Bone scintigraphy in detection of bone invasion by oral carcinoma.

Detecting osseous involvement is clinically important in the management of oral carcinoma. Thirty-one patients with osseous involvement due to oral carcinoma who underwent panoramic radiography and bone scintigraphy were evaluated retrospectively. Bone scintigraphy confirmed osseous involvement in all 31 (100%) of these patients. In 27 (87%) of 31 patients with osseous involvement, both the panoramic radiogram and bone scintigram were positive. In the remaining four patients (13%), bone scintigram was positive for mandibular or maxillary invasion, while panoramic radiogram was negative. There were no instances of an abnormal radiogram with a normal bone scintigram. These findings strongly suggest that bone scintigraphy is more sensitive than panoramic radiography in detecting osseous involvement of the mandible and maxilla due to oral carcinoma. Furthermore, bone scintigraphy was a critical pre-surgical in determining the extent of the osseous involvement.

Technetium-99m pertechnetate and gallium-67 imaging in salivary gland disease.

Thirty-two patients with salivary gland tumors or sialadenitis were studied with Tc-99m pertechnetate and Ga-67 imaging and, in some instances, sialography. The diagnostic algorithm presented allows the correct categorization of the salivary gland pathology in the vast majority of patients. The patients were studied serially with Tc-99m pertechnetate, Ga-67 and in certain situations sialography (or CT-sialography). Use of the algorithm can distinguish benign salivary tumors from malignant tumors and malignant tumors from inflammatory disease. The limitations and pitfalls of interpretation are discussed.

Gallium-67 imaging in the evaluation of thyroid malignancy.

One hundred thirty-six patients with suspected thyroid malignancy were studied prospectively with Ga-67 imaging of the thyroid and whole body. All patients subsequently had diagnoses proven by biopsy or surgical resection. Patients with malignant tumors (anaplastic carcinoma, malignant lymphoma, adenocarcinoma, medullary carcinoma, adenocarcinoma with squamous cell transformation, and metastases to the thyroid from other tumors) were examined serially after appropriate therapy. The authors draw on their own experience and a literature review to propose the following indications for Ga-67 imaging in patients with thyroid disease: 1) suspected anaplastic carcinoma or malignant lymphoma of the thyroid gland, 2) detection of distant metastases of anaplastic thyroid carcinoma and malignant lymphoma, 3) evaluation of efficacy of therapy, 4) suspected metastases to the thyroid gland from other malignancies, and 5) differentiation of malignant lymphoma from chronic thyroiditis. The strengths, limitations, and potential pit-falls of the technique are discussed.

Cerebral venous sinus thrombosis: report of a case and review of the literature.

Cerebral venous sinus thrombosis is a condition that is well documented as a complication of the latter stages of pregnancy and with an even greater incidence during the puerperium. More recently this entity had been associated with the use of oral contraceptives. A case is presented of a 15-year-old girl with this condition, in whom the occurrence as well as the resolution of a superior sagittal sinus thrombosis was demonstrated with serial computed tomography (CT) scans and radionuclide studies. The discussion of this case, coupled with a review of the literature, describes the clinical presentation, explores the possible etiology, offers a noninvasive technique for confirming the diagnosis, and presents the medical management of this condition. It is postulated that cerebral venous sinus thrombosis occurs with a greater frequency than is currently recognized. Health professionals involved with monitoring the health care of adolescents during pregnancy and in the puerperium should be aware of this potential complications. In addition, association of this condition with oral contraceptive use should be recognized.

Preoperative embolization of meningiomas.

Embolization of very vascular meningiomas prior to operation will reduce the loss of blood during operation. The technique of preoperative embolization is discussed, and 11 cases are presented.

Arterial catheter embolization followed by surgery for large chemodectoma.

We report on the first successful preoperative arterial catheter embolization of a large neck chemodectoma followed by its surgical removal. A 21-year-old man presented with a large mass in the right neck diagnosed 5 years previously by biopsy as a chemodectoma. The patient previously had refused therapy. Because of concern over the large size of the mass and increasing difficulty in swallowing, he agreed to undergo therapy. The patient underwent selective occlusion of the occipital and posterior auricular arteries and the thyrocervical trunk using Ivalon sponge emboli injected through a No. 5 Fr Hanafee catheter. A postembolization arteriogram showed 90% occlusion of tumor vascularity and 30% decrease in size of the tumor. This was followed by removal of the tumor surgically. A review of the difficult management of the patient is presented, and implications for future use of the combined procedures are discussed.

Gallium-67 scanning in the differentiation of maxillary sinus carcinoma from chronic maxillary sinusitis.

Gallium-67 scans of 25 patients in whom the clinical symptoms and radiographic findings were suggestive of either maxillary sinus carcinoma or chronic sinusitis proved to be valuable in the differentiation between the two disease processes. Those patients with carcinoma had positive scans, while those with sinusitis had either negative or only weakly positive scans.