Bone-scan-like pattern with 99Tcm(V)-DMSA scintigraphy in patients with osteomalacia and primary hyperparathyroidism.

The aim of this study was to assess the role of 99Tcm(V)-dimercaptosuccinic acid (99Tcm(V)-DMSA) scintigraphy in the evaluation of patients with metabolic bone disease. The study group comprised eight women aged 17-72 years, six with osteomalacia and two with primary hyperparathyroidism. Six patients were imaged scintigraphically before their treatments were started, whereas the other two underwent treatment during the time of examination. All six patients who had not previously been treated had prominent skeletal 99Tcm(V)-DMSA uptake, revealing a bone-scan-like pattern. In the two patients receiving medical therapy, their 99Tcm(V)-DMSA scans revealed a normal physiological distribution. Many of the fracture and pseudofracture sites detected on bone scans were also discerned with 99Tcm(V)-DMSA scintigraphy. Our results suggest that 99Tcm(V)-DMSA scintigraphy might have the potential as a screening method in patients with metabolic bone disease.

A simple method to increase the diagnostic efficiency of gastroesophageal scintigraphy using the knee-chest position.

PURPOSE: The influence of patient posture on the incidence and severity of gastroesophageal reflux is well known. Scintigraphic imaging, however, is routinely performed with the patient lying in the supine position, because current gamma camera designs do not allow for changes to the angle of the patient table. METHODS: To overcome this difficulty and to increase the diagnostic sensitivity of scintigraphy, we used an alternative patient position. Twenty-seven adult patients (eight men, 19 women; mean age, 47.5+/-11.5 years) with gastroesophageal reflux disease were prospectively studied consecutively using two body positions, the supine and the knee-chest positions. Each consisted of dynamic acquisition of 450 seconds. An entire study for each patient required only 15 minutes. Images were interpreted qualitatively by three observers. RESULTS: Although gastroesophageal reflux was positively identified in only 9 of 27 (33%) patients using the supine position, 20 of 27 (74%) patients were shown to have gastroesophageal reflux in the knee-chest position (P < 0.05). No reflux was detected in seven patients using both positions. In five patients, whose study results were positive using both positions, the number of reflux episodes was greater in the knee-chest position compared with the supine position. CONCLUSION: The knee-chest position increases the diagnostic efficiency of gastroesophageal reflux scintigraphy.