Lymphoscintigraphic Findings That Predict Favorable Outcome after Lymphaticovenous Anastomosis.

Radionuclide lymphoscintigraphy is an imaging technique used to radiologically evaluate the lymphatic system which can be utilized to evaluate signs of lymphatic obstruction that could be indication for lymphaticovenous anastomosis (LVA) operations. Our objective was to investigate and identify the radiographic signs in lymphoscinigraphy that predict favorable outcome after LVA. We retrospectively reviewed the medical charts of 80 patients with upper or lower-limb lymphedema who underwent initial lymphoscintigraphy before LVA during the 2011 to 2014 study period to evaluate statistical association between lymphoscintigraphic findings and the clinical result after LVA. Following LVA, clinical improvement was observed in 50 patients (48 female and 2 male) with no clinical improvement evident in the remaining 1 male and 29 females. Dilated lymph vessels and dermal backflow were identified as the abnormal finding in lymphoscintigraphy that were significantly correlated with improved clinical result after LVA. Our conclusion is that radionuclide lymphoscintigraphy prior to LVA is helpful in identifying patients for whom LVA is of benefit. Based on our findings, presence of dilated lymph vessels and presence of dermal backflow are significantly correlated with improved clinical result after LVA.

Somatostatin receptor tumor imaging (Tc 99m P829) in pituitary adenoma.

Technetium 99m P829 (99mTc P829) is a somatostatin like structure labelled with Technetium-99m. Somatostatin receptor positive tumors such as pituitary tumors, neuroendocrine tumors, and lymphomas show positive scintigraphy. Eleven patients suspected of having a pituitary mass (12 studies) were studied with 99mTc P829. Three pituitary adenoma patients (4 studies) showed positive somatostatin receptor tumor imaging. Eight negative somatostatin receptor scintigraphy were one hypothyroid induced pituitary hyperplasia, one craniopharyngioma, one normal pituitary tissue with focal hyperplasia, one ACTH secreting pituitary tumor, one GH, PRL secreting pituitary tumor post transphenoidal partial tumor removal, and no surgery in 3 patients. Finally, somatostatin receptor imaging may be useful as a tumor localizing technique in addition to conventional CT and MRI imaging and identify patients who might potentially benefit from octreotide treatment. In addition, the development of peptide analogs coupling to beta-emitting radiopharmaceutical may lead to a situation in which diagnosis peptide receptor scintigraphy can be followed by radionuclide therapy.

Metastatic follicular carcinoma of thyroid to pericardium.

A 62 year-old man presented with massive pericardial effusion and a thyroid nodule. One thousand ml of serosanguinous pericardial effusion was tapped and the cytology consistent with metastatic papillary carcinoma. Total thyroidectomy was done. The pathological report of the thyroid gland was follicular carcinoma, poorly differentiated with capsular and vascular invasion. The patient received a treatment of 150 mci I-131 without complications. The total body scan after I-131 treatment showed only residual thyroid tissue. There was no demonstrable abnormal uptake in other parts of the body. No significant reaccumulation of pericardial fluid occurred. The diagnosis was follicular carcinoma of the thyroid with pericardial metastasis. The patient was discharged from the hospital with an improved clinical status.

Thyroid scintigraphy in children with hypothyroidism: a five-year experience.

The presence or absence of thyroid glandular tissue demonstrated by thyroid scintigraphy is important for genetic and prognostic counseling and for acceleration of diagnosis in other affected siblings. Technetium-99m-pertechnetate thyroid scintigraphy was performed on 27 children with cretinism at the Division of Nuclear Medicine, Faculty of Medicine Siriraj Hospital during the 5-year period from June 1991. Based on scintigraphic findings, three main groups of thyroid localization were seen. Thirteen (48.1%) were athyrotic while 3 (11.1%) had an ectopic thyroid and 11 (40.8%) had gland in normal position. Perchlorate discharge test was performed in 8 children of the last group and the results were positive indicating an organification defect. Thyroid scintigraphy and perchlorate discharge test provided the useful information for diagnosis, follow-up, and prognosis in children with cretinism.

Radionuclide venography in the diagnosis of deep vein thrombosis of the lower extremities: a comparison to contrast venography.

Radionuclide venography (RNV) and contrast venography (CV) were compared in 72 limbs of 59 patients being clinically suspected of deep vein thrombosis (DVT) of the lower extremities. The criteria of positive RNV for DVT regarding flow pattern abnormality included (1) nonfilling or nonvisualization of a deep vein, (2) interruption of the flow, (3) irregular or asymmetric filling of a deep vein, and (4) presence of abnormal collateral vessels. The overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio (LR+) were 90 per cent, 88 per cent, 96 per cent, 98 per cent, 79 per cent, and 20.8 respectively. These figures are even higher when we focused on the major veins of the thigh and pelvis. They were 97 per cent, 95 per cent, 98 per cent, 98 per cent, 95 per cent, and 61 respectively. The results indicate that radionuclide venography, while technically simple, is a reliable test for detection of DVT particularly of the major veins of the lower extremities. Combined radionuclide venography and perfusion lung scan can also be performed in the same setting if Tc99m-MAA is used. Contrast venography which is an invasive procedure, should be reserved for questionable cases of those with suspected isolated calf vein thrombosis.