. When pronounced, it is a nonspecific indicator of pathology. There are relatively few published reports discussing enterogastric reflux as a prominent finding on cholescintigraphy. A unique case of pronounced enterogastric reflux from an obstructing duodenal hematoma is presented.

A false-positive scan for testicular torsion and false-negative scan for epididymitis.

A 17-year-old boy underwent a radionuclide scan for testicular torsion. The scan demonstrated a cold defect with a warm ring, indicating a "missed" testicular torsion. Operative findings, however, demonstrated epididymitis. A false-positive radionuclide study is described in a patient with epididymitis and the literature of scintigraphy in testicular torsion is reviewed.

Indium-111 DTPA flow study to evaluate surgically implanted drug pump delivery system.

The authors describe a radionuclide technique for evaluating intrathecal and intraventricular infusions by surgically implanted drug pump delivery systems. Sixteen patients underwent flow studies, performed by injecting 500 mu Ci of indium-111 DTPA into the pumps. Early and delayed images were obtained. These studies enabled distinction among functioning pumps, nonfunctioning pumps, and obstructed or occluded catheters. We conclude that indium-111 DTPA flow studies provide an excellent way to assess these drug pump delivery systems.

False-positive radionuclide venography caused by distended urinary bladder.

A 60-year-old man with a history of prostatic carcinoma presented with left lower extremity swelling. A massively distended urinary bladder produced a false-positive radionuclide venogram.

Bone imaging in patients with unexpected elevation of serum alkaline phosphatase.

Radionuclide bone imaging frequently is requested to evaluate clinically unexpected persistent elevations in serum alkaline phosphatase. To assess the efficacy of this practice, the authors reviewed bone images obtained for this purpose during a 12-month period and correlated the results with clinical data. One hundred nineteen patients were included in the study. Arthritic changes were the abnormalities most frequently present on the bone images. Several cases of occult bone metastasis, Paget's disease, and trauma were also detected in this group of patients. The authors continue to recommend bone imaging in patients with unexpected elevation of serum alkaline phosphatase; however, further prospective studies with larger and different patient populations are needed to justify this practice in the present era of cost-effectiveness.

Abnormal bone and gallium scans in a case of multifocal systemic sporotrichosis.

Sporotrichosis is a chronic infection of world wide distribution. It is caused by the diamorphic fungus Sporotrichum schenkii. The multifocal form of sporotrichosis usually involves skin, joints, long bones, lungs, and lymph nodes. Involvement of central nervous system although described is extremely rare. Bone and gallium imaging findings in a case of multifocal systemic sporotrichosis which nicely demonstrated the extensive spread of the disease are presented.

Bone scintigraphy in tuberculous sacroiliitis.

Radionuclide bone imaging is becoming increasingly important in the evaluation of musculoskeletal pain of uncertain cause. A case in which Tc-99m MDP bone imaging was employed to investigate complaints of low back pain is presented. Scan abnormalities directed clinicians towards appropriate further workup and diagnosis of unilateral tuberculous sacroiliitis.

Acute tentorial subdural hematoma as a false-positive in indium-111 leukocyte scintigraphy.

A case of acute tentorial subdural hematoma detected by In-111 leukocyte scintigraphy and confirmed by CT brain scan is herein described. White blood cells are an integral part of the blood pool and labeled white cells freely leave the intravascular space in case of active bleeding. Acute hemorrhage and hematoma can thus be a cause of a false-positive study.

Demonstration of a false-positive lesion on indium-111 leukocyte scintigraphy in a case of active Crohn's disease.

Increased fecal excretion of In-111 tagged leukocytes in patients with active inflammatory bowel disease may lead to a false-positive site of disease in patients with a diverting colostomy or ileostomy and fecal collection bags that overlie the abdominal wall or groin region.

Quantitative sacroiliac scintigraphy. The effect of method of selection of region of interest.

Various authors have advocated quantitative methods of evaluating bone scintigrams to detect sacroiliitis, while others have not found them useful. Many explanations for this disagreement have been offered, including differences in the method of case selection, ethnicity, gender, and previous drug therapy. It would appear that one of the most important impediments to consistent results is the variability of selecting sacroiliac joint and reference regions of interest (ROIs). The effect of ROI selection would seem particularly important because of the normal variability of radioactivity within the reference regions that have been used (sacrum, spine, iliac wing) and the inhomogeneity of activity in the SI joints. We have investigated the effect of ROI selection, using five different methods representative of, though not necessarily identical to, those found in the literature. Each method produced unique mean indices that were different for patients with ankylosing spondylitis (AS) and controls. The method of Ayres (19) proved superior (largest mean difference, smallest variance), but none worked well as a diagnostic tool because of substantial overlap of the distributions of indices of patient and control groups. We conclude that ROI selection is important in determining results, and quantitative scintigraphic methods in general are not effective tools for diagnosing AS. Among the possible factors limiting success, difficulty in selecting a stable reference area seems of particular importance.

Primary cardiac osteosarcoma: multidisciplinary aspects applicable to extraskeletal osteosarcoma generally.

An osteosarcoma, primary in the right ventricular epicardium, produced pericardial constriction. Intense activity on technetium-99m bone scintigraphy led to a correct preoperative diagnosis. Biopsy of unrepresentative tissue clouded the diagnosis, and autopsy resolved the issue. Several clinicopathologic correlations are presented. Major therapeutic advances mandate early recognition of extraskeletal osteosarcoma, and the topic is reviewed in regard to cardiac cancers in general. The need to biopsy both hard and fleshy areas of unusual tumors is reviewed.

Coronary artery disease: detection by phase analysis of rest/exercise radionuclide angiocardiograms.

Thirty-six patients with chest pain but no myocardial infarction or conduction defects and 4 volunteers (3 normals and 1 with asymptomatic aortic insufficiency) underwent radionuclide angiocardiography. Phase analysis was performed and the standard deviation (SD) ("spread") and skewness ("asymmetry") of the left ventricular (LV) phase histogram determined at rest and during maximum exercise. The SD of the LV phase histogram was of no value; however, when -0.1 was taken as the upper limit of normal skewness at maximum exercise, skewness was equally as sensitive as conventional criteria for coronary artery disease (CAD) and also more specific. The authors conclude that LV histogram skewness during maximum exercise may be superior to conventional criteria for detection of CAD with rest/exercise radionuclide angiocardiograms.