Bone scintigraphy hot-spot in projection to rib and kidney: role of single photon emission computer tomography/computer tomography in distinguishing a urine collection in renal calyx from a metastasis to rib.

On planar bone scintigrams, activity enhancement foci in projection to kidney and lower ribs can arise from the kidney, or from bone lesions. A differentiation based only on the exact location and shape of the hot spot can sometimes be misleading, resulting in a false qualification of a rib metastatic lesion as urine collection in the kidney or opposite. The authors illustrate the problem with three cases: In two patients, such a hot spot appeared to be the solitary metastatic focus; in one, highly suggestive for solitary metastatic focus, it was proven to be a urine collection.

Approximation of time-uptake curve to a modified Bateman equation based on three uptake tests - potential value for dosimetry of corpuscular radiation.

BACKGROUND: Many models of assessing radiopharmaceutical kinetics for dosimetry have been developed, starting from the formula of Marinelli. They are either inaccurate or require taking multiple patient uptake measurements. MATERIAL AND METHODS: Radiotracer behavior is approached to a modified Bateman equation ("biphasic model"). The calculated effective half time, maximum uptake and the cumulated uptake according to the biphasic model is compared to the values obtained with the most popular Marinelli's method ("simplified model"). The calculations can be performed by free online-accessible software on the site: www.nuk.bieganski.org ("Calculator"). RESULTS: Using of the software allows a direct comparison of the obtained effective half times according to both, the simplified and the biphasic, models. Further errors can come from imprecise measure of the maximum uptake value (especially, when the time of the measurement differs from the true point of the maximum uptake) and from neglecting of the ascending branch of the time-uptake curve. It is possible to compare the cumulated uptake values according to both models ("correction factor"). The results can be combined with the widely known formula of Marinelli. The operations require only one additional uptake measurement, which could be performed shortly after the i.v. administration of the radiotracer, i.e., during the same visit of the patient. CONCLUSION: The proposed theoretic model could be verified practically for some i.v.-administered radiopharmaceuticals.

Enhanced accumulation of bone seekers at superior lateral orbital margin: potential origin.

Enhanced accumulation of the radiotracer at superior lateral orbital margin is a common finding in bone scintigraphy. Its possible sources are discussed and illustrated with examples from own archive of the authors as well as from the literature. These sources include: Physiologically enhanced bone metabolism at frontozygomatic suture (normal variant), a metastasis at this suture (illustrated with an example of solitary metastasis from prostate cancer), lesions to the zygomatic bone or the greater wing of the sphenoid bone, deepened fossa for lacrimal gland and the gland itself.

Congenital vascular malformations in scintigraphic evaluation.

BACKGROUND: Congenital vascular malformations are tumour-like, non-neoplastic lesions caused by disorders of vascular tissue morphogenesis. They are characterised by a normal cell replacement cycle throughout all growth phases and do not undergo spontaneous involution. Here we present a scintigraphic image of familial congenital vascular malformations in two sisters. MATERIAL/METHODS: A 17-years-old young woman with a history of multiple hospitalisations for foci of vascular anomalies appearing progressively in the upper and lower right limbs, chest wall and spleen. A Parkes Weber syndrome was diagnosed based on the clinical picture. Due to the occurrence of new foci of malformations, a whole-body scintigraphic examination was performed. A 12-years-old girl reported a lump in the right lower limb present for approximately 2 years, which was clinically identified as a vascular lesion in the area of calcaneus and talus. Phleboscintigraphy visualized normal radiomarker outflow from the feet via the deep venous system, also observed in the superficial venous system once the tourniquets were released. In static and whole-body examinations vascular malformations were visualised in the area of the medial cuneiform, navicular and talus bones of the left foot, as well as in the projection of right calcaneus and above the right talocrural joint. CONCLUSIONS: People with undiagnosed disorders related to the presence of vascular malformations should undergo periodic follow-up to identify lesions that may be the cause of potentially serious complications and to assess the results of treatment. Presented scintigraphic methods may be used for both diagnosing and monitoring of disease progression.

To what extent can diverse types of liver lesions mimic hemangiomas? A retrospective quantitative analysis of masses found to be positive in SPECT/CT with labeled blood cells - a preliminary report.

BACKGROUND: Although specificity of SPECT/CT examination using technetium-99m radiolabeled red blood cells (Tc-99m-RBC) for detection of liver hemangiomas is very high, it is still not perfect. It is possible to overlook a malignancy. Moreover, the difference in accumulation of RBCs between a hemangioma and uninvolved liver remains unknown. The aim of the study is to determine the quotients of accumulation of Tc-99m-RBC in hemangiomas and in normal liver parenchyma (HEM/liv), and to verify, whether the quotient could be potentially helpful in distinguishing hemangiomas from other RBC-accumulating liver masses. MATERIAL/METHODS: 34 liver lesions larger than 1.5 cm classified scintigraphically (qualitatively) in our Department as either typical or suspicious of hemangioma 1.5-4 years earlier were enrolled in this retrospective study. Their SPECT/CT images were acquired 1 hour after in vivo labeling of RBCs with Tc-99m. In reconstructed images, ellipsoidal regions of interest (ROIs) with diameters of about 1.5 cm were created in the assessed lesions (HEM) and in the uninvolved liver parenchyma (liv). The HEM/liv quotients were calculated for each mass. The results were compared with radiological data. RESULTS: 31 lesions were found to be clinically and radiologically typical for hemangiomas, their HEM/liv ratios were at least 1.6 (smaller masses) or 1.8 (larger masses). One lesion with HEM/liv ratio equal to 1.21 was classified as metastasis. Two lesions with HEM/liv 1.42 and 1.46 were classified as benign foci other than hemangioma. CONCLUSIONS: The quantitative analysis can be preliminarily proposed as a helpful tool in the assessment of possible liver hemangiomas.

Two hundred years after discovery of iodine--less known functions of the element in human organism.

The main role of iodine in human organism is related to biosynthesis of thyroid hormones. The less known metabolic pathway of the element is formation of iodolipids (mainly iodoaldehydes and iodolactones). One of the compounds, 6-iodo-5-hydroxy-eicosatrienoic acid delta-lactone (6-IL), is believed to inhibit goiter growth, to modulate the cell response on some growth factors, and to trigger apoptosis in some types of cells. Another one, 2-iodohexadecanal (2-IHDA), probably also inhibits goiter growth and mediates the Wolff-Chaikoff-effect. Epidemiological and experimental data suggest a relation of iodine to some tumor diseases. Preventing of iodine deficiency diminishes prevalence of goiter as well as some non-goiter diseases.

Single photon emission computed tomography in pulmonary embolism - estimation of selected, scintigraphic regions of interests.

BACKGROUND: Pulmonary embolism is considered dangerous form of thrombo-embolic venous disease contracted by 25000 people annually with around 30% deaths. Accurate diagnosis of the disease and treatment could reduce mortality rate by several per cent. Discernment of ailment is obstructed by variety of clinical picture. Suspicion of pulmonary embolism is verified by diagnostic patterns, among which SPECT is used as well. Aim of this study was to prove perfusion scintigraphy with use of SPECT evaluated together with radiological examinations of chest could be efficient method of pulmonary embolism diagnosis. MATERIAL/METHODS: SPECT of lungs was performed in 92 patients, examinations were compared to X-ray scans of chest and in 13 cases to computer tomography. Regions of interest in symmetric zones of chest were also traced in order to evaluate differences radiotracer accumulation. RESULTS: Pulmonary embolism was diagnosed by means of SPECT in 59 patients (64.1%). Radiological examinations allowed to exclude other causes of decreased pulmonary perfusion. CONCLUSIONS: Difference over 10% in radiotracer accumulation in symmetric zones among patients with pulmonary embolism was stated in 42 patients, 5-10% - in 15,under 5% - in 2. Drawing symmetric regions of interest all over lungs indicates essential points of decreased perfusion whereas difference in radiotracer accumulation is greater than 10%.

A single photon emission computed tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) in sarcoidosis.

BACKGROUND: Sarcoidosis is a systemic and multiorgan disease with unknown etiopathogenesis. Granulomas that do not undergo necrosis and caseous degeneration are distinctive for this disease. Mostly it is connected with young adults, more frequently females than males, and changes are mainly situated in the lymph nodes of the pulmonary hilus and pulmonary parenchyma. Somatotropin release inhibiting hormone receptors could be located in epithelioid and giant cells that create sarcoidal tubercles and lymph nodes. Aim of the study was to determine the usefulness of a single photon emission tomography (SPECT) for an evaluation of the range of sarcoidal changes in the chest after using a receptor tracer. An assumption was made that scintigraphy with the use of Tc-99m-Depreotide could help with location of extrapulmonary sarcoidosis focuses. MATERIAL/METHODS: Authors present five patients with clinically recognized and histopathologically confirmed sarcoidosis. Patients were given Tc-99m-Depreotide and underwent SPECT of chest. The results were compared with X-rays of these patients chests and with the accumulation of radiotracer in 2 other patients with carcinoid syndrome without visible pathological changes in examination. Patients got an intravenous injection of 500 MBq (14mCi) Tc-99m-Depreotide. SPECT of chest together with a "whole body" examination, was performed after 2 hours and 24 hours. RESULTS: Higher radiotracer accumulation was observed in all patients in the area of some chest lymph nodes, in pulmonary tissue in 3 patients and in other groups of lymph nodes in 2 patients. CONCLUSIONS: Emission Tomography of the chest with the use of receptor radiotracer (Tc-99m-Depreotide) can be a crucial complement of sarcoidosis diagnostics in an evaluation of the extent of lung changes together with an estimation of chest lymph nodes abnormalities.

[The estimation of the goiter by means of ultrasonography and scintigraphy (SPECT) with using 131I]. / Ocena objetosci wola za pomoca badania ultrasonograficznego oraz badania scyntygraficznego (SPECT) z zastosowaniem 131I.

INTRODUCTION: Ultrasonography (US) and scintigraphy (SPECT) are used to evaluate the volume of thyroid glands. An accurate estimation of the thyroid volume, among other factors, is necessary to calculate the suitable radioactive iodine dose, which determines the success of the therapy. The aim of the study was to estimate the volume of the goiter by means of US and (131)I-SPECT. MATERIAL AND METHODS: A group of 80 patients with a thyroid disorder in their past medical history was examined. Patients were divided into two groups. The group A contained 50 patients (39 females, 11 males) with a goiter, where the volume of the thyroid was evaluated with the use of US and (131)I-SPECT. The group B contained 30 patients (21 females, 9 males) with a normal volume of the thyroid gland shown by US and (131)I-SPECT. US of the thyroid gland was made by means of an ALOKA SSD 500 device, with the linear head 7.5 MHz frequency. (131)I-SPECT was made by means of a one head gammacamera Diacam with a high energy collimator. RESULTS: In the group A, the average volume of the goiter was 44.55 ml in US and 49.67 ml in SPECT (p<0.001). In control group B the average volumes of the thyroid gland were respectively 13.83 ml vs. 16.19 ml (p<0.001). CONCLUSION: The results of the thyroid volume measurement was dependent on the method used in both the investigated and control groups.

The role of radioisotopic methods in imaging of intervertebral disc inflammation in children.

The authors present the case of a 17-year-old girl, with pain over lumbar spine area, treated by paediatricians and rehabilitation specialists, discussing diagnostic imaging and laboratory examinations together with clinical observations. Spondylodiscitis was diagnosed after bone scintigraphy with 99mTc-MDP, the course of disease was monitored by immunoscintigraphy amongst other techniques.

The case of Cushing's disease imaging by SPECT examination without manifestation of pituitary adenoma in MRI examination.

BACKGROUND: The aim of our study was to evaluate the possibility of imaging the pathological accumulation of (99m)Tc-MIBI in the pituitary gland in patients with Cushing's disease when MRI examination does not show microadenomas. MATERIAL AND METHODS: Cushing's disease was diagnosed in a 27 year old male on the basis of clinical and biochemical findings. The blood cortisol level of the patient was elevated (the average level was 47 ug/dl) and it showed no changeability of day and night rhythm. RESULTS: In the patient with Cushing's disease, during the SPECT examination, an increased accumulation of (99m)Tc-MIBI in the pituitary gland was noticed. MRI scanning was negative. CONCLUSION: Single photon emission computed tomography using (99m)Tc-MIBI is a useful and sensitive means of pituitary gland microadenoma detection in patients with Cushing's disease when microadenoma is not detected during MRI scanning and when the results of dexamethasone suppression test is positive.

[Transvaginal ultrasonography and sonohysterography in the diagnosis of benign uterine lesions in women at peri- and postmenopausal age]. / Przydatnosc endosonografii dopochwowej i sonohisterografii w diagnostyce lagodnych zmian macicy u kobiet w wieku okolo- i pomenopauzalnym.

Abnormal uterine bleeding is important clinical problem in women at peri- and postmenopausal age. It may be caused by the lesions located in endometrium or in deeper uterine wall layers. An aim of this paper was a comparison of transvaginal sonography (TVS) vs. sonohysterography (SIS) in the diagnostics of endometrial polyps, endometrial hyperplasia as well as uterine myomas. Also the results of the sonographic imaging were compared to those of pathologic examination of the specimens taken from the uterine cavity. The material consisted of 100 women aged 40-80 with an irregular menstruation. All of the patients were examined gynecologically, and then the transvaginal sonography, sonohysterography and the curettage of the uterine cavity were performed. Sensitivity of TVS was 43% in endometrial polyps, 77% in endometrial hyperplasia and 69% in uterine myomas imaging. Introduction of SIS increased the sensitivity to 94%, 82%, and 95%, respectively. Specificity was similar in both techniques except endometrial hyperplasia (TVS--68%, SIS--91%). Diagnostic accuracy also improved with the SIS use reaching 93% for polyps, 89% for hyperplasia and 98% for myomas imaging. Our results show higher sensitivity and accuracy of SIS in the diagnostic of benign uterine lesions.

Tuberculosis of elbow and wrist joints - usefulness of high resolution computed tomography (HRCT) in morphological changes evaluation.

Tuberculosis is an infection disease caused by Mycobacterium tuberculosis or Mycobacterium atipics. The disease involves first of all the lungs (about 95% of patients). The changes were recognized in locomotive system in about 20% of cases of the other location and they occurred mainly in the vertebral column, hip - joint and knee - joint [1]. The authors describe two cases of tuberculosis of elbow joint and wrist the use with the High Resolution Computed Tomography (HRCT) exams in the algorythm of diagnostic procedure.

[Lymphangioleiomyomatosis in a menopausal woman on estrogen replacement therapy]. / Limfangioleiomiomatoza u kobiety w menopauzie stosujacej hormonoterapie zastepcza.

The case of lymphangioleiomyomatosis (LAM) was presented. Woman (55 years) receiving for several years estrogens with the symptoms of disease (dyspnea, nonproductive cough, chylous pleural fluid) appeared after menopause. Suggestive clinical symptoms and chest HRCT scan confirmed clinical diagnosis of LAM. Two years after discontinuation of estrogen medication her clinical condition and radiological picture of lungs improved.

Langerhans' cell histiocytosis of the mandible in bone scintigraphy and CT.

UNLABELLED: The authors present a case of a 4-year old boy with a quickly growing tumor of the jaw. The CT examination revealed a destructive tumor in the body of the mandible involving soft tissues. A diagnosis of eosinophilic granuloma of the mandible was confirmed by a biopsy of the tumor. Skeletal scintigraphy showed areas of increased and decreased radiotracer uptake. The fusion of CT and scintigraphy images showed that the "cold" focus corresponds with the osteolytic area and the "hot" focuses are larger than the areas of osseous reconstruction shown in CT. CONCLUSION: In cases of histiocytosis skeletal scintigraphy and CT are complementary methods that enable one to make an assessment of the extent of the disease.

[Osteoporosis in glucocorticoid-treated asthmatic patients. Part I. Frequency and intensity of changes]. / Osteoporoza u chorych na astme oskrzelowa leczonych glikokortykosteroidami. Czesc I. Czestosc wystepowania i nasilenie zmian.

The purpose of this study was evaluation of the frequency and severity of osteoporosis in glucocorticoid-treated asthmatic patients. The examinations were performed in 82 patients aged 29-70 years, treated with different types of steroids for 1-25 years. In the analysed patients bone mineral density (BMD) of lumbar spine, assessed by quantitative computer tomography (QCT) was measured, and prevalence of osteoporosis was evaluated on the basis of spine radiograms. The results of BMD measurements in glucocorticoid-treated postmenopausal women were additionally compared with a control group of 28 postmenopausal healthy women. The QCT examination revealed osteoporosis in 39% patients, while spine radiograms demonstrated it in 33% patients. The highest incidence of osteoporosis and the highest reduction of bone mass were found in postmenopausal glucocorticoid-treated women. The statistical analysis revealed no significant differences in the diagnosis of osteoporosis established by QCT or spinal radiograms, but the sensitivity of radiograms was found to be of limited value, particularly in patients with slight reduction of bone mass.